| Background: Cryptorchidism is one of the common congenital malformations of genitourinary system in children.If it is not treated in time,cryptorchidism stays in the abdominal cavity or groin for a long period of time.Due to the influence of high temperature or abnormal growth environment,it may easily lead to testicular developmental disorders and causes infertility and even malignant cells in the testis,increasing the incidence of malignant tumors.The early diagnosis of cryptorchidism has important clinical significance for the decision-making and improvement of prognosis.Imaging examination is a common method for non-invasive diagnosis of clinically unresolved cryptorchidism,but each has its own advantages and disadvantages.Color Doppler ultrasound is simple,economical,and safe.It is often used as the first choice diagnostic method,but the rate of missed diagnosis of abdominal cryptorchidism is high;CT examination is more accurate in anatomical positioning,but with radiation,the 2014 American Urological Association guidelines and the 2017 Canadian Urology Association,the guidelines of the Association of Pediatricians and Urologists of Canada have pointed out that children should be used cautiously or as little as possible;MRI equipment is expensive,examination takes a long time,and children need sedation,which is not conducive to popularization;nuclear blood testicular perfusion imaging is rarely reported for clinically inaccessible inguinal cryptorchidism.The sensitivity is high,safe,simple and economical.The radiation is extremely low,but the diagnosis of peritoneal cryptorchidism is uncertain.n short,in order to improve imaging diagnostic efficiency,clinicians must consider ethical and economic factors when selecting these methods.In particular,they should minimize or avoid unnecessary radiation exposure.Therefore,the complementarycombination the development and application of new imaging diagnostic methods and the exploration of common diagnostic imaging methods is of great value in providing clinically optimal diagnostic models of cryptorchidism.Objective: To retrospectively analyze color Doppler ultrasonography,CT,and testicular blood perfusion imaging in the diagnosis of clinical inability to reach the inguinal cryptorchidism and the detection rate of color Doppler ultrasonography and CT in the diagnosis of intra-abdominal cryptorchidism for clinical diagnosis of different types of cryptorchidism,thus to provide an optimized diagnostic model.Methods: Retrospective analysis was performed on 275 patients with clinical cryptorchidism in our hospital from December 2005 to December 2016.Among them,205 cases(212 cryptorchidism)were confirmed as cryptorchidism by surgical pathological diagnosis.Between the ages of 63,the average age was(21.82±12.08)years old;26 patients(29 cryptorchidism)with intra-abdominal cryptorchidism were confirmed by surgical pathological diagnosis,aged between 2-53 years,mean age(20.69±12.48)At the age of six,there are six inner rings in the groin,nine in the pelvis,and fourteen in the abdomen.Surgical pathological diagnosis confirmed other types of patients(inguinal hernia,inguinal lymph nodes,hydrocele,etc.)in 44 patients.All the inguinal cryptorchidism patients and other types of patients had undergone preoperative color Doppler ultrasonography,CT,and testicular blood perfusion imaging.The three imaging methods alone,color ultrasonography combined with CT,color Doppler combined with testicular blood perfusion imaging and three The combined use of these methods for the clinical diagnosis of inviscid inguinal cryptorchidism;according to the size of the cryptorchidism determined by the surgical pathology,divided into ? 3cm cryptorchidism group,<3cm ~ ? 2cm cryptorchidism group,<2cm ~ ? 1cm The cryptorchidism group and <1cm cryptorchidism group compared the size of cryptorchidism with color Dopplerultrasonography,CT and testicular blood perfusion imaging in the diagnosis of inguinal cryptorchidism sensitivity.Comparison of cryptorchidism with complications on color Doppler ultrasound,CT and testicular blood perfusion imaging in the diagnosis of inguinal cryptorchidism sensitivity;all patients with intra-abdominal cryptorchidism have been performed preoperative ultrasound,CT examination,analysis and comparison of single use and combination of color Doppler ultrasound and CT to the detection rate of intra-abdominal cryptorchidism.Results: 1.The results of color Doppler ultrasonography,CT,and testicular blood perfusion imaging on the diagnosis of clinical unreachable inguinal cryptorchidism were consistent with the surgical pathological diagnosis rate of 82.03%,80.08% and80.86%,respectively,there was no significant difference between the three.Differences(P>0.05);coincidence rates of color Doppler combined with CT,color Doppler ultrasonography,and testicular blood perfusion imaging combined with surgical pathological diagnosis were 90.23%,91.80%,and 94.53%,respectively.The former two were compared with the latter.No significant difference was found(P>0.05);the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of color Doppler ultrasonography,CT,and testicular blood perfusion imaging in diagnosing clinically untouched inguinal cryptorchidism were not observed.Significant difference was seen(P>0.05),but the sensitivity,accuracy,and negative predictive value of color Doppler combined with CT and combined testicular perfusion imaging were significantly higher than those of color Doppler ultrasonography and single CT(P<0.05).There was no significant difference in the diagnostic efficacy of the method combined with color Doppler combined with CT or combined testicular blood perfusion imaging(P>0.05).2.Observing and comparing the size of different cryptorchidism on the sensitivity of colorectal,CT and testicular blood perfusion imaging in the diagnosis of inguinalcryptorchidism showed that: with the decrease of cryptorchidism,the sensitivity of three methods were significantly reduced(all P<0.05);When the cryptorchidism volume was ?2cm,there was no significant difference in the sensitivity of the three methods(P>0.05).When the cryptorchidism volume was <2cm to ?1cm,the diagnostic sensitivity of CT and testicular blood perfusion imaging was significantly higher than that of the color Doppler ultrasound.P<0.05),but the cryptorchidism volume <1cm,CT and color Doppler ultrasound diagnosis of cryptorchidism was significantly higher than the testicular blood perfusion imaging(P <0.05).3.Inguinal cryptorchidism combined with oblique septum(21),intestinal gas(3)and inguinal abscess(a),spermatic hydrocele(a),inguinal lymph nodes(1)and inflammatory mass(1 At the time of diagnosis,the sensitivity of color ultrasound,CT,and testicular blood perfusion imaging in the diagnosis of inguinal cryptorchidism was 60.71%,92.86%,and 71.43%,respectively.The sensitivity of CT diagnosis was significantly higher than that of color Doppler ultrasonography(P<0.05),but it was associated with testicular blood flow.No significant difference was found in perfusion imaging(P>0.05).4.The detection rates of intra-abdominal cryptorchidism by color Doppler ultrasonography and CT were 68.9% and 86.2%,respectively.The detection rate of CT was significantly higher than that of color Doppler ultrasound(P<0.05).Among them,the detection rates of the internal ring and pelvic cryptorchidism,color Doppler ultrasonography and CT were 83.3%,66.7%,66.7%,and 88.9%,respectively.There was no significant difference between the two groups(P>0.05).The detection rates of cryptorchidism,color Doppler ultrasonography and CT were 64.3% and 92.9%respectively,and the detection rate of CT was significantly higher than that of color Doppler ultrasound(P<0.05).Conclusions: The sensitivity and accuracy of testicular blood perfusion imagingin the diagnosis of clinical untouched inguinal cryptorchidism are comparable to those of CT,but the economic and radiation doses are lower than those of thin-slice CT.Thin-slice CT has obvious advantages in the detection and determination of intra-abdominal cryptorchidism,and color Doppler ultrasonography can obtain better detection rates for the inner ring and pelvic cryptorchidism.Therefore,for patients with clinically suspected inguinal cryptorchidism and negative color scan,we should give priority to the selection of testicular blood perfusion imaging for further examination.For patients with clinically suspected intra-abdominal cryptorchidism,priority is given to further examination of thin-slice CT. |
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