MR Imaging of Nonmalignant Penile Lesions.ppt

MR Imaging ofNonmalignant PenileLesions Alexander P. S. Kirkham RadioGraphics 2008 Introduction The penis is a superficial organ in which many diseases can be seen or palpated and is readily imaged at high resolution with ultrasonography . In addition, we discuss and illustrate the MR imaging findings in a wide spectrum of pathologic conditions of the penis, including penile fracture, suspensory ligament rupture, priapism, erectile dysfunction, Peyronie disease, penile fibrosis, penile implants, and urethral disorders. Normal Anatomy 阴茎勃起的基础是阴茎动脉的扩张和阴茎海绵体小梁的舒张，海绵窦血流增加，海绵体小梁对白膜压力增加，压迫白膜下静脉，使窦状隙内血流受阻，海绵体压力增加，阴茎勃起 MR Imaging Anatomy MR Imaging Technique Our mainstay for MR imaging of the penis is thin-section (≤4-mm) high-resolution (matrix of at least 256 × 192) spin-echo T2-weighted sequences performed in orthogonal planes with use of a surface coil. The sequences are performed with a small field of view and without fat suppression. In addition, we usually perform spin-echo T1-weighted sequences in the axial plane. Erection We routinely inject 10 μg of prostaglandin E1 (alprostadil), except in cases of priapism, acute penile fracture, painful erection, or penile prosthesis. For erectile dysfunction, the dose may be increased to 20 μg, and in young patients with normal erections it can be reduced to 5 μg. Safety All current inflatable penile prostheses can be safely imaged with MR imaging. Two malleable prostheses (OmniPhase and DuraPhase; Dacomed, Minneapolis, Minn) containing metallic elements show fairly strong deflection with 1.5-T magnets and should not be imaged. Trauma: Penile Fracture Suspensory Ligament Rupture Priapism (持续勃起症) It can usefully be divided into two types:high or low flow. Low-flow priapism is usually a disorder of venous outflow and has many causes, including 伟哥，镰刀红细胞贫血，白血病，恶性浸润，30%-50%为自发性。 High-flow priapism：外伤后动静脉瘘 Erectile Dysfunction Erectile dysfunction of vascular origin may be caused by an arterial inflow disord