Article

Preoperative detection and localization of accessory pudendal artery with contrast-enhanced MR angiography.

Departments of Radiology and Urology, Anam Hospital, Korea University, College of Medicine, 5-Ka Anam-dong, Sungbuk ku, Seoul 136-705, Korea.
Radiology (Impact Factor: 6.34). 03/2012; 262(3):903-11. DOI:10.1148/radiol.11110934
Source: PubMed

ABSTRACT To evaluate the diagnostic performance of contrast material-enhanced magnetic resonance (MR) angiography for preoperative detection and localization of accessory pudendal arteries (APAs) in patients with prostate cancer.
This prospective study was approved by the institutional review board, and informed consent was obtained. Between July 2007 and December 2010, 127 patients underwent contrast-enhanced MR angiography following prostate MR imaging at 3.0 T before robot-assisted laparoscopic radical prostatectomy (RALP). APAs were defined as any arteries located in the periprostatic region and anastomosed with the common penile artery or its branches; they were then subclassified into lateral and apical APAs. For detecting and localizing APAs, MR angiograms were evaluated prospectively by one reader and retrospectively by two independent blinded readers. Diagnostic performance was determined on a per-patient basis by using surgical findings as the reference standard. In addition, the origin of APAs identified at both surgery and contrast-enhanced MR angiography was determined by consensus of two retrospective readers. Interreader agreements were assessed by using k statistics.
At surgery, 19 APAs (seven right apical, three left apical, four right lateral, and five left lateral) were detected in 16 patients, and 16 of these APAs were localized in 13 patients at preoperative contrast-enhanced MR angiography. Prospectively, sensitivity, specificity, and accuracy of contrast-enhanced MR angiography for the localization of APAs were 81.3%, 93.7%, and 92.1%, while retrospectively they were 87.5%, 91.9%, and 91.3% for reader 2 and 75.0%, 90.1%, and 88.2% for reader 3, respectively. Overall interreader agreement was substantial (k = 0.795). Nine and seven APAs originated from the obturator artery and the inferior vesical artery, respectively.
Contrast-enhanced MR angiography can be used for the preoperative detection of APAs in patients with prostate cancer.

0 0
 · 
1 Bookmark
 · 
171 Views
  • [show abstract] [hide abstract]
    ABSTRACT: Angiography of the ileopudendal vascular tree was performed for the evaluation of impotence in 73 patients. This technique proved useful in identifying those cases caused by vascular lesions in major arteries and small penile vessels. Organic diseases cause a much higher proportion of impotence than in generally suspected, with vascular occlusions causing the greatest number of cases. Nocturnal penile tumescence (NPT) studies are the best screening procedure in the author's view. In this series, NPT was followed by angiography, which provided the definitive diagnosis.
    Radiology 10/1982; 144(4):773-80. · 6.34 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B). Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed. Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury. We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.
    British Journal of Urology 02/1994; 73(1):75-82.
  • [show abstract] [hide abstract]
    ABSTRACT: The arterial supply to the penis remains unclear. The frequency of occurrence and functional significance of accessory pudendal arteries remains controversial and it has been suggested that the presence of variations is correlated with atheromatous disease involving internal pudendal arteries. We dissected pelvic and penile arteries in 20 adult fresh male cadavers. The results are expressed according to age and the presence of atherosclerosis. Three patterns of penile arterial supply can be described: type I arising exclusively from internal pudendal arteries (3/20), type II arising from both accessory and internal pudendal arteries (14/20) and type III arising exclusively from accessory pudendal arteries (3/20). This study emphasizes the findings previously reported by early anatomists. No correlation between the presence of accessory pudendal arteries and the extent of atheroclerosis was observed. Accordingly we postulate that these variations are usually congenital. Terminal branches of accessory pudendal arteries mainly supply the corpora cavernosa. As they are located very close to the prostate, the risk of injury is high during radical prostatectomy. The possibility of impotence from such injury after radical prostatectomy needs therefore to be reconsidered.
    Surgical and Radiologic Anatomy 02/1997; 19(3):161-7. · 1.13 Impact Factor

Full-text

View
0 Downloads
Available from