Departments of Radiology, Tzaneion General Hospital, Piraeus, Greece.
Departments of Urology, Tzaneion General Hospital, Piraeus, Greece.
Diagn Interv Radiol. 2019 Mar;25(2):134-143. doi: 10.5152/dir.2019.18410.
We aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH).
Thirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100-700 µm) were utilized for PAE. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow (Qmax), prostatic volume (PV) and post void residual volume (PVR) were measured at baseline and at 1, 3, and 6 months post PAE. Unenhanced transabdominal US was utilized for PV and PVR measurements; prostatic enhancement was studied with transabdominal CEUS at baseline, during the procedure, 1 day and 1, 3, and 6 months post PAE. Technical success was defined as embolization of the PA of at least one pelvic side. Clinical success was based on the improvement of IPSS and QoL, with no need for any additional treatment. Follow-up time ranged from 6 to 18 months (mean, 9.7±4.3 months). Clinical success rates were calculated and changes in prostatic enhancement were correlated with the outcome parameters.
Technical success rate was 90.3%. Clinical success rates at 3, 6, and 12 months post PAE were 85.7%, 85.7%, and 79.1% respectively. Improvement of outcome parameters (baseline vs. 6-month values) was statistically significant, with 12.4 points mean reduction of IPSS (50.4%, P = 0.003), 2.0 points mean reduction of QoL (45.4%, P < 0.001), 30.3 mL mean reduction of PV (30.2%, P < 0.001), 72.6 mL mean reduction of PVR (51.8%, P = 0.005) and 8.6 mL/s mean increase in Qmax (103%, P = 0.002). The most significant complications were bladder ischemia (n=1), and ischemic rectal ulcer (n=1), both attributable to nontarget embolization, with complete recovery. CEUS 1 day post PAE demonstrated prostatic infarcts in 26/28 (92.8%) patients. The percentage of prostatic infarction (pPI, defined as prostatic infarcted volume 1 day post PAE divided by baseline PV) was 1%-71%. There was a very strong positive correlation between pPI and prostate shrinkage (r=0.81, P < 0.001), but a weak correlation between pPI and the improvement of the other outcome parameters (r= 0.01-0.36; P = 0.093-0.965). However, in the subgroup of patients with indwelling bladder catheter (9/28 patients), successful removal of the catheter was achieved only in patients with pPI>10%.
CEUS appears to be a practical method for the study of the local ischemic effect of PAE, with potential predictive value.
我们旨在评估对比增强超声（CEUS）作为前列腺动脉栓塞术（PAE）治疗症状性良性前列腺增生（BPH）影像评估的主要方法的临床和预测作用。
本前瞻性单中心研究纳入了 2016 年 10 月至 2018 年 2 月期间接受 PAE 治疗的 31 例症状性 BPH 患者。使用 100-700µm 的微球进行 PAE。在基线和 PAE 后 1、3 和 6 个月，分别测量国际前列腺症状评分（IPSS）、生活质量（QoL）、最大尿流率（Qmax）、前列腺体积（PV）和剩余尿量（PVR）。使用经腹超声测量 PV 和 PVR；在基线、手术期间、PAE 后 1 天以及 1、3 和 6 个月，使用经腹 CEUS 研究前列腺增强情况。技术成功定义为至少一侧骨盆侧支的 PA 栓塞。临床成功基于 IPSS 和 QoL 的改善，无需任何其他治疗。随访时间为 6 至 18 个月（平均 9.7±4.3 个月）。计算临床成功率，并将前列腺增强变化与结局参数相关联。
技术成功率为 90.3%。PAE 后 3、6 和 12 个月的临床成功率分别为 85.7%、85.7%和 79.1%。结局参数的改善具有统计学意义，IPSS 平均降低 12.4 分（50.4%，P=0.003），QoL 平均降低 2.0 分（45.4%，P<0.001），PV 平均减少 30.3mL（30.2%，P<0.001），PVR 平均减少 72.6mL（51.8%，P=0.005），Qmax 平均增加 8.6mL/s（103%，P=0.002）。最常见的并发症是膀胱缺血（n=1）和缺血性直肠溃疡（n=1），均归因于非目标栓塞，均完全恢复。PAE 后 1 天的 CEUS 显示 28 例中的 26 例（92.8%）患者存在前列腺梗死。前列腺梗死百分比（pPI，定义为 PAE 后 1 天前列腺梗死体积与基线 PV 的比值）为 1%-71%。pPI 与前列腺缩小之间呈很强的正相关（r=0.81，P<0.001），但与其他结局参数的改善之间呈弱相关（r=0.01-0.36；P=0.093-0.965）。然而，在留置导尿管的患者亚组（28 例患者中的 9 例）中，仅在 pPI>10%的患者中成功取出了导尿管。
CEUS 似乎是一种评估 PAE 局部缺血作用的实用方法，具有潜在的预测价值。
