title: Utility of Ultrasound and Magnetic Resonance Imaging in Patients with Disorders of Sex Development Who Undergo Prophylactic Gonadectomy.
abstract: OBJECTIVE
  To evaluate ultrasonography and magnetic resonance imaging (MRI) in identifying gonads in patients with disorders of sex development (DSD) who undergo prophylactic gonadectomy, and to assess the capacity of preoperative imaging to detect premalignant and malignant transformation.
  
  
  METHODS
  Retrospective cohort at a tertiary referral center of 39 patients with DSD who underwent MRI and/or ultrasonography before prophylactic gonadectomy.
  
  
  METHODS
  None.
  
  
  METHODS
  Identification of gonads on preoperative imaging.
  
  
  RESULTS
  Thirty-three patients underwent ultrasonography, which identified 54% (35/65) of gonads and 14 patients had MRI, which identified 41% (11/27) of gonads. There was no significant difference between imaging modalities in the proportion of gonads identified (P = .25). The proportion of pathology-confirmed dysgenetic gonads identified was higher on ultrasound compared with MRI (51% vs 8%; P = .02). There was no difference in the proportion of pathology-confirmed testes identified on ultrasound and MRI (54% vs 71%; P = .33). Eleven out of 39 patients (28%) were diagnosed with a premalignant lesion, and there were no distinguishing characteristics documented on imaging reports to suggest transformation. The only diagnosed malignancy in this series had imaging describing a "normal-sized ovary."
  
  
  CONCLUSIONS
  Ultrasonography and MRI identified 40%-50% of gonads in patients with DSD who underwent prophylactic gonadectomy, with no significant difference between the 2 modalities. Clinicians should, therefore, consider ultrasonography as a first-line imaging modality. Premalignant lesions were not detected on either imaging modality. The only malignancy was described as a "normal-sized ovary" which should raise concern in a patient with complete gonadal dysgenesis expected to have streak gonads.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan. Electronic address: Alaniz@med.umich.edu.
authors.forename: V I
authors.initials: VI
authors.lastname: Alaniz
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: E K
authors.initials: EK
authors.lastname: Kobernik
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: J
authors.initials: J
authors.lastname: Dillman
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: E H
authors.initials: EH
authors.lastname: Quint
mesh_terms: D000328:Adult; D002369:Castration; D012734:Disorders of Sex Development / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006059:Gonadal Dysgenesis / Q000000981:diagnostic imaging*; D006066:Gonads / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D065286:Prophylactic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Children; DSD; Disorders of sex development; Dysgerminoma; Gonadectomy; Gonadoblastoma; Imaging; MRI; Ultrasound