Diagnostic Accuracy of MRI in Cryptorchidism Keeping Laparoscopy as Gold Standard

Background: Cryptorchidism is a common congenital disorder in male children that, if left untreated, poses significant risks of infertility and malignancy. While laparoscopy remains the gold standard for diagnosis, there is a knowledge gap regarding the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) as a non-invasive alternative in pediatric populations. Objective: This study aimed to evaluate the diagnostic accuracy of DW-MRI in detecting undescended testes among pediatric patients, using laparoscopy as the gold standard and assessing sensitivity, specificity, predictive values, and agreement between modalities. Methods: This descriptive cross-sectional study included 292 male children with non-palpable testes, recruited consecutively at a tertiary care hospital. Patients with prior scrotal or inguinal surgery were excluded. All participants underwent DW-MRI followed by laparoscopic confirmation. Primary outcomes were sensitivity, specificity, positive predictive value, negative predictive value, and agreement (kappa statistic) between DW-MRI and laparoscopy. Ethical approval was obtained, and all procedures adhered to the Declaration of Helsinki. Data were analyzed using SPSS version 22.0 with significance set at p < 0.05. Results: DW-MRI showed high sensitivity (92.0%) and negative predictive value (94.3%), with moderate specificity (70.0%) and positive predictive value (61.3%). Kappa statistics indicated moderate agreement (κ = 0.432) with the gold standard. The difference in detection rates between modalities was statistically significant (p < 0.001), supporting DW-MRI as a reliable tool for ruling out undescended testes. Conclusion: DW-MRI offers a highly sensitive, non-invasive approach for excluding cryptorchidism in pediatric patients, although positive findings require surgical confirmation. Incorporating DW-MRI can improve diagnostic pathways, reduce unnecessary surgeries, and enhance pediatric urological care.