Role of Coil Embolization during Prostatic Artery Embolization: Incidence,Indications, and Safety Profile☆

Purpose

To determine if coil embolization is a safe adjunctive measure to prevent nontarget embolization during prostatic artery embolization (PAE).

Utility of Cone-Beam CT Imaging in Prostatic Artery Embolization

PurposeTo evaluate the utility of cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia.Materials and MethodsFrom January 2012 to January 2013, 15 patients (age range, 59–81 y; mean, 68 y) with moderate- or severe-grade lower urinary tract symptoms, in whom medical management had failed were enrolled in a prospective United States trial to evaluate PAE. During pelvic angiography, 15 cone-beam CT acquisitions were performed in 11 patients, and digital subtraction angiography was performed in all patients. Cone-beam CT images were reviewed to assess for sites of potential nontarget embolization that impacted therapy, a pattern of enhancement on cone-beam CT suggesting additional PAs, confirmation of prostatic parenchymal perfusion before embolization, and contralateral prostatic parenchymal enhancement.ResultsCone-beam CT was successful in 14 of 15 acquisitions, and PAE was successful in 14 of 15 patients (92%). Cone-beam CT provided information that impacted treatment in five of 11 patients (46%) by allowing for identification of sites of potential nontarget embolization. Duplicated prostatic arterial supply and contralateral perfusion were each identified in 21% of patients (three of 11). Prostatic perfusion was confirmed before embolization in 50% of acquisitions (seven of 14).ConclusionsCone-beam CT is a useful technique that can potentially mitigate the risk of nontarget embolization. During treatment, it can allow for the interventionalist to identify duplicated prostatic arterial supply or contralateral perfusion, which may be useful when evaluating a treatment failure.     

肺动脉栓塞在多层螺旋CT强化及后处理中的影像表现及诊断评价

目的观察肺动脉栓塞（PAE）在多层螺旋CT（MSCT）强化下扫描及后处理图象中的特征,评价其对肺动脉栓塞的诊断价值。方法35例可疑PAE病人均行MSCT强化扫描,并进行多平面重建（MPR）、最大密度投影（MIP）、容积再现（VR）及仿真内窥镜（VE）后处理。结果35例受检者主干肺动脉至段肺动脉的显示率为100％;对亚段及5级肺动脉的显示率为80．23％。在35例中32例可见到不同部位、不同类型和形态的充盈缺损,并有不同种类的间接征象。3例未见肺动脉内充盈缺损,其中2例各有1种间接征象。结论多层螺旋CT扫描及重建后处理是肺动脉栓塞的快速、有效、安全、简便可行的诊断方法。     

环丙沙星和二氟沙星对大肠杆菌和金葡球菌的体外抗菌后效应

采用常规活菌落计数法观察环丙沙星和二氟沙星在３种不同浓度（４ＭＩＣ２ＭＩＣ和０．５ＭＩＣ）下对大肠杆菌ＡＴＣＣ２５９２２和金葡球菌ＡＴＣＣ２５９２３的体外抗菌后效应（ＰＡＥ），结果表明所试药物对两种细菌均显示不同程度的ＰＡＥ（０．５０～３．２５ｈ）且其ＰＡＥ时间与药物剂量呈正相关。     

Prostatic Artery Embolization in the Treatment of Localized Prostate Cancer: A Bicentric Prospective Proof-of-Concept Study of 12 Patients

Purpose

To provide initial data on tumoricidal efficacy of embolization on prostate cancer via histopathologic examination of prostatectomy specimens after embolization.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Prospective Randomized Trial of 100–300 μm versus 300–500 μm versus 100- to 300-μm + 300- to 500-μm Embospheres

PurposeThis study compared the safety and efficacy of prostatic arterial embolization (PAE) with that of trisacryl gelatin microspheres of different sizes for treatment of benign prostatic hyperplasia (BPH).Materials and MethodsThis study consisted of a single-center, randomized controlled clinical trial in 138 patients who underwent PAE for BPH between July 2015 and December 2016. Patients were randomized to PAE using microspheres of different sizes: group A patients were treated with microspheres 100–300 μm, group B with 300–500 μm, and group C with 100–300 μm followed by 300–500 μm. All patients were evaluated before and at 1, 3, 6, 12, and 18 months after PAE. Baseline data were comparable across the 3 groups, using the following mean International Prostate Symptom Score/quality of life (IPSS/QoL); prostate volume (PV) scores, respectively: 23.0/4.14; 87.9 cm³ (group A); 23.0/4.09; 89.0 cm³ (group B); and 24.2/4.29; 81.0 cm³ (group C) (P > 0.05).ResultsMean IPSS/QoL scores; PV after PAE were: 9.98/2.49; 65.1 cm³ (group A); 8.24/2.26; 63.1 cm³ (group B); and 10.1/2.69; 53.1 cm³ (group C) (P = 0.23; P = 0.39; P = 0.24). There were 26 clinical failures. The cumulative probabilities of clinical success at 18 months were 76.7% in group A, 82.6% in group B, and 83.3% in group C (P = 0.68). Nontarget embolization was prevented in 6 patients by coil embolization. All adverse events were mild and self-limited with rates of 86.0% in group A (37 of 43); 41.3% in group B (19 of 46); and 58.3% in group C (28 of 48) (P < 0.001). Dysuria was the most frequent adverse event (28 of 137 [20.4%]).ConclusionsPAE outcomes were not significantly different among microspheres of different sizes. The use of 100- to 300-μm microspheres was associated with an increased risk of minor adverse events.     

Case-Control Comparison of Conventional End-Hole versus Balloon-Occlusion Microcatheter Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia

PurposeTo compare procedural metrics and clinical improvement for prostatic artery embolization (PAE) performed with a balloon-occlusion (BO) versus end-hole (EH) microcatheter in patients with benign prostatic hyperplasia.Materials and MethodsRetrospective review was performed of 129 patients undergoing PAE with 100–300 μm Embosphere microspheres from April 2013 through August 2018. Microcatheter selection was nonrandom, based on prostatic artery anatomy. Five technical failures and 5 microcatheter crossover cases were excluded. BO group (n = 46, age 72.8 y ± 9.0, gland volume 184 mL ± 83, 42% in retention) and EH group (n = 73, age 76.0 y ± 9.0, gland volume 190 mL ± 116, 44% in retention) were compared using procedural metrics (excluding 30 EH learning-curve cases); symptomatic improvement at 3, 6, and 12 months after PAE; voiding trial success; and adverse events (reported used Clavien-Dindo classification).ResultsProcedural and fluoroscopy times were lower in the BO group (n = 46) vs EH group (n = 43) (152.0 min ± 34.0 vs 172.8 min ± 47.9, P < .02; 37.8 min ± 12.9 vs 50.3 min ± 18.9, P < .001). Collaterals coiled, contrast material used, and injected particle volume were similar for both groups (P = NS). International Prostate Symptom Score improvement was similar for BO group (n = 25) (before PAE 23.5 ± 6.5, 12 months after PAE 7.6 ± 6.8) and EH group (n = 30) (before PAE 20.9 ± 5.9, 12 months after PAE 6.6 ± 5.2) (P = NS). Quality-of-life improvements were also similar (BO: before PAE 4.5 ± 1.2, 12 months after PAE 1.4 ± 0.9; EH: before PAE 4.1 ± 1.0, 12 months after PAE 0.9 ± 0.7), as were 12-month postvoid residual improvements, voiding trial failure rates (EH 12%, BO 8%), and adverse event rates (grade II, III: EH 15%, BO 11%) (P = NS for all).ConclusionsBO microcatheter use in PAE did not affect injected particle volume, contrast material use, or protective coiling and did not impact symptomatic improvement, postvoid residual improvement, voiding trial success, or adverse events after PAE. Lower procedure and fluoroscopy times with BO microcatheter were likely due to selection bias.     

Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic Hyperplasia

PurposeTo evaluate the presence of intravesical prostatic protrusion (IPP) and its thickness-to-height (T/H) ratio as a predictor for the clinical outcome and morbidity of prostatic artery embolization (PAE) for benign prostatic hyperplasia.Materials and MethodsThis was a prospective, single-center, institutional review board-approved study from June 2015 to December 2018 of 82 consecutive patients (age, 53–79 years; median, 66 years) with International Prostate Symptom Score (IPSS) ≥15 and quality-of-life (QOL) score ≥3. The presence of IPP and its T/H ratio were assessed on baseline magnetic resonance imaging for their correlation with the clinical outcomes of suboptimal IPSS (IPSS ≥10) and suboptimal QOL (QOL ≥3) up to 12 months after PAE and the occurrence of post-procedure complications (≤30 days), which caused a certain degree of urinary outflow obstruction. The chi-squared test was used for analysis.ResultsIPP was present in 57 of 82 patients (69.5%). The presence of IPP correlated with the occurrence of post-procedure complications (P = .009) but not with suboptimal IPSS at 12 months (P = .758). IPP with a T/H ratio ≤1.3 correlated with suboptimal IPSS at 12 months (P = .025) and suboptimal QOL at 6 months (P = .025) and 12 months (P = .008), as well as with the occurrence of post-procedure complications (P = .009).ConclusionsIPP with a T/H ratio ≤1.3 predicted the occurrence of post-procedure complications with urinary obstruction. A T/H ratio ≤1.3 but not the presence of IPP alone predicted the clinical outcome up to 12 months after PAE.     

Role of Urodynamic Studies in Management of Benign Prostatic Obstruction: A Guide for Interventional Radiologists

Urodynamic testing is the most accurate representation of bladder outlet obstruction physiology. As prostate artery embolization becomes an increasingly common therapy for benign prostatic obstruction, knowledge of urodynamic assessment and reports can assist the interventional radiologist in selecting appropriate patients. This review summarizes the role of urodynamic studies in the management of benign prostatic obstruction, including patient selection, interpretation of urodynamic studies, and their potential to predict patient outcomes.