title: Pre-embolization evaluation of high-flow priapism: magnetic resonance angiography of the penis.
abstract: OBJECTIVE
  High-flow priapism is often a sequela of perineal trauma resulting in an arteriocavernosal fistula (ACF) between a cavernosal artery and lacunar spaces of the penis. We report our experience utilizing magnetic resonance angiography (MRA) in addition to color Doppler Sonography (CDS) in the workup and treatment planning of 4 patients with high-flow priapism.
  
  
  METHODS
  All patients had suspected high-flow priapism diagnosed by clinical exam and CDS and underwent MRA of the penis prior to sub-selective arterial embolization (SSAE) of the feeding vessel(s).
  
  
  RESULTS
  While CDS is valuable in diagnosing and lateralizing high-flow priapism, it does not provide clear anatomic delineation of the number and origin of feeding vessels. MRA provided demonstration of the fistula, demonstrated bilateral ACF supply in 2 patients, and afforded three-dimensional display of the feeding vessels which facilitated pre-embolization planning.
  
  
  CONCLUSIONS
  In all four cases, MRA was an effective tool for displaying arterial and venous anatomy, localizing the ACF, and planning subsequent SSAE. MRA influenced management in two out of 4 patients by demonstrating bilateral feeding vessels to their ACFs that required bilateral SSAE.
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, CA 90095, USA. carissamwhite@gmail.com
authors.forename: Carissa
authors.initials: C
authors.lastname: White
authors.forename: Mittul
authors.initials: M
authors.lastname: Gulati
authors.forename: Antoinette
authors.initials: A
authors.lastname: Gomes
authors.forename: Jacob
authors.initials: J
authors.lastname: Rajfer
authors.forename: Steven
authors.initials: S
authors.lastname: Raman
mesh_terms: D000293:Adolescent; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries; D010502:Perineum / Q000098:blood supply; D011317:Priapism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D012039:Regional Blood Flow; D012861:Skating / Q000293:injuries; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult