Deuk Jae Sung MD, Presenter: Nothing to Disclose

Shin Young Whang MD, Abstract Co-Author: Nothing to Disclose

Beom Jin Park MD, Abstract Co-Author: Nothing to Disclose

Min Ju Kim, Abstract Co-Author: Nothing to Disclose

Sung Bum Cho, Abstract Co-Author: Nothing to Disclose

Yun Hwan Kim MD,PhD, Abstract Co-Author: Nothing to Disclose

Kyoo Byung Chung MD, Abstract Co-Author: Nothing to Disclose

Jun Cheon, Abstract Co-Author: Nothing to Disclose

To evaluate the feasibility of contrast-enhanced magnetic resonance (MR) angiography in the preoperative detection of accessory pudendal arteries (APAs) in patients with prostate cancer.  

This combined prospective and retrospective study was institutional review board approved, and informed consent was obtained from all patients. Between July 2007 and December 2010, 127 patients underwent contrast-enhanced MR angiography following prostate MR imaging at 3.0 T before robot-assisted laparoscopic radical prostatectomy (RALP). APAs were defined as any arteries located in the periprostatic region and anastomosing with common penile artery or its branches, or internal pudendal artery and then subclassified into lateral and apical APAs. For the localization of APAs, MR angiograms were evaluated prospectively by one experienced reader and retrospectively by two independent blinded readers with different experience levels. Diagnostic performance was determined on a per-patient basis by using surgical findings as the reference. Additionally, the origin of APAs identified at both surgery and contrast-enhanced MR angiography was determined by consensus of two retrospective readers. Interreader agreement was assessed by using κ statistic.

At surgery, 19 APAs (right lateral, 4; left lateral, 5; right apical 7, left apical, 3) were detected in 16 patients, and 16 (84%) of these APAs had been localized at preoperative contrast-enhanced MR angiography in 13 patients. Sixteen APAs were preserved, and 13 of these APAs were depicted preoperatively. Prospectively, sensitivity, specificity, and accuracy of contrast-enhanced MR angiography for the localization of APAs were 81%, 94%, and 92%, respectively. Retrospectively, sensitivity, specificity, and accuracy were 88%, 92%, and 91% for reader 2 and 75%, 90%, and 88% for reader 3, respectively. Overall interreader agreement was substantial (κ = 0.770). Nine and seven APAs originated from obturator artery and inferior vesical artery, respectively.

Contrast-enhanced MR angiography can be useful for detecting APAs and could play a role in facilitating APA-sparing RALP for a possible favorable influence on postoperative erectile function.

Contrast-enhanced MR angiography can demonstrate APAs thought to be significant for the maintenance of postoperative erectile function and is recommended as part of preoperative prostate MR imaging.

Sung, D, Whang, S, Park, B, Kim, M, Cho, S, Kim, Y, Chung, K, Cheon, J, Usefulness of Contrast-enhanced MR Angiography for Preoperative Detection of Accessory Pudendal Arteries: A Combined Prospective and Retrospective Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006779.html