Improving Cone-Beam CT Angiography for Prostatic Artery Embolization: Is a Low-Dose Protocol Equivalent to the...

Area of Science:

• Interventional Radiology
• Medical Imaging
• Urology

Background:

• Prostatic artery embolization (PAE) is a treatment for benign prostatic hyperplasia.
• Cone-beam CT (CBCT) angiography is used during PAE to visualize arteries and identify potential complications.
• Nontarget embolization (NTE) is a complication where embolic material goes to unintended arteries.

Purpose of the Study:

• To compare the diagnostic utility of low-dose versus standard-dose CBCT angiography protocols.
• To assess the effectiveness of these protocols in identifying NTE during PAE.
• To evaluate the radiation dose reduction achieved with the low-dose protocol.

Main Methods:

• A prospective, single-center Phase-1 study (NCT02592473) included patients with benign prostatic hyperplasia undergoing PAE.
• Patients received either a standard-dose (6-second rotation) or low-dose (5-second rotation) CBCT angiography protocol.
• Clinical outcomes (IPSS, QoL, IIEF, etc.) and procedural data, including NTE instances, were recorded and analyzed.

Main Results:

• A 40.4% radiation dose reduction was achieved with the low-dose protocol compared to the standard protocol.
• No significant difference was found in the identification of NTE between the low-dose and standard-dose protocols (P=.125).
• Patient-reported outcomes, including IPSS and QoL scores, significantly improved post-PAE.

Conclusions:

• Low-dose CBCT angiography provides equivalent clinical utility to standard-dose protocols for identifying NTE during PAE.
• The low-dose protocol offers a significant reduction in radiation exposure, making it a favorable option.
• PAE effectively treats lower urinary tract symptoms in benign prostatic hyperplasia with no adverse impact on erectile function.