Rostambeigi Nassir, Crawford Daniel, Golzarian Jafar
Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, 510 South Kingshighway Blvd, MO, 63110.
Vascular and Interventional Radiology, North Star Vascular & Interventional / University of Minnesota, Golden Valley, USA.
CVIR Endovasc. 2024 May 15;7(1):46. doi: 10.1186/s42155-024-00459-1.
Prostatic artery embolization (PAE) has proven to be an efficacious treatment for urinary symptoms of benign prostatic hyperplasia. PAE is performed in a complex and challenging anatomical field which may pose difficulties from procedural standpoint. Cone beam computed tomography (CBCT) has been proposed as an invaluable tool during the PAE procedure. A review of different techniques and advancements, as well as demonstration of CBCT benefits via a pictorial overview of the salient examples is lacking. The techniques of CBCT are discussed herein and the virtual injection technology as an advancement in CBCT is discussed. To show the merits of CBCT in PAE, a pictorial overview of various clinical scenarios is presented where CBCT can be crucial in decision making. These scenarios are aimed at showing different benefits including identification of the origin of the prostatic artery and avoiding non-target embolization. Other benefits may include ensuring complete embolization of entire prostate gland as angiographic appearance alone can be inconclusive if it mimics a severely thickened bladder wall or ensuring adequate embolization of the median lobe to provide relief from "ball-valve" effect. Further examples include verification of embolization of the entire prostate when rare variants or multiple (> 2) arterial feeders are present.
前列腺动脉栓塞术（PAE）已被证明是治疗良性前列腺增生症尿路症状的一种有效方法。PAE是在一个复杂且具有挑战性的解剖区域进行的，从手术角度来看可能会带来困难。锥形束计算机断层扫描（CBCT）已被提议作为PAE手术中的一种宝贵工具。目前缺乏对不同技术和进展的综述，以及通过突出示例的图片概述来展示CBCT的益处。本文讨论了CBCT的技术，并讨论了作为CBCT进展的虚拟注射技术。为了展示CBCT在PAE中的优点，呈现了各种临床场景的图片概述，其中CBCT在决策中可能至关重要。这些场景旨在展示不同的益处，包括识别前列腺动脉的起源和避免非靶栓塞。其他益处可能包括确保整个前列腺的完全栓塞，因为仅血管造影表现可能无法确定，因为它可能模仿严重增厚的膀胱壁，或者确保中叶的充分栓塞以缓解“球阀”效应。进一步的例子包括当存在罕见变异或多个（>2）动脉供血支时，验证整个前列腺的栓塞情况。
