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Updated: Jun 14, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
A novel non-invasive diagnostic marker for arterial erectile dysfunction: cavernosal artery ondulation index measured
Göksel Tuzcu1, Erhan Ateş2, Ali Alkaşi1
1Department of Radiology, Aydın Adnan Menderes University, Faculty of Medicine, Aydın, Turkey.
Background:
Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS).
Aim:
To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED.
Methods:
This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance.
Outcomes:
The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI.
Results:
Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5 years, P < .001) and had a higher prevalence of diabetes mellitus (P < .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P < .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI.
Clinical Implications:
Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection.
Strengths And Limitations:
The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard.
Conclusion:
CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.
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