Planning Prostate Artery Embolisation: Is it Essential to Perform a Pre-procedural CTA?

Area of Science:

• Interventional Radiology
• Vascular Imaging
• Urology

Background:

• Prostate artery embolisation (PAE) is complex due to variable prostatic artery origins and frequent anastomoses.
• CT angiography aids PAE planning but isn't universally available.
• Assessing CT angiography's utility in identifying prostatic arteries and anastomoses is crucial.

Purpose of the Study:

• To evaluate the effectiveness of pre-procedural CT angiography in identifying prostatic arteries.
• To assess CT angiography's accuracy in detecting anastomoses to adjacent organs before PAE.
• To determine the role of CT angiography in planning PAE for benign prostatic obstruction.

Main Methods:

• Retrospective review of 110 patients undergoing PAE for benign prostatic obstruction.
• Analysis of pre-procedural CT angiography findings.
• Comparison of CT angiography results with intraprocedural angiography to assess accuracy.

Main Results:

• CT angiography identified prostatic arterial supply in 97.3% of cases (214/220 pelvic sides).
• It suggested anastomoses in 52 pelvic sides, confirmed in 49 (94.2%).
• CT angiography showed 59.0% sensitivity and 94.2% specificity for anastomoses detection.

Conclusions:

• Pre-procedural CT angiography reliably predicts prostatic arterial anatomy for PAE planning.
• It is a valuable investigation for patients undergoing PAE.
• Low sensitivity for anastomoses necessitates careful periprocedural assessment.