I just summits this abstract ESSM Congress in 2016(The 18th Congress of the European Society for Sexual Medicine (ESSM):
The role of MRI in diagnostic evaluation and therapeutic algorithm in Peyronie’s Disease: findings from one hundred patients single-institution cohort
The Peyronie’s disease is a psychologically and physically devastating disorder that is manifested by a fibrous scar with loss of elasticity of the tunica albuginea, resulting in palpable induration of the penis flaccid condition and causing deformation of the penis (including curvature penis), narrowing, shortening or painful erections. The Peyronie’s disease remains a considerable therapeutic dilemma.
Vincent Hupertan, W. Akapko, P. Fernandez, I. Ouzaid, JF. Hermieu, S. Dominique, V. Ravery
Evaluation of the added value of MRI in the management of Peyronie’s disease as a tool in the initial assessment and during the decision-making algorithm before treatment.
Between 2012 and 2015, all patients presented at our institution for a suspected Peyronie’s disease underwent a clinical assessment and a penile MRI. The data of the first 100 patients were analyzed and presented. The standardized MRI protocol was performed by a single dedicated radiologist. It included a 1.5 Tesla acquisition with T1 sequences with and without gadolinium, a T2 sequence, and a 3D reconstruction of the mapping of the plaques. The radiologist also performed an ultrasound of the penis. Patients’ demographics, symptoms at presentation, erectile function assessment, clinical and MRI characteristics of the plaques were collected. Treatment options included surveillance, analgesics and shock wave therapy, surgery, and intralesional verapamil injections. the clinical benefits of the MRI were reviewed for the present analysis.
Overall, 107 MRI were performed in 100 patients. The mean age of the cohort was 52 years (range: 24-70). Seven patients had a second treatment after verapamil injections. MRI allowed us to detect up to 20% of occult plaques at clinical examination or ultrasound. Active plaques showed high/low signals on T1 and T2 respectively whereas quiescent plaques were high/low signals. Correlations of clinical and MRI findings showed painless plaques may remain active on imaging. In addiction, active plaques might be seen only on MRI and remain occult to examination or ultrasound.
In our experience, the use of MRI as part of the initial assessment of Peyronie’s disease allowed us to:
- Define precisely the MRI semiology of Peyronie’s disease.
- Confirm the plaques and their extent including he inflammatory or quiescent status.
- Particularly, identify lesions of corpus cavernosum and in particular of the septum that were not palpable during clinical examination
- Evaluate the therapeutic response after iterative intralesional verapamil injection.
The impact of the use of MRI on the treatment outcomes should be evaluated before routinely include this imaging modality in daily practice.