From the Departments of Interventional Radiology (J.L.Z., M.Q.W., K.Y., H.N.X., J.X.F., J.Y.Y., Y.W.) and Radiology (Y.G.S., H.Y.Y., H.T.Z.), Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing 100853, PR China.
Radiology. 2019 May;291(2):370-378. doi: 10.1148/radiol.2019181524. Epub 2019 Feb 26.
Background A major technical challenge of prostatic arterial embolization (PAE) is the identification and catheterization of the prostatic arteries (PAs). Recently, MR angiography has been shown to help visualize PAs, but the clinical utility of MR angiography for this purpose is not known. Purpose To determine the efficacy of contrast material-enhanced MR angiography in identifying the PA and to evaluate its role in PAE for benign prostatic hyperplasia (BPH). Materials and Methods In this prospective study, 100 consecutive men who were scheduled to undergo PAE for BPH from January 2015 to May 2017 were assigned by using a randomized block design to either group A ( = 50; mean age, 71.7 years ± 11.9 [standard deviation]) without MR angiography or group B ( = 50; mean age, 72.3 years ± 12.2) with MR angiography prior to PAE. MR angiography findings of the PA anatomy were compared with those of digital subtraction angiography (DSA). The Student test and Wilcoxon rank-sum test were used to compare the differences between the parameters indicating the performance of PAE. Results The mean age of the 100 men in the study was 72.0 years ± 11.8 (range, 51-88 years). Compared with DSA as the reference standard, MR angiography identified PAs with a sensitivity of 91.5% (97 of 106) and a positive predictive value of 100% (97 of 97). With the knowledge of tube obliquity and anatomy, group B had lower procedure times than group A (82.3 minutes ± 5.4 vs 123.9 minutes ± 12.4, < .001) and shorter fluoroscopy times (13.8 minutes ± 2.7 vs 28.5 minutes ± 8.0, < .001). Additionally, radiation dose was reduced for group A versus group B, from a median of 920 to 339 mGy ( = .004). Conclusion Contrast-enhanced MR angiography can accurately show anatomy for the prostate arteries, leading to shorter prostatic artery embolization times and lower radiation dose than when preprocedural prostate MR angiography is not performed. Published under a CC BY 4.0 license. . See also the editorial by Prince in this issue.
前列腺动脉栓塞术（PAE）的一个主要技术挑战是识别和导管插入前列腺动脉（PA）。最近，磁共振血管造影术（MRA）已被证明有助于显示 PA，但目前尚不清楚 MRA 在此目的中的临床应用价值。目的：确定对比增强 MRA 识别 PA 的效果，并评估其在良性前列腺增生（BPH）的 PAE 中的作用。材料与方法：在这项前瞻性研究中，我们使用随机分组设计，将 2015 年 1 月至 2017 年 5 月期间因 BPH 而计划接受 PAE 的 100 例连续男性患者分为两组：A 组（n = 50；平均年龄 71.7 岁 ± 11.9 [标准差]）无 MRA；B 组（n = 50；平均年龄 72.3 岁 ± 12.2）在 PAE 前进行 MRA。比较 PA 解剖结构的 MRA 结果与数字减影血管造影（DSA）的结果。使用学生 t 检验和 Wilcoxon 秩和检验比较 PAE 表现参数之间的差异。结果：100 例男性患者的平均年龄为 72.0 岁 ± 11.8（范围 51-88 岁）。与 DSA 作为参考标准相比，MRA 对 PA 的检出率为 91.5%（97/106），阳性预测值为 100%（97/97）。B 组在了解管倾斜度和解剖结构的情况下，手术时间短于 A 组（82.3 分钟 ± 5.4 比 123.9 分钟 ± 12.4，<.001），透视时间短（13.8 分钟 ± 2.7 比 28.5 分钟 ± 8.0，<.001）。此外，与 A 组相比，B 组的辐射剂量降低，中位数从 920 至 339 mGy（=.004）。结论：增强对比 MRA 可以准确显示前列腺动脉的解剖结构，与不进行前列腺 MRA 术前检查相比，PAE 时间更短，辐射剂量更低。在知识共享署名 4.0 许可下发布。请参阅本期杂志上 Prince 的社论。
