Imaging modalities in Peyronie's disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients

Peyronie's disease is an ill-understood condition afflicting men in their 40s with the reported age ranging from 18 to 68 years. It is characterized by a plaque in the tunica albuginea which leads to penile deformity making sexual intercourse difficult if not impossible and is often accompanied by severe pain upon erection in the early stage; erectile dysfunction is present in about 2% of cases. Diagnosis rests upon medical history, clinical examination with plaque palpation and autophotography in two planes. These diagnostic steps are not plaque-specific and therefore we wanted to assess which imaging modalities would allow for an objective determination of the plaque status.We evaluated 20 patients with Peyronie's disease. All patients underwent clinical examination including autophotography and the subsequent use of the following imaging techniques: (1) ultrasound (US) using a 7.5-MHz transducer with a profile for semiquantitative density analysis; (2) X-ray in mammography technique in two planes; (3) computerized tomography (CT) with a density profile, and (4) magnetic resonance imaging (NMR).(1) Degree of deviation: Penile deviation ranged from 15 degrees to 63 degrees. It was best assessed using radiography in mammography technique reflecting the results obtained by autophotography. (2) Calcifications: Plaque calcifications were seen in 12 patients, 8 had no calcifications but thickening of the tunica albuginea only, 2 also had a fibrosis of the corpus cavernosum distant to the plaque. Calcifications were visualized using ultrasound sonography (12/12), radiographically (12/12), CT (12/12), NMR (9/12). Thickening of the tunica albuginea only was visualized using ultrasound sonography (7/8), radiographically (0/8), CT (2/8), NMR (6/8). (3) Morphological pattern in ultrasound: Three distinct patterns could be detected: (type 1) the plaque appeared as a thickening of the tunica albuginea without acoustic shadowing and only minimal density increase in the histogram profile; (type 2) moderately calcified plaque with typical ultrasound shadow but minimal density increase in the density profile; (type 3) severely calcified plaque with typical acoustic shadowing and density increase in the histogram profile. (4) Plaque inflammation: Only NMR with gadolinium DTPA showed periplaque inflammation.High-resolution ultrasound sonography is the best imaging modality in assessment of plaques. NMR is the modality of choice to monitor the inflamed plaque. X-ray in mammography technique and CT are not necessary in daily routine.