MR imaging of acute penile fracture

Penile fracture is a rare but serious urologic condition that typically requires surgical repair. Because of its multiplanar capability and excellent tissue contrast, magnetic resonance (MR) imaging can be a useful diagnostic tool in the evaluation of patients with acute penile fracture. MR imaging can accurately depict the presence, location, and extent of tunical tear, which manifests as discontinuity of the tunica albuginea. Moreover, because the tunica albuginea is well demonstrated as a low-signal-intensity structure on both T1- and T2-weighted images, MR imaging is optimal for the evaluation of the integrity of this anatomic structure even in patients with severe pain and swelling of the penis. This capability makes MR imaging particularly helpful in determining the need for surgical intervention, which is largely based on the integrity of the tunica albuginea. Associated injuries to adjacent structures (eg, corpus spongiosum, urethra) can also be demonstrated. In patients with no penile fracture, MR imaging can demonstrate an intact tunica albuginea and the presence of intracavernosal or extra-tunical hematoma. It remains uncertain whether the routine use of contrast material-enhanced MR imaging is justified, and further study is needed to determine the role of this modality.