Clinical value of pelvic and penile magnetic resonance angiography in preoperative evaluation of penile revascularization

Penile angiography is invasive, costly and requires postinterventional surveillance. The aim of this pilot study was to determine whether three dimensional magnetic resonance (3D-MR)-angiography may replace conventional penile angiography in preoperative planning of penile revascularization. Twelve patients with a mean age of 39 (21 - 59) y were evaluated. All patients underwent evaluation with intracavernous pharmacotesting, color Doppler sonography (CDS), digital subtraction angiography (DSA) and pelvic MR-angiography with gadolinium diethylene-triaminepentaacetic acid (Gd-Dota) 0.2 - 0.3 mmol/kg body weight. MR-angiography demonstrated the anatomy of the internal iliac arteries in 9 out of 12 patients. Intrapenile vessels were visible in 7 out of 12 patients. In comparison DSA provided complete visualization of all pelvic and penile vessels. Relevant arterial obstruction was found in 10 out of 12 patients. CDS revealed a mean maximal arterial now of 27 (22 - 40)cm/s and showed in accordance to angiography arterial insuffiency in 10 out of 12 cases. Indication for revascularization could have been based on MR-angiography alone in only one patient. Therefore, selective penile angiography remains the 'gold standard' for preoperative planning of revascularization procedures.