MiRNome and transcriptome aided pathway analysis in human regulatory T cells.

Owing to their manifold immune regulatory functions, regulatory T cells (Treg) have received tremendous interest as targets for therapeutic intervention of diverse immunological pathologies or cancer. Directed manipulation of Treg will only be achievable with extensive knowledge about the intrinsic programs that define their regulatory function. We simultaneously analyzed miR and mRNA transcript levels in resting and activated human Treg cells in comparison with non-regulatory conventional T cells (Tcon). Based on experimentally validated miR-target information, both transcript levels were integrated into a comprehensive pathway analysis. This strategy revealed characteristic signal transduction pathways involved in Treg biology such as T-cell receptor-, Toll-like receptor-, transforming growth factor-ß-, JAK/STAT (Janus kinase/signal transducers and activators of transcription)- and mammalian target of rapamycin signaling, and allowed for the prediction of specific pathway activities on the basis of miR and mRNA transcript levels in a probabilistic manner. These data encourage new concepts for targeted control of Treg cell effector functions.

Carrier-bound Alt a 1 peptides without allergenic activity for vaccination against Alternaria alternata allergy.

BACKGROUND: The mould Alternaria alternata is a major elicitor of allergic asthma. Diagnosis and specific immunotherapy (SIT) of Alternaria allergy are often limited by the insufficient quality of natural mould extracts. OBJECTIVE: To investigate whether recombinant Alt a 1 can be used for reliable diagnosis of Alternaria alternata allergy and to develop a safe, non-allergenic vaccine for SIT of Alternaria allergy. METHODS: The qualitative sensitization profile of 80 Alternaria-allergic patients from Austria and Italy was investigated using an allergen micro-array and the amount of Alternaria-specific IgE directed to rAlt a 1 was quantified by ImmunoCAP measurements. Peptides spanning regions of predicted high surface accessibility of Alt a 1 were synthesized and tested for IgE reactivity and allergenic activity, using sera and basophils from allergic patients. Carrier-bound peptides were studied for their ability to induce IgG antibodies in rabbits which recognize Alt a 1 and inhibit allergic patients' IgE reactivity to Alt a 1. RESULTS: rAlt a 1 allowed diagnosis of Alternaria allergy in all tested patients, bound the vast majority (i.e. >95%) of Alternaria-specific IgE and elicited basophil activation already at a concentration of 0.1 ng/mL. Four non-allergenic peptides were synthesized which, after coupling to the carrier protein keyhole limpet hemocyanin, induced Alt a 1-specific IgG and inhibited allergic patients' IgE binding to Alt a 1. CONCLUSIONS AND CLINICAL RELEVANCE: rAlt a 1 is a highly allergenic molecule allowing sensitive diagnosis of Alternaria allergy. Carrier-bound non-allergenic Alt a 1 peptides are candidates for safe SIT of Alternaria allergy.

Thyrotropin increases the iodine content of rat circulating thyroglobulin as measured by equilibrium density gradient centrifugation.

In previous work we demonstrated that circulating thyroglobulin contains very little or no iodine. We have now characterized circulating thyroglobulin following administration of thyrotropin (TSH) to determine whether its iodine content remains low or increases after stimulation. The iodine content of circulating thyroglobulin was estimated from its density determined by equilibrium density gradient (isopycnic) centrifugation. TSH stimulated thyroglobulin from 182 +/- 28 ng/ml to 571 +/- 83 ng/ml at 8-14 h. Circulating thyroglobulin in the basal state had a density consistent with very little or no iodine. Its density increased following TSH to a maximum at 8-14 h which was nearly the same as the density of thyroglobulin extracted directly from the thyroid. To determine whether selective peripheral metabolism, based on the degree of iodination, could account for the density shift, purified rat thyroid thyroglobulin was injected into thyroidectomized rats. The density of thyroglobulin remained unchanged for 25 h during which time it was metabolized by more than 97%. Therefore, selective metabolism of thyroglobulin based on iodine content did not occur. We conclude that TSH causes a marked increase in the iodine content of circulating thyroglobulin. It is most likely that in the basal state circulating thyroglobulin comes from selective release of poorly iodinated molecules, while after TSH, it comes from release of previously synthesized, iodinated and stored molecules.

Echocardiographic correlates of survival in patients with chest pain.

OBJECTIVES: This study sought to identify echocardiographic predictors of survival in patients with chest pain and to assess the utility of qualitative echocardiographic data in the prognostic stratification of this cohort. BACKGROUND: The potential usefulness of echocardiographic data in prognostic stratification of patients with acute chest pain is unclear, in part because of the qualitative nature of routinely available echocardiographic readings. METHODS: The study group comprised 513 patients who underwent transthoracic two-dimensional and Doppler echocardiography within 1 month of emergency department visits for acute chest pain. Clinical and electrocardiographic (ECG) data were recorded for these patients at the time of their initial evaluations, and echocardiographic data were subsequently obtained from the official hospital reports. Follow-up survival rate data were obtained from medical records or the Massachusetts Bureau of Vital Statistics. RESULTS: A mean of 28.5 months after the index visit, 102 patients (20%) had died, including 58 (57%) for whom the primary cause of death was cardiovascular. In analysis of routinely available qualitative echocardiographic data, left ventricular size and function, the presence of regional wall motion abnormalities, mitral regurgitation and structural abnormalities of the mitral valve were significant univariate correlates of both overall mortality and death from cardiovascular causes. Severe left ventricular dysfunction (adjusted rate ratio 3.8, 95% confidence interval [CI] 1.9-7.5) and moderate or severe mitral regurgitation (adjusted rate ratio 2.4, 95% CI 1.5-3.7) were independent predictors of mortality in a multivariate Cox regression analysis that adjusted for clinical and ECG variables. Moderate or severe left ventricular dysfunction and mitral regurgitation were predictors of mortality in the subset of patients without acute myocardial infarction. CONCLUSIONS: Qualitative echocardiographic reports of left ventricular dysfunction and mitral regurgitation were independent correlates of prognosis in patients with acute chest pain, including patients without acute myocardial infarction. Further data are needed to assess the generalizability of these findings and the implications for use of this diagnostic technology.

Biosynthesis of a novel thyroxine-binding protein (27K protein) in human hepatoma (Hep G2) cells.

Human hepatoma (Hep G2) cells were shown to synthesize and secrete a novel T4-binding protein, called 27K protein for its apparent mol wt on sodium dodecyl sulfatepolyacrylamide gel electrophoresis. The mRNA coding for this protein was characterized by immunoprecipitation of [125I]T4 bound to 27K protein secreted into the medium of oocytes injected with total Hep G2 RNA. Sucrose gradient fractionation of RNA from Hep G2 cells showed that TBG mRNA and 27K mRNA had different sizes, indicating that TBG and 27K protein are two distinct proteins. In vitro translation of RNA in a rabbit reticulocyte lysate demonstrated that the translation product immunoprecipitated by anti-27K serum had the same mol wt as the immunoprecipitated protein from whole cells labeled with [35S]methionine, thus suggesting that 27K protein is neither derived from TBG nor synthesized through a larger mol wt precursor, and also that it does not contain carbohydrates. The absence of carbohydrates was further supported by the observation that [3H]mannose was not covalently bound to the 27K protein when Hep G2 cells were labeled with [3H]mannose, nor was there a shift in apparent mol wt when the cells were treated with the glycosylation inhibitor tunicamycin. The kinetics of secretion of 27K protein were similar to those of albumin and faster than those of TBG, which is also in keeping with the nonglycoprotein nature of 27K protein.

Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease.

PURPOSE: Patients with diabetes and acute chest pain may be admitted to hospitals more frequently than patients without diabetes because physicians suspect atypical presentations for ischemic heart disease. This study aimed to determine whether the presentation of acute myocardial infarction and risk for major cardiac complications differs among patients without known coronary artery disease who do or do not have diabetes. PATIENTS AND METHODS: Data from an emergency department of an urban teaching hospital on the medical histories, physical examinations, and electrocardiograms of 2,694 subjects with acute chest pain and without known coronary artery disease were prospectively recorded. RESULTS: Diabetes was present in 301 (11%) patients. Compared with patients without diabetes, patients with diabetes were more likely to be < or = 60 years old (51% versus 20%) and to have a history of hypertension (70% versus 35%) or high blood cholesterol (35% versus 19%). A discharge diagnosis of acute myocardial infarction was made in 25 diabetic (8%) and in 148 nondiabetic (6%; P = 0.16) patients. A major cardiac complication occurred in two patients with diabetes (0.7%) and in 20 patients without diabetes (0.8%; P = 1.0). Patients with and without diabetes who had atypical chest pain complaints had similar rates of myocardial infarction (3% and 4%, respectively; P = 0.6). Patients with diabetes were more likely to be hospitalized (67% versus 47%; P = 0.001) both before and after adjusting for clinical and electrocardiographic data. CONCLUSIONS: For patients with acute chest pain without a prior history of coronary artery disease, diabetes was not associated with a higher rate of acute myocardial infarction or complications. However, diabetes was associated with a higher rate of hospitalization in this population, suggesting that physicians have a lower threshold for admission to the hospital of patients with diabetes.

Echocardiographic prediction of complications in patients with chest pain.

The optimal role of Doppler echocardiography in the evaluation of patients with acute chest pain syndromes is unclear. We prospectively studied a cohort of 466 patients admitted with acute chest pain syndromes to clarify the relation between echocardiographic data and the risk of serious predischarge complications, and to determine if echocardiographic data can provide incremental prognostic information beyond clinical and electrocardiographic variables. Doppler echocardiograms, performed an average of 21 hours after presentation, were independently analyzed by 2 echocardiographers for information on global left and right ventricular function and valvular disease. Regional function was assessed by a wall motion index (WMI). A composite complications end point was positive if significant recurrent myocardial ischemia, heart failure, or arrhythmia developed after the echocardiogram. In univariate analysis, left (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.6, 5.1) and right (OR 2.7, 95% CI 1.2, 6.2) ventricular function, left ventricular end-diastolic (OR 1.6/cm, 95% CI 1.1, 2.3) and end-systolic (OR 1.4/cm, 95% CI 1.1, 1.9) dimensions, and WMI (OR 3.0, 95% CI 1.8, 4.8) predicted complications that developed after the echocardiogram. In multivariate analysis, WMI remained an incremental predictor of risk with an OR of 2.2/unit (95% CI 1.2, 3.9) scaled from 1 to 4. Even in the subset of 403 patients without acute myocardial infarction, WMI was associated with an OR of 1.9 (95% CI 1.0, 3.7). We conclude that early echocardiography provides incremental prognostic information concerning risk of subsequent complications in patients hospitalized with chest pain.

Impact of valvular regurgitation and ventricular dysfunction on long-term survival in patients with chest pain.

Doppler echocardiography is often used in evaluating patients with chest pain, but information on prognostic value of this testing and data to help guide selective use are limited. We prospectively studied 448 patients admitted from the emergency department for acute chest pain to assess the utility of qualitative echocardiographic data in predicting long-term survival and the incremental value of this information over routine clinical and electrocardiographic data. Doppler echocardiograms, recorded an average of 21 hours after presentation, were analyzed independently by 2 echocardiographers for global left and right ventricular function and valvular disease. Regional function was assessed by wall motion index. Data on long-term survival were collected with an average follow-up of 35.0 +/- 12.1 months. In univariate Cox regression analysis, left ventricular function and size, wall motion index, right ventricular function, and aortic, mitral, and tricuspid insufficiency were significant predictors of total and cardiovascular mortality. In multivariate analysis, moderate or severe left ventricular dysfunction (mortality rate ratio 3.2, 95% confidence intervals 1.8 to 5.8] and more than mild valvular regurgitation (mortality rate ratio 2.0, 95% confidence interval 1.1 to 3.6) were independent predictors of mortality in a model adjusted for clinical and electrocardiographic data. These factors were more common in patients aged >60 years, in those with prior acute myocardial infarction or angina, and in those with rales on physical examination. In the absence of these clinical characteristics, only 8 of 124 patients (7%) had moderate or severe left ventricular dysfunction or valvular regurgitation. In patients with moderate or severe regurgitation, a murmur was noted on the admission physical examination in 41 of 69 cases (59%). We conclude that echocardiographic evidence of moderate or severe left ventricular dysfunction or valvular regurgitation identifies a high-risk group for overall and cardiovascular mortality in patients with chest pain, and this evidence may not be detected clinically.

Aortic flow velocity patterns in chronic aortic regurgitation: implications for Doppler echocardiography.

Aortic regurgitation is associated with retrograde diastolic flow in the aorta. Echocardiographic quantitative analysis of the magnitude of the flow reversal is believed to provide an estimate of severity of regurgitant disease despite variations in flow profiles. The purpose of this study was to evaluate the uniformity of flow patterns in the aorta of patients with aortic regurgitation and to investigate the relationship between these profiles and the echocardiographic estimates of flow reversal. Seventeen patients with chronic aortic regurgitation underwent cine-phase magnetic resonance imaging in an axial section through the ascending and descending aorta. The regurgitant fraction in the ascending aorta 4 cm above the aortic valve and the descending aorta were calculated from the velocity maps. These results were compared with data from nine individual sample volumes in the ascending and descending aorta. The magnetic resonance ascending aortic regurgitant fraction was compared with Doppler echocardiographic descending aortic flow velocity patterns. The descending aortic regurgitant fraction correlated only weakly with the ascending aortic regurgitant fraction (descending aortic regurgitant fraction = 0.62% ascending aortic regurgitant fraction + 0.04%; r = 0.75; p < 0.001). Regurgitant proportions in all sample volumes in the descending aorta, but not in the ascending aorta, were significantly related to the ascending aortic regurgitant fraction. The best descending aortic Doppler echocardiographic parameter for predicting ascending aortic regurgitant fraction was the end-diastolic velocity (end-diastolic velocity = 32.2 cm/sec. ascending aortic regurgitant fraction + 1.4 cm/sec; r = 0.94; p < 0.001). Pulsedwave Doppler sampling of descending aortic flow reflects severity of aortic regurgitant disease, in part the result of more uniform blood-velocity profiles in the descending aorta compared with the ascending aorta. The Doppler end-diastolic velocity in the descending aorta is a useful parameter of severity of aortic regurgitation.

Cefodizime, an aminothiazolylcephalosporin. V. Synthesis and structure-activity relationships in the cefodizime series.

The synthesis as well as in vitro antibacterial activity and pharmacokinetic behavior of cefodizime (HR 221, 1a), its analogs and derivatives is described. In this comparison, cefodizime stands out for its balance between its high antibacterial activity, prolonged elimination half-life and high AUC in mice and dogs.

Synthesis and structure-activity relationships in the cefpirome series. II. Analogues of cefpirome with different 7-heteroarylacetamido and 3'-ammonium substituents.

The synthesis and antibacterial activity in vitro of 7-(2-heteroarylacetamido)-3-[(2,3- cyclopentenopyridinium)methyl]cephalosporins and of some related compounds with different ammonium functions in 3'-position are described. The 7-[5-amino-1,2,4-thiadiazol-3-yl] and the 7-[4-aminopyrimidin-2-yl] analogues of cefpirome and compounds with 3-aliphatic ammoniummethyl functions have excellent antibacterial activity. Cephalosporins with different N-heterocycles other than pyridine in 3'-position are less active than their 3-pyridiniummethyl analogues. Attachment of a pyridinium group to a cephem at C-3 via a thiomethyl or an aminomethyl bridge causes reduction of antibacterial activity.

Synthesis and structure-activity relationships in the cefpirome series. I. 7-[2-(2-Aminothiazol-4-yl)-2-(Z)-oxyiminoacetamido]-3-[(su bstituted-1-pyridinio)methyl]ceph-3-em-4-carboxylate s.

7-[2-(2-Aminothiazol-4-yl)-2-(Z)-oxyiminoacetamido]-3-[(s ubs tituted-1-pyridinio)methyl]ceph-3-em-4-carboxylates II are a group of beta-lactam antibiotics with extraordinary high antibacterial activity. The promising member of this group, cefpirome (HR 810, II-1) is a candidate for clinical use. Synthetic pathways to II starting from cefotaxime derivatives I or 7-aminocephalosporanic acid (7-ACA) are described. A preferred method for the conversion of I to II or 7-ACA to precursors III respectively employs iodotrimethylsilane and an excess of the pyridine base. Structure-activity studies reveal an optimum overall activity in the series of pyridines with fused saturated and unsaturated rings or cyclopropyl- and alkoxy substituents. Favorable oxyimino substituents are methyl, ethyl, difluoromethyl and carbamoylmethyl groups. Acidic substituents lead to decreased activity against Staphylococcus aureus SG 511. Introduction of halogen in the thiazole nucleus causes improvement of activity against the K1 beta-lactamase producing Klebsiella aerogenes 1082 E strain.

Noninvasive cardiac testing in the geriatric patient.

The use and interpretation of noninvasive cardiac testing in the elderly may differ from that in younger patients due to changes in disease prevalence, normal values, comorbidities, or patient and physician preferences. This paper reviews the experience with several commonly used noninvasive tests such as electrocardiography, exercise testing, and stress imaging with echocardiography or with scintigraphy in geriatric patients. Most commonly used noninvasive tests remain feasible and safe. Data suggest that exercise stress testing is feasible in many elderly patients with a good safety profile and should be considered as a first-line test due to the extra information provided by the duration and hemodynamic response to exercise. Adjunctive imaging may be particularly helpful when the electrocardiogram is uninterpretable or suspect due to underlying baseline abnormalities or when determining the extent or distribution of ischemia is felt to be important.

[Presentation of the distal border-line in TUR resection of the prostate (author's transl)]. / Darstellung der distalen Resektionsgrenze bei der transurethralen Resektion der Prostata

A method is described by which TUR of the prostate safely can be performed without endangering the external sphincter. A fold proximal to the external sphincter can be induced by digital pressure in the rectum determinating the distal borderline of the resection.

[Pain relief by percutaneous cervical cordotomy in urological patients (author's transl)]. / Schmerzausschaltung durch perkutane zervikale chordotomie bei urologischen Patienten

Percutaneous cervical cordotomy is excellent for extended elimination of pain, also in urological cases. A report of four cases is presented.

Noninvasive imaging for the diagnosis of coronary artery disease: focusing the development of new diagnostic technology.

BACKGROUND: New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease. OBJECTIVE: To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests. DESIGN: Decision model and cost-effectiveness analysis. DATA SOURCES: Literature review and meta-analysis. TARGET POPULATION: 55-year-old men and 65-year-old women presenting with chest pain. TIME HORIZON: Lifetime of the patient. PERSPECTIVE: Health care policy. INTERVENTIONS: MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography. OUTCOME MEASURES: Target sensitivity and specificity values for a new noninvasive test. RESULTS OF BASE-CASE ANALYSIS: Assuming that society is willing to pay $75000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective. RESULTS OF SENSITIVITY ANALYSIS: Assuming that society is willing to pay $50000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%. CONCLUSIONS: New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology.

Cost-effectiveness of diagnostic strategies for patients with chest pain.

BACKGROUND: Many noninvasive tests exist to determine whether patients should undergo coronary angiography. The routine use of coronary angiography without previous noninvasive testing is typically not advocated. OBJECTIVE: To determine the cost-effectiveness of diagnostic strategies for patients with chest pain. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published data. TARGET POPULATION: Patients who present with chest pain, have no history of myocardial infarction, and are able to perform an exercise stress test. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: No testing, exercise electrocardiography, exercise echocardiography, exercise single-photon emission computed tomography (SPECT), and coronary angiography alone. OUTCOME MEASURES: Quality-adjusted life expectancy, lifetime cost, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: The incremental cost-effectiveness ratio of routine coronary angiography compared with exercise echocardiography was $36,400 per quality-adjusted life-year (QALY) saved for 55-year-old men with typical angina. For 55-year-old men with atypical angina, exercise echocardiography compared with exercise electrocardiography cost $41,900 per QALY saved. If adequate exercise echocardiography was not available, exercise SPECT cost $54,800 per QALY saved compared with exercise electrocardiography for these patients. For 55-year-old men with nonspecific chest pain, the incremental cost-effectiveness ratio of exercise electrocardiography compared with no testing was $57,700 per QALY saved. RESULTS OF SENSITIVITY ANALYSIS: On the basis of a probabilistic sensitivity analysis, there is a 75% chance that exercise echocardiography costs less than $50,900 per QALY saved for 55-year-old men with atypical angina. CONCLUSIONS: Exercise electrocardiography or exercise echocardiography resulted in reasonable cost-effectiveness ratios for patients at mild to moderate risk for coronary artery disease in terms of age, sex, and type of chest pain. Coronary angiography without previous noninvasive testing resulted in reasonable cost-effectiveness ratios for patients with a high pretest probability of coronary artery disease.

Brucellosis: serological methods compared.

At least 12 persons contracted clinical, and 4 persons subclinical Brucella melitensis infection during a brucellosis epidemic in the spring and summer of 1983 in Southern Germany, a region which had been free of this disease for the past 20 years. All cases of illness were traced to one infected herd of sheep. The presence of antibodies against B. melitensis was examined in 72 sera of infected patients using the following tests: agglutination, Coomb's test, two complement fixation tests with different antigen preparations (CFT 1 and 2), IgG and IgM enzyme-linked immunosorbent assay (ELISA), and opsonophagocytosis; and the occurrence of cross-reacting antibodies against Yersinia enterocolitica O 9 was investigated in the agglutination and complement fixation tests. Sera from 100 blood donors and 112 other people with close contact with sheep were also examined. The results revealed the need to consider an intermediate range in the interpretation of ELISA results--due to elevated values of persons in groups at risk but without clinical signs of illness. In all other tests, however, such persons revealed the same cut-off levels as the general population. Results from all initial sera of infected persons revealed titres of optical densities above the baseline levels determined in the present study, with the exception of the Coomb's and CFT2 tests. The agglutination test, but not brucella CFT2, revealed complete cross-reactivity between Y. enterocolitica O 9 and B. melitensis. ELISA stood out as the only test which is suited to diagnosis of both recent and past infection, since ELISA IgM determination permits conclusions about the time of the onset of illness, and determination of IgG may still yield values above the cut-off level up to 623 days after the onset of illness. In 2 of the 16 infected persons, IgG ELISA was the only test revealing previous infection 424 and 528 days after the onset of illness. A procedural scheme is presented which may help to simplify the diagnosis of brucellosis.

Gadolinium-enhanced magnetic resonance angiography of the pelvis in patients with erectile impotence.

This study evaluated the potential of contrast-enhanced digital-subtraction magnetic resonance angiography (CE-DS-MRA) for noninvasive angiographic delineation of the arterial supply of the penis in patients with erectile dysfunction. After induction of an erection with prostaglandin E, a three-dimensional fast imaging with steady-state precision (FISP) sequence with TE of 1.8-2 milliseconds, TR of 4.4-5 milliseconds, and flip angle of 40 degrees-60 degrees was used to obtain high-resolution angiograms of the pelvis and penis during the injection of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) 0.3 mmol/kg body weight, within 30-50 seconds. DS maximum intensity projections (MIPs) and multiplanar reconstructions (MPRs) were compared with clinical work-up and directional Doppler ultrasound in 11 patients. In all 11 patients (100%), the arterial supply of the penis could be delineated from the aortic bifurcation via the iliac and internal pudendal arteries to the dorsal and deep penile arteries. Of the 22 internal pudendal arteries, 6 (27%) were occluded on CE-DS-MRA and 5 (23%) had stenoses, of which 4 (18%) were greater than 50%. In 7 patients (64%) good correlation between CE-DS-MRA and clinical findings and/or Doppler ultrasound was found; in 2 patients (18%), the correlation was moderate, and in 2 patients (18%) results were discrepant. In 6 patients (55%), MRA provided additional information to the clinical and Doppler ultrasound work-up. CE-DS-MRA can delineate small vessels such as the internal pudendal and penile arteries and thus has the potential to become a noninvasive angiography method in the work-up of erectile impotence.