Value of prenatal MRI in observing fetal testicular descent and development trend

doi:10.3877/cma.j.issn.1673-5250.2021.05.008

Objective

To explore the trend of fetal testicular descent and its relationship with gestational age by fetal MRI.

Methods

A total of 1 023 cases of male singleton fetuses who underwent prenatal fetal MRI examination in West China Second University Hospital, Sichuan University from July 2016 to March 2019 with gestational age of 19 to 38 weeks and without abnormal genitourinary system were retrospectively analyzed. There were 20, 19, 32, 66, 66, 81, 85, 72, 86, 111, 113, 124, 83, 34, 17 and 14 fetuses respectively with gestational age of 19-23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 38 weeks. The descending and developmental trend of unilateral and bilateral testes in scrotum of fetuses were observed on T2WI and balanced-turbo field echo (B-TFE) sequence of fetal MRI, and testicular descent was confirmed on any two planes in coronal, aberrant or axial position. Gestational age of left and right testicular descent was compared by independent-samples t test. The decline rate of bilateral testis in fetuses of different gestational ages and their gestational age were curve-fitted. This study was in line with requirements of the World Medical Association Helsinki Declaration revised in 2013.

Results

①Of the 1 023 fetuses, testis was not observed in scrotum of 20 fetuses with gestational age of 19 to 23 weeks by MRI. Unilateral testicular descent was first observed in scrotum of a fetus with gestational age of 24⁺¹ weeks. Bilateral testicular descent rate of 245 fetuses with gestational age of 25-28 weeks changed significantly. The rates of bilateral testicular descent were 28.1% (9/32), 31.8% (21/66), 62.1% (41/66), and 83.9% (68/81) respectively in fetuses with gestational age of 25, 26, 27 and 28 weeks. Bilateral testicular descent rate was 100.0% (385/385) in fetuses with gestational age of 33-38 weeks. ②Of the 1 023 fetuses, 49 cases (4.79%) showed that the status of bilateral testicular descent was inconsistent (only one side of testicle descended to scrotum). MRI showed that gestational age of fetuses (n=886) with left testis descending to scrotum was (31.6±3.0) weeks, and gestational age of fetuses (n=875) with right testis descending to scrotum was (31.7±2.9) weeks, the difference was not statistically significant (P>0.05). MRI showed that gestational age of fetuses (n=137) whose left testis did not descend to scrotum was (25.7±2.5) weeks, and gestational age of fetuses (n=148) whose right testis did not descend to scrotum was (25.7±2.3) weeks, and the difference was not statistically significant (P>0.05). ③Curve fitting results of fetal bilateral testicular descent rate and fetal gestational age showed that the best fitting model was a quadratic polynomial curve model, and its expression was y=-943.79+ 61.23x-0.89x², in which y referred as fetal bilateral testicular descent rate of fetuses with different gestational ages (%), and x referred as gestational age of fetuses (weeks).

Conclusions

MRI detection can directly observe the testicular descent and development trend of male singleton fetuses. Fetal testicular descent has a certain regularity, which begins at gestational age of 24 weeks and almost completely descends into scrotum at gestational age of 33 weeks. Some fetuses have inconsistent bilateral testicular descent.

Key words: Testis, Magnetic resonance imaging, Prenatal diagnosis, Cryptorchidism, Scrotum, Curve fitting, Fetus, male

表1 本组1 023例不同胎龄胎儿MRI检查其睾丸下降至阴囊的情况[例数(%)]

胎龄(周)	例数	双侧下降	单侧下降	双侧未下降	胎龄(周)	例数	双侧下降	单侧下降	双侧未下降
19~23	20	0(0)	0(0)	20(100.0)	31	86	82(95.3)	1(1.2)	3(3.5)
24	19	0(0)	3(15.8)	16(84.2)	32	111	109(98.2)	1(0.9)	1(0.9)
25	32	9(28.1)	2(6.3)	21(65.6)	33	113	113(100.0)	0(0)	0(0)
26	66	21(31.8)	14(21.2)	31(47.0)	34	124	124(100.0)	0(0)	0(0)
27	66	41(62.1)	12(18.2)	13(19.7)	35	83	83(100.0)	0(0)	0(0)
28	81	68(83.9)	8(9.9)	5(6.2)	36	34	34(100.0)	0(0)	0(0)
29	85	74(87.0)	6(7.1)	5(5.9)	37	17	17(100.0)	0(0)	0(0)
30	72	68(94.4)	2(2.8)	2(2.8)	38	14	14(100.0)	0(0)	0(0)

表1 本组1 023例不同胎龄胎儿MRI检查其睾丸下降至阴囊的情况[例数(%)]

胎龄(周)	例数	双侧下降	单侧下降	双侧未下降	胎龄(周)	例数	双侧下降	单侧下降	双侧未下降
19~23	20	0(0)	0(0)	20(100.0)	31	86	82(95.3)	1(1.2)	3(3.5)
24	19	0(0)	3(15.8)	16(84.2)	32	111	109(98.2)	1(0.9)	1(0.9)
25	32	9(28.1)	2(6.3)	21(65.6)	33	113	113(100.0)	0(0)	0(0)
26	66	21(31.8)	14(21.2)	31(47.0)	34	124	124(100.0)	0(0)	0(0)
27	66	41(62.1)	12(18.2)	13(19.7)	35	83	83(100.0)	0(0)	0(0)
28	81	68(83.9)	8(9.9)	5(6.2)	36	34	34(100.0)	0(0)	0(0)
29	85	74(87.0)	6(7.1)	5(5.9)	37	17	17(100.0)	0(0)	0(0)
30	72	68(94.4)	2(2.8)	2(2.8)	38	14	14(100.0)	0(0)	0(0)

图3 1例胎儿(胎龄为36周，男性单胎)MRI检查B-TFE序列图像(图3A：冠状位图像，可见阴囊充满高信号液体，双侧均可见等-稍高信号睾丸，白色箭头所示；图3B：失状位图像，仍可见睾丸显示，白色箭头所示)

表2 MRI检查可见胎儿左、右侧睾丸下降至阴囊及未下降至阴囊的胎儿胎龄比较(周，±s)

胎儿	例数	胎龄	胎儿	例数	胎龄
左侧睾丸下降	886	31.6±3.0	左侧睾丸未下降	137	25.7±2.5
右侧睾丸下降	875	31.7±2.9	右侧睾丸未下降	148	25.7±2.3
t值		0.610	t值		0.250
P值		0.540	P值		0.800

表2 MRI检查可见胎儿左、右侧睾丸下降至阴囊及未下降至阴囊的胎儿胎龄比较(周，±s)

胎儿	例数	胎龄	胎儿	例数	胎龄
左侧睾丸下降	886	31.6±3.0	左侧睾丸未下降	137	25.7±2.5
右侧睾丸下降	875	31.7±2.9	右侧睾丸未下降	148	25.7±2.3
t值		0.610	t值		0.250
P值		0.540	P值		0.800

表3 不同胎龄胎儿的双侧睾丸下降率与其胎龄的曲线拟合结果

曲线拟合模型	模型表达式	R²值	F值	P值
线性模型	y＝-131.79+6.74x	0.740	40.730	<0.001
对数模型	y＝-639.26+209.35log(x)	0.800	55.030	<0.001
逆曲线模型	y＝286.76-6343.54/x	0.840	75.870	<0.001
二次多项式曲线模型	y＝-943.79+61.23x-0.89x²	0.960	172.880	<0.001

表3 不同胎龄胎儿的双侧睾丸下降率与其胎龄的曲线拟合结果

曲线拟合模型	模型表达式	R²值	F值	P值
线性模型	y＝-131.79+6.74x	0.740	40.730	<0.001
对数模型	y＝-639.26+209.35log(x)	0.800	55.030	<0.001
逆曲线模型	y＝286.76-6343.54/x	0.840	75.870	<0.001
二次多项式曲线模型	y＝-943.79+61.23x-0.89x²	0.960	172.880	<0.001

图4 不同胎龄胎儿的双侧睾丸下降率与其胎龄的拟合曲线图

[1]	Gurney JK, McGlynn KA, Stanley J, et al. Risk factors for cryptorchidism[J]. Nat Rev Urol, 2017, 14(9): 534-548. DOI: 10.1038/nrurol.2017.90.
[2]	蒋学武. 睾丸下降与睾丸下降不全的已知和未知[J]. 中华实用儿科临床杂志，2017, 32(17): 1281-1284. DOI: 10.3760/cma.j.issn.2095-428X.2017.17.001.
[3]	Favorito LA, Sampaio FJ. Testicular migration chronology: do the right and the left testes migrate at the same time? Analysis of 164 human fetuses[J]. BJU Int, 2014, 113(4): 650-653. DOI: 10.1111/bju.12574.
[4]	吉六舟，刘秀平，李洪涛，等. 多层螺旋CT在隐睾及其恶变诊断中的临床应用[J]. 实用放射学杂志，2012, 28(3): 409-411. DOI: 10.3969/j.issn.1002-1671.2012.03.023.
[5]	王晓艳，张焱，程敬亮，等. 隐睾的MRI表现[J]. 实用放射学杂志，2014, 30(1): 173-175. DOI: 10.3969/j.issn.1002-1671.2014.01.041.
[6]	Nemec SF, Nemec U, Weber M, et al. Male sexual development in utero: testicular descent on prenatal magnetic resonance imaging[J]. Ultrasound Obstetr Gynecol, 2011, 38(6): 688-694. DOI: 10.1002/uog.8964.
[7]	Radmayr C, Dogan HS, Hoebeke P, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines[J]. J Pediatr Urol, 2016, 12(6): 335-343. DOI: 10.1016/j.jpurol.2016.07.014.
[8]	Shadpour P, Kashi AH, Arvin A. Scrotal testis size in unilateral non-palpable cryptorchidism, what it can and cannot tell: study of a Middle Eastern population[J]. J Pediatr Urol, 2017, 13(3): 268.e1-268.e6. DOI: 10.1016/j.jpurol.2016.12.013.
[9]	Cour-Palais IJ. Spontaneous descent of the testicle[J]. Lancet, 1966, 287(7452): 1403-1405. DOI: 10.1016/s0140-6736(66)90306-0.
[10]	Mathers MJ, Sperling H, Rübben H, et al. The undescended testis: diagnosis, treatment and long-term consequences[J]. Dtsch Arztebl Int, 2009, 106(33): 527-532. DOI: 10.3238/arztebl.2009.0527.
[11]	李振东，聂芳，李天刚，等. 双侧隐睾合并左侧多睾1例[J]. 中国医学影像技术，2019, 35(12): 1920. DOI: 10.13929/j.1003-3289.201903091.
[12]	Benzi TSCG, Costa WS, Sampaio FJ, et al. Inguinoscrotal stage of testicular descent: analysis in 217 human fetuses[J]. J Pediatr Urol, 2020, 16(2): 198-204. DOI: 10.1016/j.jpurol.2020.01.016.
[13]	白大春，杨言春，张萍，等. 超声对胎儿睾丸下降与发育趋势的观测[J]. 临床泌尿外科杂志，2007, 22(1): 36-37. DOI: 10.3969/j.issn.1001-1420.2007.01.014.
[14]	Moore KL, Persaud TVN, Torchia MG. The developing human: clinically oriented embryology[M]. 11th ed. Philadelphia: Saunders Elsevier, 2020.
[15]	Cho A, Thomas J, Perera R, et al. Undescended testis[J]. BMJ, 2019, 364: l926. DOI: 10.1136/bmj.l926.
[16]	Hutson JM, Vikraman J, Li R, et al. Undescended testis: what paediatricians need to know[J]. J Paediatr Child Health, 2017, 53(11): 1101-1104. DOI: 10.1111/jpc.13744.
[17]	Cendron M, Huff DS, Keating MA, et al. Anatomical, morphological and volumetric analysis: a review of 759 cases of testicular maldescent[J]. J Urol, 1993, 149(3): 570-573. DOI: 10.1016/s0022-5347(17)36151-7.
[18]	张展，方玲，裴勖斌，等. 小儿隐睾合并扭转的早期超声诊断[J]. 中国医学影像学杂志，2017, 25(2): 146-147. DOI: 10.3969/j.issn.1005-5185.2017.02.018.
[19]	Committee opinion No.723: guidelines for diagnostic imaging during pregnancy and lactation[J]. Obstet Gynecol, 2017, 130(4): e210-e216. DOI: 10.1097/aog.0000000000002355.
[20]	中华医学会放射学分会儿科学组，中华医学会儿科学分会放射学组. 胎儿MRI中国专家共识[J]. 中华放射学杂志，2020, 54(12): 1153-1161. DOI: 10.3760/cma.j.cn112149-20200605-00779.
[21]	张恒，宁刚. 《美国胎儿影像指南(2014)》胎儿MRI检查部分解读[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(3): 276-280. DOI: 10.3877/cma.j.issn.1673-5250.2017.03.006.
[22]	Mittal PK, Abdalla AS, Chatterjee A, et al. Spectrum of extratesticular and testicular pathologic conditions at scrotal MR imaging[J]. Radiographics, 2018, 38(3): 806-830. DOI: 10.1148/rg.2018170150.
[23]	邹玉坚，郑晓林，杨沛钦，等. MRI诊断隐睾症的临床价值[J]. 放射学实践，2006, 21(7): 706-708.
[24]	Emad-Eldin S, Abo-Elnagaa N, Hanna SA, et al. The diagnostic utility of combined diffusion-weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes[J]. J Med Imaging Radiat Oncol, 2016, 60(3): 344-351. DOI: 10.1111/1754-9485.12458.
[25]	宁刚. 胎儿MRI：出生缺陷产前影像学诊断的生力军[J/CD]. 中华妇幼临床医学杂志(电子版), 2021, 17(3): 257-261. DOI: 10.3877/cma.j.issn.1673-5250.2021.03.003.

[1]	Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[2]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[3]	Lei Liu, Xin Yang, Xiaohua Xu, Shengmou Lin, Chuqin Xiong, Lilu Nong, Zhenyu Dong, Shengli Li. Measurement of fetal prenasal thickness and nasal bone length as a screening tool for trisomy 21, 18, and 13 in the second trimester of pregancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(05): 506-510.
[4]	Yanna Ye, Ruiting Ye, Yanling Chen, Wen Peng, Le Liu, Wenqiu Xiao, Hui Huang, Mingshen Li, Muyi Zhong, Xian Ye. Nomogram based on clinicopathological and imaging features to predict recurrence of benign and borderline breast phyllodes tumor[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(04): 229-237.
[5]	Xinyu Fang, Changyu Huang, Hongxin Hu, Yiming Lin, Yang Chen, Nanxin Zhang, Wenming Zhang. Treatment options and efficacy analysis of subchondral insufficiency fractures of knee[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 583-587.
[6]	Xiaoyan Dong, Qi Zhao, Jun Tang, Li Zhang, Xiaoyan Yang, Jiao Li. Clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 595-603.
[7]	Chao Xue, Ye Zhang, Ying Zhao, Jiancheng Han, Xiaoyan Gu, Lin Sun, Xiaowei Liu, Wei Song, Yihua He. Ultrasonographic characteristics and prognosis of fetal congenital absent pulmonary valve syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 410-418.
[8]	Wei Zhang, Yang Li, Peizhong Shang, Dandan Shang, Wei Zhang. Adult cryptorchidism extracted by minilaparoscopy during TAPP for indirect inguinal hernia：a case report[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 586-587.
[9]	Yu Han, Wu Zhang, Anqi Li, Wenying Chen, Sidong Xie. Diagnostic value of MRI Liver Image Reporting and Data System (LI-RADS) for hepatocellular carcinoma in patients with non-cirrhotic hepatitis B[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 669-673.
[10]	Manshi Lei, Sisi Deng, Xinrong Wang, Jinbin Huang, Qing Xiang, Anni Xiong, Zhan'ao Meng. Application of artificial intelligence-assisted compression sensing technology in upper abdominal fat-suppressed T2WI sequence[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 551-556.
[11]	Guangjun Zhong, Chunhua Liu, Wansen Zhu, Xiaolei Xu, Zhaojun Wang. Application of conventional MRI combined with different scanning sequences in preoperative staging diagnosis, chemotherapy efficacy and prognosis evaluation of gastric cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 378-382.
[12]	Baoru Hu, Naijian Shang, Di Gao. DCE-MRI and DWI findings of advanced hepatocellular carcinoma and their correlation with prognosis after immunotherapy[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 399-403.
[13]	Yuxian Wu, Yayuan Feng, Lei Huo, Ningyang Jia, Juan Zhang. Study on the diagnostic value of imaging in primary hepatic lymphoma[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(05): 349-353.
[14]	Haitao Feng, Tao Xu, Wenyang Liu, Chen Sun, Shangchao Cao. Value of three-dimensional arterial spin labeling combined with DCE-MRI in the diagnosis of postoperative recurrence and radiation brain necrosis of glioma[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(04): 262-265.
[15]	Zhiwen Wang, Xuemei Zheng, Qingkun Zhang, Haijiang Wang. Clinical analysis of 75 cases of spontaneous intracranial hypotension[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 398-401.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export