Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

Abstract

Background To investigate the influence of benign prostatic hyperplasia (BPH) patterns detected with MRI on clinical outcomes after prostatic artery embolization (PAE). Materials & methods This retrospective study included 71 consecutive patients with lower urinary tract symptoms (LUTS), who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). LUTS were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome. Results For clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41—75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion, and prostatic urethral angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15%—34%). Bilateral embolization was a significant predictor for volume reduction at follow-up. Multiple linear regression analysis showed significant effect of high initial volume on reduction in IPSS after treatment (p < 0.01). Presence of AdBPH was significantly associated with both, volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH pattern based on the Wassermann type nor modified BPH classification were significantly related with postinterventional IPSS and volume loss. Conclusions Men benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume and presence of AdBPH on MRI should be considered for outcome prognosis after PAE.

Value of magnetic resonance angiography before prostatic artery embolization for intervention planning

“…Prostatic artery embolization was conducted by the same interventional radiologist in all 78 patients. Technical aspects of the procedure have been described in detail previously 19 . All PAE were performed using an angiographic unit with a digital flat-panel detector system (Allura Xper FD20; Phillips Healthcare, Best, The Netherlands) equipped with cone beam CT option.…”

Clinical, Technical, and MRI Features Associated with Patients’ Outcome at 3 Months and 2 Years following Prostate Artery Embolization: Is There an Added Value of Radiomics?

“…Three radiologists (C.M. and E.J., senior radiologists with 10 and 8 years of experience in urological imaging, respectively, and A.M. a fellow with a 6-month internship in interventional radiology and urological imaging) double-blinded assessed the following radiological features from MRI 0 : (i) PPI, categorized as: grade 1 + 2: ≤10 mm and grade 3: >10 mm [17]; (ii) adBPH according to Little et al (defined as two or more adenomas [i.e., with intermediate T1-WI/T2-WI signal, surrounded by a low T1-WI/T2-WI capsule and marked contrast-enhancement after gadolinium-chelates injection] within the peri-urethral transition zone of 1 cm or greater) [9]; (iii) qualitative assessment of the signal intensity (SI) of the transitional zone on T2-WI (subjectively categorized as high, intermediate, or low compared to the pelvic muscles); (iv) simplified Wasserman classification (categorized as type 1: bilateral transitional zone hyperplasia, type 2: retro-urethral median lobe hyperplasia [reference], type 3: type 1 + type 2) [10,18]; (v) intra-bladder lithiasis; (vi) bladder diverticula.…”

“…Thus, several studies have investigated features associated with PAE success but with diverging results. High prostate volume, younger age, and adenomatous benign BPH (adBPH) have been linked with higher rates of success [7][8][9][10] whereas cardiovascular comorbidities, unilateral embolization, or glue and large microspheres may provide worse prognosis [8,11,12]. Moreover, radiological features assessing the shape of the adenoma such as prostate protrusion index (PPI) within the bladder, or the presence of a median lobe have shown controversial results [4,10,13,14].…”

“…High prostate volume, younger age, and adenomatous benign BPH (adBPH) have been linked with higher rates of success [7][8][9][10] whereas cardiovascular comorbidities, unilateral embolization, or glue and large microspheres may provide worse prognosis [8,11,12]. Moreover, radiological features assessing the shape of the adenoma such as prostate protrusion index (PPI) within the bladder, or the presence of a median lobe have shown controversial results [4,10,13,14]. Lastly, Boschheidgen et al have suggested that a simplified Wasserman classification for BPH would correlate with PAE success [10].…”

“…Moreover, radiological features assessing the shape of the adenoma such as prostate protrusion index (PPI) within the bladder, or the presence of a median lobe have shown controversial results [4,10,13,14]. Lastly, Boschheidgen et al have suggested that a simplified Wasserman classification for BPH would correlate with PAE success [10].…”