Division of Vascular and Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina.
Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.
J Vasc Interv Radiol. 2021 Apr;32(4):562-568. doi: 10.1016/j.jvir.2020.12.016. Epub 2021 Feb 6.
To compare the utility of low-dose versus standard cone-beam computed tomography (CT) angiography protocols in identifying nontarget embolization (NTE) during prostatic artery embolization (PAE).
A prospective, single-center, Phase-1 study (NCT02592473) was conducted for lower urinary tract symptoms in benign prostatic hyperplasia. Prostate volume, international prostate symptom score (IPSS), quality of life score (QoL), International Index of Erectile Function (IIEF), peak flow rate, UCLA Prostate Cancer Index (UCLA-PCI), and postvoid residual were recorded at baseline and 1, 3, 6, 12, and 24-months after PAE. Six-second (standard protocol, n = 29) or 5-second (low-dose protocol n = 45) rotations were made. Images were selected and matched in pairs by areas of NTE and compared by readers using a binomial generalized estimating equation model. Procedural outcomes were analyzed using a linear mixed model.
Seventy-four cone-beam CT angiographies were performed in 21 patients. IPSS and QoL scores significantly improved (P <.05). There was no change in UCLA-PCI or IIEF scores. Dose area product of the low- and standard-dose protocol were 37,340.82 mGy·cm ± 104.66 and 62,645.66 mGy·cm ± 12,711.48, respectively, representing a dose reduction of 40.4%. A total of 120 comparisons showed no preference between the 2 protocols (P =.24). Observers identified 76 and 69 instances of NTE in the standard- and low-dose protocols, respectively (P =.125).
Low-dose cone-beam CT angiography achieved equivalent clinical utility in identifying NTE during PAE, with the advantage of a lower radiation dose.
比较低剂量与标准锥形束 CT 血管造影（CTA）方案在识别前列腺动脉栓塞（PAE）过程中发生的非靶区栓塞（NTE）的效用。
本研究为前瞻性、单中心、1 期研究（NCT02592473），旨在评估良性前列腺增生患者下尿路症状的治疗效果。记录前列腺体积、国际前列腺症状评分（IPSS）、生活质量评分（QoL）、国际勃起功能指数（IIEF）、最大尿流率、加利福尼亚大学洛杉矶分校前列腺癌指数（UCLA-PCI）和残余尿量等基线值，以及 PAE 后 1、3、6、12 和 24 个月的值。进行 6 秒（标准方案，n=29）或 5 秒（低剂量方案，n=45）旋转。通过 NTE 区域选择并配对图像，然后由读者使用二项广义估计方程模型进行比较。使用线性混合模型分析手术结果。
21 名患者共进行了 74 次锥形束 CTA 血管造影。IPSS 和 QoL 评分显著改善（P<.05）。UCLA-PCI 和 IIEF 评分无变化。低剂量和标准剂量方案的剂量面积乘积分别为 37340.82 mGy·cm±104.66 和 62645.66 mGy·cm±12711.48，分别降低了 40.4%。共进行了 120 次比较，两种方案之间无偏好（P=.24）。在标准剂量和低剂量方案中，观察者分别识别出 76 次和 69 次 NTE（P=.125）。
低剂量锥形束 CTA 血管造影在识别 PAE 过程中的 NTE 方面具有等效的临床效用，且具有较低的辐射剂量优势。
