MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance
Abstract
:1. Introduction
2. ED Due to Venous Leakage
3. Diagnostic Imaging Role in ED Due to Venous Leak
4. Methods and Results
4.1. Patient Selection
4.2. Preparation and Implementation of the cav-MRI Protocol
4.3. Interpretation of cav-MRI Findings
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Types of ED | Pathophysiologic Mechanisms |
---|---|
Psychogenic ED | The psychogenic component, consequent to various forms of neurosis, clearly prevails in the absence of organic damage. |
Situational or relational ED | Form typically linked to a particular situation or specific partner and not present in other conditions. |
Functional ED | When it is not possible to recognize any clear neurotic or psychotic pathology, but only a specific somatic “habitus” dominated by general symptomatology attributable to alpha-adrenergic hypertonia: sweating of the hands, tachycardia, etc. |
Neurogenic ED | Secondary to diseases of the central or peripheral nervous system |
Arterial or venous vascular ED | From arterial deficiency or veno-occlusive dysfunction |
Iatrogenic ED | A side effect of pharmacological therapy or a sequel of a surgical intervention. |
Endocrinology ED | Due to a deficiency of male sexual hormones (hypogonadism) related to an increase in prolactin (hypophysial hyperplasia/adenoma) or significant alteration in thyroid metabolism. |
Diabetic ED | Due to vasculopathic or neuropathic etiopathogenesis diabetes-related. |
ED related to chronic systemic diseases | Related to chronic kidney, liver, or heart diseases. |
ED from congenital or acquired penile malformations | Phimosis, curvature, Induratio Penis Plastica. |
ED from abuse of voluptous substances | Alcohol or drugs. |
Type of Acquisition * | Type of Sequence * | Results |
---|---|---|
Morphological acquisition | SSFSE T2 axial sequence with 3 mm slice thickness | Anatomical and morphological sequence |
Optional supplemental morphological acquisitions depending on the pathology | Coronal and sagittal SSFSE T2W sequences with 3 mm slice thickness | Anatomical and morphological sequence (optional) |
SSFSE T2W fat sat axial sequence with 3 mm slice thickness | Anatomical and morphological sequence (optional) | |
Dynamic acquisitions for venographic study | Axial 3D GRE T1W fat sat with 2 mm slice thickness, prior to intracavernous administration of contrast agent | Anatomical and morphological sequence |
Axial 3D GRE T1W sequence with fat suppression with 2 mm slice thickness, after intracavernous administration of contrast agent | Dynamic sequences with MPR and MIP reconstructions, |
Sequence | Phase Time | Plane | FOV | Matrix | Slice Thickness/Gap | TR (ms) | TE (ms) | Flip Angle | Fat Saturation |
---|---|---|---|---|---|---|---|---|---|
SSFSE survey | Pre-contrast | 3 plane | 39 | 256 × 158 | 7 mm/0 mm | 6000 | 1–1.6 | 90 | No |
SSFSE T2W * | Pre-contrast | Axial | 25 | 320 × 320 | Mar-00 | 6000–8000 | 146 | 160 | No |
Coronal | 27 | 256 × 256 | Mar-00 | 6000–8000 | 146 | 160 | No | ||
Sagittal | 25 | 320 × 320 | Mar-00 | 6000–8000 | 108 | 160 | No | ||
SSFSE T2W FAT SAT | Pre-contrast | Axial | 25 | 320 × 320 | Mar-00 | 6000–8000 | 146 | 160 | Yes |
GRE T1W 3D FAT SAT | Pre-contrast | Axial | 25 | 320 × 320 | 3 | AUTO TR | MIN FULL | / | Yes |
GRE T1W 3D FAT SAT | Post-contrast sequential dynamic 50 acquisition consecutively acquired starting with the injection of contrast agent for 5 min. | Axial | 25 | 320 × 320 | 3 | AUTO TR | MIN FULL | / | Yes |
Comparison between Cavernous CT and Cavernous MRI: Advantage and Limits | ||
---|---|---|
Cavernous MRI | ||
Indications: Young patients Good compliance with MRI Suitable for magnetic field | Advantage | Good spacial resolution High contrast resolution Low volumes of contrast agent and reduced injection rate No ionizing radiations |
Limits | Magnetic fields (no conditional) Claustrophobia Quite long examination times | |
Cavernous CT | ||
Indications: Old patients Claustrophobic Weak compliance with MRI Not suitable for magnetic field | Advantage | Elevated spacial resolution Good resolution in contrast Fast acquisition times Post-processing |
Limits | Ionizing radiations Bigger volumes of contrast agent to high injection rate |
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Di Serafino, M.; Pucci, L.; Iacobellis, F.; Fasbender Jacobitti, M.; Ronza, R.; Sabatino, V.; De Luca, L.; Iossa, V.; Langella, N.A.; Persico, F.; et al. MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance. Diagnostics 2023, 13, 2178. https://doi.org/10.3390/diagnostics13132178
Di Serafino M, Pucci L, Iacobellis F, Fasbender Jacobitti M, Ronza R, Sabatino V, De Luca L, Iossa V, Langella NA, Persico F, et al. MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance. Diagnostics. 2023; 13(13):2178. https://doi.org/10.3390/diagnostics13132178
Chicago/Turabian StyleDi Serafino, Marco, Luigi Pucci, Francesca Iacobellis, Marco Fasbender Jacobitti, Roberto Ronza, Vittorio Sabatino, Luigi De Luca, Vincenzo Iossa, Nunzio Alberto Langella, Francesco Persico, and et al. 2023. "MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance" Diagnostics 13, no. 13: 2178. https://doi.org/10.3390/diagnostics13132178
APA StyleDi Serafino, M., Pucci, L., Iacobellis, F., Fasbender Jacobitti, M., Ronza, R., Sabatino, V., De Luca, L., Iossa, V., Langella, N. A., Persico, F., Grimaldi, D., Schillirò, M. L., Lessoni, L., Notorio, M., Carrino, M., & Romano, L. (2023). MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance. Diagnostics, 13(13), 2178. https://doi.org/10.3390/diagnostics13132178