MRI Technique

Our mainstay for MR imaging of the penis is high resolution (matrix at least 256 x 192), small field of view, thin-slice (4 mm or less) T2-weighted spin echo sequences, without fat suppression, in orthogonal planes, using a surface coil. In addition, we usually perform T1 spin echo sequences in the axial plane. One of the strengths of MR imaging is the anatomical information it provides, and it helps if the imaging planes correspond accurately to those of the scanner. Taping the penis to the anterior abdominal wall in the midline, with padding if necessary, helps to achieve this, although others tape the penis in a dependent position because of breathing artifact.7

There is little evidence that contrast enhancement improves the performance of MRI for local staging,18 but in certain cases enhancement of the corpora cavernosa may be useful to differentiate intracavernosal tumor invasion. In practice we have found it difficult to define the vascular anatomy with contrast-enhanced scans as the vessels are fairly small: ultimately they are better seen as flow voids on T2-weighted sequences or areas of high signal on STIR. If contrast is given, we use intracavernosal prostaglandin and perform Tl-weighted fat saturated sequences before and at least 10 min after contrast. It can take some time for full opacification of the tumescent corpora cavernosa, a point that is particularly relevant for the imaging of priapism patients.8

Images of the pelvic nodes can be obtained by extending the axial scans into the pelvis, or performing a separate T1 or T2-weighted spin echo pelvic scan at slightly higher slice thickness (4-5 mm). The groin nodes are also well seen on the coronal images of the penis, and scanning in orthogonal planes is useful for estimating short axis diameter.

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