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MR imaging of La Peyronie's disease
Clinical findings
A 51 year old man complained of partial impairment of erection and deviation of the penis during erection. The patients had previously undergone two sonographic examinations. The first exam had demonstrated one sclerotic plaque, whereas the second had shown two.
Imaging findings
Sagittal FSE T2 image shows the presence of a plaque
in the laterodorsal aspect of the penis (arrows). The penis is bowed anteriorly.
Oblique axial FSE T2 image shows the plaque involves
the laterodorsal aspect of the left corpus carvenosum, the dorsal aspect
of the right one and the septum (arrows).
Oblique axial SE T1 images before and after
Gd-DTPA. No enhancement of the plaque after Gd-DTPA administration.
The plaque is sclerotic (arrows).
Gd-DTPA enhanced coronal SE T1 image. The penis is
bowed to the right.
Discussion
La Peyronie's disease (induratio penis plastica) is a rare affection with an incidence of 0.3 to 0.7% of all urological patients. Clinically the patients complain of painful erection and deviation of the penis. Furthermore they may suffer an impairment of the erection, due to a venous steal. The histology reveals an inflammatory reaction in the layer between the tunica albuginea and the corpora cavernosa in the early stage. Then local edema and proliferation of fibroblasts cause sclerosis and the formation of a plaque. Ultrasonography represents the primary investigation tool. It is able to detect the plaques with great sensitivity and provides localization and classification. Ultrasonography particularly allows the demonstration of non-palpable plaques. MR imaging provides additional information in terms of detection and localizations of plaques. Gd-DTPA enhanced MR imaging is very useful in the assessment of the activity of the inflammatory reaction and may help to determine the exact time for the surgical intervention. In our case MR imaging demonstrated the plaque was only one and sclerotic because of the lack of enhancement after the administration of Gd-DTPA.
References
1) Helweg G, Judmaier K, Oberhauser A, zur Nedden D, Ennemoser O, Knapp R, Bangerl I, Buchbunger W. Ultrasound and MRI in the diagnosis of penile induration (Peyronie's disease) Eur Radiol 2, 230-232 1992.
2) Hricak H, Marotti M, Gilbert T, Lue T, Wetzel L, Mc Anich J, Tanako J. Normal penile anatomy and abnormal penile conditions: evaluation with MR imaging. Genitourin Radiol 169: 683-690 1988.
3) Barozzi L, Pavlica P, Balzani E, Trebbi F. Ecografia e Risonanza Magnetica del pene. Radiol Med 87: 814-821, 1994.
4) Tamburrini O, Della Sala M, Sessa M, Carallo OF, Imbimbo C, Mirone V, Morrone G. Risonanza Magnetica funzionale nella malattia di La Peyronie nella fase cronica stabilizzata. Radiol Med 86: 851-855, 1993.
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