Utility of dynamic MRA in the evaluation of male erectile dysfunction

  • Alexandra RoudenkoEmail author
  • Rand N. Wilcox Vanden Berg
  • Christopher Song
  • Martin R. Prince
  • Darius A. Paduch
  • Daniel Margolis
Special Section: Male pelvis



To assess the efficacy of time-resolved MR angiography (MRA) in evaluating penile vasculature in patients with clinically suspected vascular anomalies contributing to their erectile dysfunction correlating with penile doppler ultrasound (PDUS) findings and clinical outcomes after surgical intervention.


Men (n = 26) with signs of early vascular shunting on PDUS underwent time-resolved, contrast-enhanced (0.1 mMol/kg gadobutrol at 1 ml/s followed by saline flush) 3-dimensional spoiled gradient echo T1-weighted MRA sequence performed over 3 min with 4.6 s frame rate after intracavernosal injection of an erectogenic agent. Additional T1- and T2-weighted sequences were performed for anatomic co-localization and tissue characterization. MRA images were evaluated for early filling of draining veins as well as arteriovenous malformations and fistulas and correlated with findings at surgery.


29 MRA examinations on 26 patients (mean age 39 years) demonstrated abnormal early venous drainage (n = 22) as well as diminutive/delayed cavernosal enhancement (n = 3), incomplete tumescence (n = 2), and combined arterial inflow/venous outflow disease (n = 1). The MRA had a concordance of 85.2% at determining the presence, or lack thereof of a shunt/AVM when compared to PDUS.


Time-resolved MRA allows for both temporal and spatial resolution with visualization of both arterial and venous abnormalities which may be suggested with a screening PDUS examination. This technique allows us to provide detailed anatomic information prior to any surgical intervention.


Erectile dysfunction MR angiography Time-resolved MRA Venous leak Dynamic MRA 



  1. 1.
    McCabe MP, Sharlip ID, Atalla E, et al: Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J. Sex. Med. 2016; 13: 135–43.CrossRefGoogle Scholar
  2. 2.
    Prins J, Blanker MH, Bohnen AM, et al: Prevalence of erectile dysfunction: a systematic review of population-based studies. Int. J. Impot. Res. 2002; 14: 422–432.CrossRefGoogle Scholar
  3. 3.
    Kubin M, Wagner G and Fugl-Meyer AR: Epidemiology of erectile dysfunction. Int. J. Impot. Res. 2003; 15: 63–71.CrossRefGoogle Scholar
  4. 4.
    Vaucher L, Bolyakov A and Paduch DA: Evolving techniques to evaluate ejaculatory function. Curr. Opin. Urol. 2009; 19: 606–614.CrossRefGoogle Scholar
  5. 5.
    Golijanin D, Singer E, Davis R, et al: Doppler evaluation of erectile dysfunction – Part 1. Int. J. Impot. Res. 2007; 19: 37–42.CrossRefGoogle Scholar
  6. 6.
    Lasker GF, Maley JH and Kadowitz PJ: A Review of the Pathophysiology and Novel Treatments for Erectile Dysfunction. Adv. Pharmacol. Sci. 2010. Available at:, accessed December 28, 2018.
  7. 7.
    Rhoden EL, Telöken C, Sogari PR, et al: The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int. J. Impot. Res. 2002; 14: 245–250.CrossRefGoogle Scholar
  8. 8.
    Hosain GMM, Latini DM, Kauth M, et al: Sexual dysfunction among male veterans returning from Iraq and Afghanistan: prevalence and correlates. J. Sex. Med. 2013; 10: 516–523.CrossRefGoogle Scholar
  9. 9.
    Laumann EO, West S, Glasser D, et al: Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey. J. Sex. Med. 2007; 4: 57–65.CrossRefGoogle Scholar
  10. 10.
    Sand MS, Fisher W, Rosen R, et al: Erectile dysfunction and constructs of masculinity and quality of life in the multinational Men’s Attitudes to Life Events and Sexuality (MALES) study. J. Sex. Med. 2008; 5: 583–594.CrossRefGoogle Scholar
  11. 11.
    Nicolosi A, Glasser DB, Moreira ED, et al: Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study. Int. J. Impot. Res. 2003; 15: 253–257.CrossRefGoogle Scholar
  12. 12.
    Caskurlu T, Tasci AI, Resim S, et al: The etiology of erectile dysfunction and contributing factors in different age groups in Turkey. Int. J. Urol. Off. J. Jpn. Urol. Assoc. 2004; 11: 525–9.Google Scholar
  13. 13.
    Ye T, Li J, Li L, et al: Computed tomography cavernosography combined with volume rendering to observe venous leakage in young patients with erectile dysfunction. Br. J. Radiol. 2018; 91: 20180118.CrossRefGoogle Scholar
  14. 14.
    Vargas HA, Donati OF, Wibmer A, et al: Association Between Penile Dynamic Contrast‐Enhanced MRI‐Derived Quantitative Parameters and Self‐Reported Sexual Function in Patients with Newly Diagnosed Prostate Cancer. J. Sex. Med. 2014; 11: 2581–2588.CrossRefGoogle Scholar
  15. 15.
    Glodny B, Petersen J, Bendix N, et al: Microcoil embolization of an arteriovenous fistula from the arteria bulbi penis to the corpus spongiosum penis in the treatment of erectile dysfunction: normal function regained immediately after intervention. Br. J. Radiol. 2007; 80: e265-267.CrossRefGoogle Scholar
  16. 16.
    Lurie AL, Bookstein JJ and Kessler WO: Posttraumatic impotence: angiographic evaluation. Radiology 1988; 166: 115–119.CrossRefGoogle Scholar
  17. 17.
    Papagiannopoulos D, Nehra A and Khare N: Evaluation of young men with organic erectile dysfunction. Asian J. Androl. 2015; 17: 11.CrossRefGoogle Scholar
  18. 18.
    Pretorius ES, Siegelman ES, Ramchandani P, et al: MR Imaging of the Penis. RadioGraphics 2001; 21: S283–S298.CrossRefGoogle Scholar
  19. 19.
    Kirkham A: MRI of the penis. Br. J. Radiol. 2012; 85: S86–S93.CrossRefGoogle Scholar
  20. 20.
    Parker RA, Menias CO, Quazi R, et al: MR Imaging of the Penis and Scrotum. RadioGraphics 2015; 35: 1033–1050.CrossRefGoogle Scholar
  21. 21.
    Rosen RC, Catania J, Pollack L, et al: Male Sexual Health Questionnaire (MSHQ): Scale development and psychometric validation. Urology 2004; 64: 777–782.CrossRefGoogle Scholar
  22. 22.
    Henry BM, Pękala PA, Vikse J, et al: Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy. J. Urol. 2017; 198: 345–353.CrossRefGoogle Scholar
  23. 23.
    Thai CT, Karam IM, Nguyen-Thi PL, et al: Pelvic magnetic resonance imaging angioanatomy of the arterial blood supply to the penis in suspected prostate cancer patients. Eur. J. Radiol. 2015; 84: 823–827.CrossRefGoogle Scholar
  24. 24.
    Erdoğru T, Kaplancan T, Aker O, et al: Cavernosal arterial anatomic variations and its effect on penile hemodynamic status. Eur. J. Ultrasound Off. J. Eur. Fed. Soc. Ultrasound Med. Biol. 2001; 14: 141–148.CrossRefGoogle Scholar
  25. 25.
    Chiou RK, Alberts GL, Pomeroy BD, et al: Study of cavernosal arterial anatomy using color and power Doppler sonography: impact on hemodynamic parameter measurement. J. Urol. 1999; 162: 358–360.CrossRefGoogle Scholar
  26. 26.
    Sakamoto H, Nagata M, Saito K, et al: Anatomic variations of cavernous arteries and their effect on measurement of hemodynamic parameters: a power Doppler study. Urology 2004; 63: 539–544.CrossRefGoogle Scholar
  27. 27.
    Dean RC and Lue TF: Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urol. Clin. North Am. 2005; 32: 379–v.CrossRefGoogle Scholar
  28. 28.
    Hsu G-L, Hsieh C-H, Wen H-S, et al: Penile venous anatomy: application to surgery for erectile disturbance. Asian J. Androl. 2002; 4: 61–66.PubMedGoogle Scholar
  29. 29.
    Porst H, Burnett A, Brock G, et al: SOP conservative (medical and mechanical) treatment of erectile dysfunction. J. Sex. Med. 2013; 10: 130–171.CrossRefGoogle Scholar
  30. 30.
    El-Sakka AI: What is the current role of intracavernosal injection in management of erectile dysfunction? Int. J. Impot. Res. 2016; 28: 88–95.CrossRefGoogle Scholar
  31. 31.
    Jung DC, Park SY and Lee JY: Penile Doppler ultrasonography revisited. Ultrasonography 2018; 37: 16–24.PubMedGoogle Scholar
  32. 32.
    Najari BB, Introna L and Paduch DA: Improvements in Patient-reported Sexual Function After Microsurgical Varicocelectomy. Urology 2017; 110: 104–109.CrossRefGoogle Scholar
  33. 33.
    Rastrelli G and Maggi M: Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl. Androl. Urol. 2017; 6: 79–90.CrossRefGoogle Scholar
  34. 34.
    Donatucci CF and Lue TF: Erectile dysfunction in men under 40: etiology and treatment choice. Int. J. Impot. Res. 1993; 5: 97–103.PubMedGoogle Scholar
  35. 35.
    Tiguert R, Harb JF, Hurley PM, et al: Management of shotgun injuries to the pelvis and lower genitourinary system. Urology 2000; 55: 193–197.CrossRefGoogle Scholar
  36. 36.
    Balzano FL and Hudak SJ: Military genitourinary injuries: past, present, and future. Transl. Androl. Urol. 2018; 7: 646–652.CrossRefGoogle Scholar
  37. 37.
    Szafran AA, Redett R and Burnett AL: Penile transplantation: the US experience and institutional program set-up. Transl. Androl. Urol. 2018; 7: 639–645.CrossRefGoogle Scholar
  38. 38.
    Li J, Qin F, Han P, et al: Penile transplantation: A long way to routine clinical practice. Pak. J. Med. Sci. 2017; 33: 493–497.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyMount Sinai Health SystemNew YorkUSA
  2. 2.Department of RadiologyWeill Cornell MedicineNew YorkUSA
  3. 3.Department of UrologyWeill Cornell Medicine/New York PresbyterianNew YorkUSA
  4. 4.Arthur Smith Institute for UrologyNorthwell HealthGreat NeckUSA
  5. 5.Bioimaging LabConsulting Research Services, IncNorth BergenUSA

Personalised recommendations