Virtual cavernoscopy: a novel diagnostic tool for use in the corpus cavernosal lumen in patients with erectile dysfunction

• Published in: BJU international 2011-10, Vol.108 (8), p.1316-1320
• Main Authors: Izumi, Kazuyoshi, Kawanishi, Yasuo, Muguruma, Hiroshi, Kusuhara, Yoshihito, Komori, Masatsugu, Yamanaka, Masahito, Yamamoto, Akira, Numata, Akira, Kishimoto, Tomoteru, Kanayama, Hiro‐omi
• Format: Article
• Language: English
• Subjects: 3D‐CT cavernosography; Adolescent; Adult; Aged; Angiography - methods; Arteries; Biological and medical sciences; CT angiography; DICC; Erectile Dysfunction - diagnostic imaging; Gynecology. Andrology. Obstetrics; Humans; Imaging, Three-Dimensional - methods; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Non tumoral diseases; Penis - blood supply; Penis - diagnostic imaging; Tomography, X-Ray Computed - methods; User-Computer Interface; virtual cavernoscopy; virtual endoscopy; Young Adult
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.10003.x

Study Type – Diagnostic (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? In visualizing the artery in patients with ED, digital subtraction angiography, CT angiography and color Doppler ultrasonography has been performed. There were difficulties with the previous methods in visualizing the stenotic lesion, or parts beyond the obstruction of the artery. Virtual cavernoscopy can visualize an artery independently of blood flow. We therefore believe that this new imaging technology will contribute to better ED practice. OBJECTIVE • To evaluate virtual cavernoscopy as a diagnostic tool in erectile dysfunction. PATIENTS AND METHODS • Forty patients who visited our hospital for investigation of erectile dysfunction underwent cavernosography using three‐dimensional (3D)‐computed tomography (CT). • Virtual cavernoscopic images were reconstructed from 3D‐CT data. RESULTS • Virtual cavernoscopic images were obtained from all patients. • Virtual cavernoscopy visualized the corpus cavernosal lumen surrounded by the tunica albuginea, the septum of the cavernosum, the outlets of the veins, and cavernous arteries. • The visualization of each structure depended on the window level (WL). At WL 400, the virtual cavernoscopy visualized only a fibrous structure. At this WL, the internal view of the corpus cavernosum was expressed as a hollow space. At WL 1600, the virtual cavernoscopy visualized the cavernous artery as a filling defect. • Out of 80 lumens in the 40 subjects, arteries in 14 lumens were detected by both virtual cavernoscopy and CT angiography, while arteries in 50 lumens were detected only by virtual cavernoscopy. Arteries in two lumens could not be visualized by either method and those in 14 lumens were visualized only by CT angiography. CONCLUSION • In visualizing the artery, conventional imaging techniques depend on blood flow, whereas using virtual cavernoscopy an artery can be visualized independently of blood flow. Virtual cavernoscopy is unique in this regard and we therefore believe that this new imaging technology will contribute to better ED practice.