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Volume : 40 Issue : 4 Year : 2021
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pelviperineology. 2019; 38(2): 35-41 | DOI: 10.34057/PPj.2019.38.02.002

Identification of peri-prostatic neurovascular fibers before and after radical prostatectomy by means of diffusion tensor imaging (DTI) with clinical correlations: initial experience

SALVATORE SIRACUSANO1, ANTONIO B. PORCARO1, ALESSANDRO TAFURI1, RENATO TALAMINI2, ADAM J. CYBULSKI3
1Department of Urology, AOUI Verona, University of Verona, Verona (VR), Italy, 2Epidemiology Unit CRO Aviano, Italy, 3Department of Radiology, AOUI Verona, University of Verona, Verona (VR), Italy

Aim: :To evaluate if Diffusion Tensor Imaging (DTI) is able to detect morphological changes of peri-prostatic neurovascular fibers (PNF) before and after robot-assisted radical prostatectomy (RARP) and if these changes are related to urinary incontinence (UI) and erectile dysfunction (ED).
Materials and methods: :From October 2014 and August 2017 26 patients with biopsy-proven prostate cancer underwent prostatic multi-parametric magnetic resonance imaging (mp-MRI) including DTI sequencing before and six months after, RARP. Images were analyzed by placing six regions of interest (ROI) respectively at the base, mid-gland and apex, one for each side, to obtain tractography reconstruction of the PNF. Patients were asked to complete an International Consultation Incontinence Questionnaire – Short Form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires before RARP and 6 months postoperatively. Fractional anisotropy (FA), number (N) and length (L) of PNF before and after RARP were compared by means of Student’s t-test; Spearman test was used to evaluate the correlation between DTI parameters and questionnaires scores. We observed a significant difference in N values before and after RARP (p<0.001) and a negative correlation between IIEF-5 score and post-operative FA values at both the right (rho=-0.42; p= 0.0456) and left (rho=-0.66; p=0.0006) base of the prostate. DTI with tractography of PNF is able to detect quantitative changes in N, L and FA values in PNF after RARP. In particular we observed an inverse correlation between FA of PNF and ED at 6 months after RARP. Further investigations are needed to confirm this trend.


Cite This Article

SIRACUSANO S, PORCARO A, TAFURI A, TALAMINI R, CYBULSKI A. Identification of peri-prostatic neurovascular fibers before and after radical prostatectomy by means of diffusion tensor imaging (DTI) with clinical correlations: initial experience. 2019; 38(2): 35-41

Corresponding Author: SIRACUSANO S.

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