MRI assessment of prostatic ischaemia: best predictor of clinical success after prostatic artery embolisation for benign prostatic hyperplasia

Early post-interventional sonographic evaluation of prostatic artery embolization. A promising role for contrast-enhanced ultrasonography (CEUS)

“…Infarction visible on early CEUS was also associated with subsequent shrinkage of the gland. The strong association between infarction and clinical benefit and between infarction and prostate shrinkage is also supported by the results of one of the two aforementioned MRI studies, in which MR was performed one month post PAE [7]. Ischemic necrosis appears to play a vital role in the therapeutic effect of PAE.…”

“…However, the main purpose of these studies was to evaluate clinical and other outcome parameters of PAE and CEUS findings were not extensively analyzed. Prostatic infarctions were also the key finding of two reports (Kisilevzky et al and Frenk et al [3,7]), which had focused Table II. Prevalence and measurements of prostatic infarcts early post prostatic artery embolization (PAE) and at the 3 months follow-up.…”

Sonographic evaluation of prostatic artery embolization: Far beyond size measurements

“…The embolized, infarcted adenomas of BPH undergo gradual shrinkage, the mass effect on the prostatic urethra is relieved and symptoms, as well as urinary flow, are improved. At present, our knowledge regarding imaging of prostatic ischemia post-PAE is derived primarily from contrast-enhanced MR (CEMR) studies[ 6 , 7 , 17 , 19 ]. Nevertheless, contrast-enhanced US (CEUS), as a modality of real-time and detailed imaging of micro- and macrocirculation, has also yielded promising results[ 8 , 9 , 20 , 21 ].…”

“…In the following weeks, prostatic infarcts become gradually smaller and the majority disappear 3-6 mo post-PAE[ 20 , 21 ] (Figure 1 ). PAE-induced prostatic infarcts have been observed in 71.4%-92.8% of patients with CEUS[ 20 , 21 ] and in 33%-100% with MR[ 7 , 17 ]. Differences in the prevalence and extent of prostatic infarcts post-PAE are explained by variations in the embolization technique: Superselective cannulation of the PAE, distal advancement of the microcatheter in the intraprostatic branches and utilization of smaller embolic agents (with diameters < 300 μm) are factors associated with more frequent and extensive infarction[ 4 , 7 , 22 ].…”

“…At present, magnetic resonance (MR) is considered the “gold standard” modality for imaging evaluation of PAE. By virtue of its superior soft tissue contrast resolution, MR accurately shows size and texture changes of the prostate post-PAE[ 5 - 7 ]; ischemic changes caused by PAE are also associated with signal alterations in unenhanced T1 and T2 sequences, although their delineation is more clear and detailed on gadolinium-enhanced T1 sequences[ 6 , 7 ]. However, equipment and examination costs may limit the availability and repeatability of MR and the technique (or its dedicated contrast media) may be contraindicated in some patients.…”