Role of medical imaging in diagnosing ais and presurgical assesment in such patients

1. Role of Medical Imaging in diagnosis and
Presurgical Assessment of Androgen
Insensitivity Syndrome
DR. MUHAMMAD BIN ZULFIQAR
PGR II FCPS NEW RADIOLOGY DEPTT.
SIMS/SHL

2. IMAGING MODALITIES
• USG
• CT
• MRI

3. USG
• Inexpensive, Safe and Widely Available
• More Sensitive if testis are located within or
caudal to inguinal ring.
• Multi-approach ultrasound (including
transabdominal, transvaginal, transperineal
and occasionally transrectal) to identify the
pelvic anatomy. On multimodality approach
ultrasound is 89.8% accurate compared to
85.7% with MRI.
(Mansour et al.)

4. Mr./Miss X 14 Years Old

5. Seminal Vesicle
Prostate
Perabdominal USG shows no evidence of uterus and
Ovaries.

6. • High resolution USG with linear array probe
shows location of both testis in the inguinal
canal.

7. MISS/MR. Y 8 Years Old
Maternal Cousin to X

8. Perabdominal USG shows no evidence of Uterus and
Ovaries.

9. High resolution USG with linear array probe shows location of
both testis in the inguinal canal.

10. MR. Z 16 Years old
Brother of X

11. • Perabdominal USG shows no evidence of
uterus and Ovaries.

12. Penile Urethra
• High Resolution scan through penile shaft shows
urethra. However no corpora cavernosa or
spongiosa apppreciated.

13. • Both testis are visualized in scrotal sac. Both testis
are normal in size and echotexture.

14. • Color Flow Imaging shows Normal Flow and
Pattern in Testicular Artery.
Epididymis

15. USG Pitfalls
• Dependant on sonographer skill.
• Multimodality USG is a little bit more invasive
especially in a virginal teenage girl presenting
with pubertal development issues.
• Deep seated and fibrosed atrophic testis

16. MRI
• (MRI) has been studied more extensively.
• MRI is superior to USG in detection of
undescended testis in AIS.
• Imaging in multiple planes and good contrast
resolution.
• MRI has improved detection of intraabodminal
gonads e.g. fibrosed testis.
• Abnormal internal anatomy more precisely
depicted.
(Fenner et al), (Tanaka et al).

17. • Sagittal T2w-MRI
confirms absence of the
uterus and the proximal
two thirds of the vagina.
The distal rudimental
vagina is visible (arrow).

18. • Axial T2 weighted MR image reveals bilateral
inguinal canal testes (arrow 1) and atrophic
epididymides (arrow 2).

19. • Coronal T2w-MRI shows testes near to
superficial inguinal rings. Female external
genitalia are also evident.

20. CT Scan
• Commonly used for detection or
characterization of malignancy.
Disadvantage
– less accessible
– More costly than ultrasound
– There is exposure to ionizing radiation.
– CT scan does not characterize soft tissues as well,
as MRI.

21. CONCLUSION
• Ultrasound is best choice for initial evaluation
specially if testis are located in or caudal to
inguinal canal and lower abdomen.
• MRI has been recommended as the preferred
method of imaging in presurgical assessment if
– Not traced by USG
– Located intrabdominally.
– Fibrosed
• CT is only used for characterization of malignancy .

22. THANX