Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization

Thomas J Vogl; Christian Booz; Vitali Koch; Nour-Eldin A Nour-Eldin; Emad H Emara; Felix Chun; Shirin El Nemr; Leona S Alizadeh

doi:10.1016/j.ejrad.2022.110236

Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization

Eur J Radiol. 2022 May:150:110236. doi: 10.1016/j.ejrad.2022.110236. Epub 2022 Mar 7.

Authors

Thomas J Vogl¹, Christian Booz², Vitali Koch², Nour-Eldin A Nour-Eldin³, Emad H Emara⁴, Felix Chun⁵, Shirin El Nemr², Leona S Alizadeh⁶

Affiliations

¹ Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany.
² Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany.
³ Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Cairo, Egypt.
⁴ Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Egypt.
⁵ Department of Urology, University Hospital Frankfurt, Germany.
⁶ Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany. Electronic address: leona.alizadeh@outlook.de.

PMID: 35279621
DOI: 10.1016/j.ejrad.2022.110236

Abstract

Purpose: Impact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome.

Method: Retrospective evaluation of 259 patients (mean age 68 ± 9, range 41-92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE.

Results: Origin of the PA was identified in all cases. Significant differences regarding volume reduction (-20 ± 13 ml with MRA vs -17 ± 9 ml without MRA) and ADC value reduction were found (-78 ± 111 10^-6 mm²/s with MRA vs -45 ± 99 10^-6 mm²/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym² with MRA vs 23963.50 ± 19792.25 µGym² without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (-11 ± 8 points with MRA vs -7 ± 9 points without MRA, p < 0.001), while QOL (-2 ± 1 points with MRA and -2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05).

Conclusions: Pre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

Keywords: Lower urinary tract symptoms; MRA; Prostatic artery embolization; Prostatic hyperplasia; Workflow.

MeSH terms

Aged
Embolization, Therapeutic*
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Prostate / pathology
Prostatic Hyperplasia* / diagnostic imaging
Prostatic Hyperplasia* / therapy
Quality of Life
Retrospective Studies
Treatment Outcome
Workflow