Role of MRI in assessment of ejaculatory duct obstruction

This study aims to analyze magnetic resonance imaging (MRI) features of ejaculatory duct obstruction, and to provide an accurate diagnostic imaging approach for surgical planning of minimally invasive procedures treating ejaculatory duct obstruction. A total of 18 men with ejaculatory duct obstruction were enrolled in the study. The patients were admitted to our hospital and had undergone MRI examination and surgical treatment from January 2003 to February 2011. The data was collected by searching keywords ('ejaculatory duct obstruction') from our PACS. Patients suspected having ejaculatory duct obstruction according to the manifestations through MRI examinations and further being confirmed by surgery were included. The MRI features of ejaculatory duct obstruction in these patients were summarized. Five cases with ejaculatory duct cysts were detected by MRI, ranging in size from 4 mm × 4 mm × 7 mm to 4 mm × 4 mm × 9 mm and located in the paramedian line; ejaculatory duct dilation near the median line, with the internal diameter ranging from 5 mm to 30 mm was detected in nine cases; and among thirteen cases who underwent both non-contrast enhanced and contrast enhanced MRI scanning, significant enhancement of the wall of the ejaculatory duct on enhanced scanning was observed in three cases. Mullerian duct cysts complicated with dilation of the ejaculatory duct and seminal vesicles were detected in four cases; in these cases, the cysts were located in the median line, ranging in size from 4 mm × 5 mm × 6 mm to 34 mm × 35 mm × 44 mm, tear-drop appearance, with the tip pointing toward the area of the seminal colliculus. Findings of MRI were confirmed by the observations during the surgery. MRI is more accurate at displaying the ejaculatory duct. We recommend that ejaculatory duct diameter of > 2 mm can be used as a diagnostic criterion with MRI image analyses for ejaculatory duct dilation.