Introduction
Although ultrasonography (US) has been the pri-mary modality for cross-sectional imaging of thepenis, the superior soft-tissue contrast and spatialresolution afforded by magnetic resonance (MR)imaging provide an opportunity to advance imag-ing evaluation of this organ. Clinical questionsthat remain unresolved after US examination canoften be answered with penile MR imaging.This article reviews the anatomy of the penis asshown with surface-coil MR imaging performedat 1.5 T. Strategies for optimal MR imaging of the penis are discussed, including organ and sur-face coil positioning, pulse sequence selection,vasodilator injection, and gadolinium administra-tion. Among the conditions presented are primaryand metastatic penile malignancies, periurethralabscess, venous thrombosis, Peyronie disease,and penile fracture. The MR imaging appearanceof the postsurgical penis and of penile prosthesesis also demonstrated.
Anatomy and Physiology
The penis is composed of three cylindrical bodiesofendothelium-linedcavernousspaces:thepaireddorsolateral corpora cavernosa, and the single,ventral, and midline corpus spongiosum (Fig 1).The variable MR signal intensity of thesestructures is dependent on the rate of blood flowwithin the cavernous spaces that constitute thecorporal bodies. In general, the three corpora areof intermediate T1-weighted and high T2-weighted signal intensity. The corpora cavernosaare isointense relative to one another, as they areconnected via fenestrations in their septum andtherefore have similar flow. The corpus spongio-sum is a separate space and may normally haveflow and signal intensity characteristics differentfrom those of the cavernosa. The posterior por-tions of the corpora cavernosa are known as thecrura, which flare laterally to attach to the ischio-pubic rami. The corpus spongiosum arises withinthe perineum from the bulbous spongiosum andextendsanteriorlytoformtheglanspenis(Fig2a).
Figure 2.
Normal penile anatomy in a 20-year-old man.
(a)
Axial T2-weighted MR image shows the normal at-tachment of the posterior aspects of the corpora cavernosa, the crura (curved arrows), and to the ischial rami (thinarrows). At T2-weighted imaging, signal intensity in the penile bulb (open straight arrow), which is the base of thecorpus spongiosum, is different from that in the corpora cavernosa (thick solid arrows). This finding is normal.
(b)
Axial T2-weighted image (5,000/96 [repetition time msec/echo time msec]) shows the paired corpora cavernosasurrounded by the Buck fascia and the tunica albuginea, which at MR imaging appear as a single hypointense borderto the cavernosa (small straight black arrow). The central arteries of the corpora cavernosa (large curved black ar-rows) and the septum (thin arrow) that divides the corpora cavernosa are also seen. The flattened, nondistended ure-thra is seen within the unpaired ventral corpus spongiosum (small curved black arrow). The hypointense tunica dar-tos (straight white solid arrow) is present, just deep to the skin. Midline within the connective tissue, deep to the tu-nica dartos, lies the dorsal vein of the penis (curved white arrow). The epidermis is hyperintense relative to the dartosat T2 weighting and is the most external layer (open arrow).
(c)
T1-weighted MR image (433/10) provides less ana-tomic detail than does the corresponding T2-weighted image. The corpus spongiosum is surrounded by a thin, hy-pointense layer of tunica albuginea (white arrow). The tunica albuginea is thicker around the corpora cavernosa(black arrow), where it is fused with the Buck fascia.
(d)
Parasagittal T2-weighted image (3,500/96) obtained afterintracavernosal injection of prostaglandin E
1
shows normal high signal intensity within the corpus cavernosum(curved arrow) and corpus spongiosum (open arrow) surrounded by the low-signal-intensity tunica albuginea (blackarrows). The penis has been dorsiflexed and taped against the lower abdomen.
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Figure 1. (a)
Axial illustration of penile anatomy.
(b)
Sagittal illustration of penile anatomy. (Fig 1a and 1b cour-tesy of Frank M. Corl, MS, Johns Hopkins Medical Institutions, Baltimore, Md.)
S284 October 2001
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Volume 21
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Special Issue
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