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European Radiology

, Volume 26, Issue 10, pp 3466–3473 | Cite as

Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE

  • Yen-Ting LinEmail author
  • Grégory Amouyal
  • Jean-Michel Correas
  • Héléna Pereira
  • Olivier Pellerin
  • Costantino Del Giudice
  • Carole Déan
  • Nicolas Thiounn
  • Marc Sapoval
Interventional

Abstract

Objectives

To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones.

Methods

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.

Results

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).

Conclusions

PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions.

Key Points

• 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.

Keywords

Benign prostatic hyperplasia Prostate Therapeutic embolisation Magnetic resonance imaging Anatomy, cross-sectional 

Abbreviations

BPH

Benign prostatic hyperplasia

CG

Central gland

DCE-MRI

Dynamic contrast - enhanced magnetic resonance imaging

IIEF

International Index of erectile function

IPSS

International prostate symptom score

LUTS

Lower urinary tract symptoms

ML

Median lobe

MRI

Magnetic resonance imaging

PAE

Prostatic arterial embolisation

PErFecTED

Proximal embolization first then embolize distal

PSA

Prostate-specific antigen

PVR

Post-voiding residual urine

PZ

Peripheral zone

Qmax

Maximum urinary flow rate

QoL

Quality of life

WPV

Whole prostate volume

Notes

Acknowledgments

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.

References

  1. 1.
    Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479PubMedGoogle Scholar
  2. 2.
    Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140CrossRefPubMedGoogle Scholar
  3. 3.
    McVary KT, Roehrborn CG, Avins AL et al (Revised, 2010) American Urological Association Guideline: management of Benign Prostatic Hyperplasia (BPH). American Urological AssociationGoogle Scholar
  4. 4.
    Bagla S, Martin CP, van Breda A et al (2014) Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 25:47–52CrossRefPubMedGoogle Scholar
  5. 5.
    Bilhim T, Pisco J, Rio Tinto H et al (2013) Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 36:403–411CrossRefPubMedGoogle Scholar
  6. 6.
    Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG (2011) Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 22:11–19, quiz 20CrossRefPubMedGoogle Scholar
  7. 7.
    Schreuder SM, Scholtens AE, Reekers JA, Bipat S (2014) The role of prostatic arterial embolization in patients with benign prostatic hyperplasia: a systematic review. Cardiovasc Intervent Radiol 37:1198–1219CrossRefPubMedGoogle Scholar
  8. 8.
    Pisco JM, Rio Tinto H, Campos Pinheiro L et al (2013) Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 23:2561–2572CrossRefPubMedGoogle Scholar
  9. 9.
    Carnevale FC, Moreira AM, Antunes AA (2014) The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Intervent Radiol 37:1602–1605CrossRefPubMedGoogle Scholar
  10. 10.
    Truong H, Logan J, Turkbey B et al (2013) MRI characterization of the dynamic effects of 5alpha-reductase inhibitors on prostate zonal volumes. Can J Urol 20:7002–7007PubMedGoogle Scholar
  11. 11.
    Turkbey B, Fotin SV, Huang RJ et al (2013) Fully automated prostate segmentation on MRI: comparison with manual segmentation methods and specimen volumes. AJR Am J Roentgenol 201:W720–W729CrossRefPubMedGoogle Scholar
  12. 12.
    Williams AM, Simon I, Landis PK et al (1999) Prostatic growth rate determined from MRI data: age-related longitudinal changes. J Androl 20:474–480PubMedGoogle Scholar
  13. 13.
    Frenk NE, Baroni RH, Carnevale FC et al (2014) MRI findings after prostatic artery embolization for treatment of benign hyperplasia. AJR Am J Roentgenol 203:813–821CrossRefPubMedGoogle Scholar
  14. 14.
    Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830CrossRefPubMedGoogle Scholar
  15. 15.
    Rastinehad AR, Caplin DM, Ost MC et al (2008) Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 71:181–184CrossRefPubMedGoogle Scholar
  16. 16.
    Golzarian J, Antunes AA, Bilhim T et al (2014) Prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia and bleeding in patients with prostate cancer: proceedings from a multidisciplinary research consensus panel. J Vasc Interv Radiol 25:665–674CrossRefPubMedGoogle Scholar
  17. 17.
    Carmignani G, Belgrano E, Puppo P, Cichero A, Giuliani L (1980) Transcatheter embilization of the hypogastric arteries in cases of bladder hemorrhage from advanced pelvic cancers: followup in 9 cases. J Urol 124:196–200PubMedGoogle Scholar
  18. 18.
    Garcia-Monaco R, Garategui L, Kizilevsky N, Peralta O, Rodriguez P, Palacios-Jaraquemada J (2014) Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization. J Vasc Interv Radiol 25:315–322CrossRefPubMedGoogle Scholar
  19. 19.
    Bilhim T, Pisco JM, Rio Tinto H et al (2012) Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 23:1403–1415CrossRefPubMedGoogle Scholar
  20. 20.
    Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ (2011) Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics 31:677–703CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bilhim T (2014) Response to “does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study”. J Vasc Interv Radiol 25:659–660CrossRefPubMedGoogle Scholar
  22. 22.
    Sun F, Sanchez FM, Crisostomo V et al (2008) Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment: preliminary study in pigs. Radiology 246:783–789CrossRefPubMedGoogle Scholar
  23. 23.
    Shapiro E, Becich MJ, Hartanto V, Lepor H (1992) The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia. J Urol 147:1293–1297PubMedGoogle Scholar
  24. 24.
    Andersson KE, Gratzke C (2007) Pharmacology of alpha1-adrenoceptor antagonists in the lower urinary tract and central nervous system. Nat Clin Pract Urol 4:368–378CrossRefPubMedGoogle Scholar
  25. 25.
    Hennenberg M, Stief CG, Gratzke C (2014) Prostatic alpha1-adrenoceptors: new concepts of function, regulation, and intracellular signaling. Neurourol Urodyn 33:1074–1085CrossRefPubMedGoogle Scholar
  26. 26.
    Bulman JC, Toth R, Patel AD et al (2012) Automated computer-derived prostate volumes from MR imaging data: comparison with radiologist-derived MR imaging and pathologic specimen volumes. Radiology 262:144–151CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Engelhard K, Hollenbach HP, Deimling M, Kreckel M, Riedl C (2000) Combination of signal intensity measurements of lesions in the peripheral zone of prostate with MRI and serum PSA level for differentiating benign disease from prostate cancer. Eur Radiol 10:1947–1953CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Yen-Ting Lin
    • 1
    • 5
    Email author
  • Grégory Amouyal
    • 1
  • Jean-Michel Correas
    • 1
    • 6
  • Héléna Pereira
    • 1
  • Olivier Pellerin
    • 1
    • 2
    • 3
  • Costantino Del Giudice
    • 1
  • Carole Déan
    • 1
  • Nicolas Thiounn
    • 4
  • Marc Sapoval
    • 1
    • 2
    • 3
  1. 1.Assistance publique Hôpitaux de Paris. Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional RadiologyParisFrance
  2. 2.Inserm (Institut national de la santé et de la recherche médicale) U970ParisFrance
  3. 3.Université Paris DescartesParisFrance
  4. 4.Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, UrologyParisFrance
  5. 5.Department of Radiology, Taichung Veterans General HospitalTaichung CityRepublic of China
  6. 6.Radiology DepartmentHôpital NeckerParisFrance

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