Magnetic Resonance Imaging Is Accurate to Detect Bleeding in the Seminal Vesicles in Patients With Hemospermia

ObjectiveTo confirm the presence of hemorrhage in the seminal vesicles by aspiration in patients with findings suspicious for hemorrhage on magnetic resonance imaging (MRI); and to investigate the relationship between findings on MRI and the freshness of hemorrhage.MethodsTwenty-six patients with hemospermia who showed high-intensity signals on T1-weighted images with or without low-intensity signals on T2-weighted images, suggesting seminal vesicle hemorrhage, were analyzed. Of the 26, 15 underwent transperineal aspiration of the seminal vesicles under transrectal ultrasound guidance to confirm the bleeding.ResultsBloody fluid was aspirated from all seminal vesicles showing a pattern suggestive of bleeding on MRI. The morphologic analysis of red blood cells in the fluid indicated relatively fresh hemorrhage in the seminal vesicles showing high-intensity signals on T1-weighted images and low-intensity signals on T2-weighted images (group A), but old hemorrhage in those showing high-intensity signal on T1-weighted images as well as T2-weighted images (group B). In 3 patients of group A who did not receive aspiration, repeated MRI during the follow-up showed that the signal intensity changed from low to high on T2-weighted images. On the other hand, in 2 patients of group B who received aspiration, repeated MRI performed 12 and 7 days after aspiration showed low signal intensity on T2-weighted images.ConclusionsHemorrhage is really present in the seminal vesicles if high signal intensity is observed on T1-weighted images. The patterns showing low and high signal intensities on T2-weighted images suggest relatively fresh and old bleeding, respectively.