Establishing the role of shear wave elastography in differentiating corporal rigidity between vasculogenic versus non-vasculogenic erectile dysfunction patients

Introduction: Shear wave elastography is a new modality for the evaluation of erectile dysfunction by assessing the stiffness of corpora cavernosal tissue. We evaluated the shear wave elastography values in erectile dysfunction participants and compared shear wave elastography values between vasculogenic and non-vasculogenic erectile dysfunction participants. Methods: Overall, 40 participants with clinically diagnosed erectile dysfunction filled out an abridged five-item version of the international index of erectile dysfunction-5 questionnaire and underwent shear wave elastography as well as pharmacologically induced penile erection test after intracavernosal papaverine injection. Shear wave elastography values were obtained serially at 5-minute interval at two locations: Central (cavernosal artery centered circular region) and Peripheral (near the tunica albuginea). Shear wave elastography values were compared with the erectile dysfunction subtypes. Results: Median international index of erectile dysfunction-5 score was 11 (interquartile range: 9–14). Median central shear wave elastography values were significantly lower in the erectile state as compared to flaccid state in both vasculogenic (8.27 kPa (interquartile range: 6.3–12.5) vs 23.27 kPa (interquartile range: 15.9–28.6) p = 0.000) and non-vasculogenic (5.50 kPa (interquartile range: 4.4–6.7) vs 23.85 kPa (interquartile range: 17.8–33.6) p = 0.000) erectile dysfunction participants. Vasculogenic erectile dysfunction participants had significantly higher central shear wave elastography value in erectile state than non-vasculogenic erectile dysfunction participants (8.27 kPa (interquartile range: 6.3–12.5) vs 5.50 kPa (interquartile range: 4.4–6.7) p = 0.001). Receiver operating characteristics curve analysis revealed that the cut-off value for central shear wave elastography was 5.65 kPa in erectile state with the sensitivity, and specificity for predicting vasculogenic erectile dysfunction being 90.9% and 61.1%, respectively (area under the curve −0.816; standard error of 0.071 ( p = 0.001)). Conclusion: Central cavernosal shear wave elastography is a good modality to objectively quantify the penile rigidity and can be used to distinguish the subtype of ED.