Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE
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To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones.
We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE.
Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p < 0.001 for all these volumes). Patients with clinical failure had smaller volume reductions for WPV, ML and CG (all p < 0.05). Patients with significant CG infarction after PAE displayed larger WPV, ML and CG volume reductions (all p < 0.01).
PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions.
• The MRI segmentation method provides detailed comparisons of prostate volume change.
• Prostatic arterial embolisation (PAE) decreased central gland and peripheral zone volumes.
• Prostates with infarction after PAE showed larger decreases in volume.
• A larger decrease in prostate volume is associated with clinical success.
KeywordsBenign prostatic hyperplasia Prostate Therapeutic embolisation Magnetic resonance imaging Anatomy, cross-sectional
Benign prostatic hyperplasia
Dynamic contrast - enhanced magnetic resonance imaging
International Index of erectile function
International prostate symptom score
Lower urinary tract symptoms
Magnetic resonance imaging
Prostatic arterial embolisation
Proximal embolization first then embolize distal
Post-voiding residual urine
Maximum urinary flow rate
Quality of life
Whole prostate volume
The scientific guarantor of this publication is Yen-Ting Lin, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Héléna Pereira kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. This study is a retrospective observational study performed at one single institute.
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