Volume 43, Issue 3, Pages 293-300 (March 2003) Diagnostic Value of Magnetic Resonance Imaging in Peyronie’s Disease—A Comparison Both with Palpation and Ultrasound in the Evaluation of Plaque Formation  Ekkehard W. Hauck, Nils Hackstein, Rolf Vosshenrich, Thorsten Diemer, Hans U. Schmelz, Thomas Bschleipfer, Immo Schroeder- Printzen, Wolfgang Weidner  European Urology  Volume 43, Issue 3, Pages 293-300 (March 2003) DOI: 10.1016/S0302-2838(03)00003-4

Fig. 1 Ultrasound findings: (a) high resolution ultrasound revealing thickening of the tunica albuginea as hyperechoic plaque (axial view); (b) longitudinal view demonstrating a hyperechoic plaque with calcification and shadowing. European Urology 2003 43, 293-300DOI: (10.1016/S0302-2838(03)00003-4)

Fig. 2 Normal penile MRI findings: (a) T1-weighted spin echo MRI sagittal image (TR: 400ms, TE: 15ms) of the corpus cavernosum of a healthy patient in flaccid state. The corpora cavernosa are visualized with a homogeneous signal intensity of medium strength. The tunica albuginea has low signal intensity. (b) The same patient and same image parameters as in part (a) during erection induced by Prostaglandin E1. The tunica albuginea is now stretched and thinner as in the flaccid state improving the opportunities for plaque detection. (c) Axial T1-weighted spin echo MRI image of the same patient as in part (a) in tumescence shows the anatomy with the two corpora cavernosa, regularly surrounded by the tunica albuginea. The corpus spongiosum is not surrounded by the tunica albuginea. At the dorsum penis, the vena dorsalis profunda penis is shown. European Urology 2003 43, 293-300DOI: (10.1016/S0302-2838(03)00003-4)

Fig. 3 MRI findings in Peyronie’s disease during tumescence: (a) Fat suppressed T1-weighted, sagittal, after Gd-DPTA: this figure shows a typical dorsal plaque without contrast medium enhancement causing dorsal bending stretching from the middle to the glans. The plaque appears as focal thickening of the tunica albuginea and has a very low signal, as they content of fibrotic tissue (scarification). No enhancement of the plaque is shown, therefore no inflammation was diagnosed, what was pathohistologically proven by biopsy. The bright areas in the corpus cavernosum can be interpreted as separation phenomenon. (b) T1-weighted, cross-section, natively: the plaque is located in the dorsal tunica albuginea visualized as thickening of the tunica albuginea between the dorsal neurovascular bundle and the corpora cavernosa. (c) T1-weighted, cross-section, with Gd-DPTA, same patient as in part (b): MR images of a patient with an inflammatory plaque during erection induced by Prostaglandin E1. Inflammation was proven histologically by penile biopsy. Enhancement of contrast medium is visible in the dorsally located plaque and the surrounding edematous tissue. Moreover, dye is visible in the well perfused corpora cavernosa, the corpus spongiosum, the dorsal vascular bundle, and the skin. (d) T1-weighted, sagittal view, with Gd-DPTA: this figure demonstrates the sagittal view of an inflammatory plaque in the same patient as in part (c). After Gd-DPTA administration a thickening of the tunica and enhancement of contrast medium in the tissue that surrounds the plaque is demonstrated. An enhancement in the corpora cavernosa depends on the high perfusion of this structure. Besides this the typical narrowing of the tunica is visible in the middle of the penile shaft. European Urology 2003 43, 293-300DOI: (10.1016/S0302-2838(03)00003-4)

Fig. 4 Comparison of the detection rates of penile plaques by palpation, ultrasound and MRI. European Urology 2003 43, 293-300DOI: (10.1016/S0302-2838(03)00003-4)