title: Utility of cone-beam CT imaging in prostatic artery embolization.
abstract: OBJECTIVE
  To evaluate the utility of cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia.
  
  
  METHODS
  From January 2012 to January 2013, 15 patients (age range, 59-81 y; mean, 68 y) with moderate- or severe-grade lower urinary tract symptoms, in whom medical management had failed were enrolled in a prospective United States trial to evaluate PAE. During pelvic angiography, 15 cone-beam CT acquisitions were performed in 11 patients, and digital subtraction angiography was performed in all patients. Cone-beam CT images were reviewed to assess for sites of potential nontarget embolization that impacted therapy, a pattern of enhancement on cone-beam CT suggesting additional PAs, confirmation of prostatic parenchymal perfusion before embolization, and contralateral prostatic parenchymal enhancement.
  
  
  RESULTS
  Cone-beam CT was successful in 14 of 15 acquisitions, and PAE was successful in 14 of 15 patients (92%). Cone-beam CT provided information that impacted treatment in five of 11 patients (46%) by allowing for identification of sites of potential nontarget embolization. Duplicated prostatic arterial supply and contralateral perfusion were each identified in 21% of patients (three of 11). Prostatic perfusion was confirmed before embolization in 50% of acquisitions (seven of 14).
  
  
  CONCLUSIONS
  Cone-beam CT is a useful technique that can potentially mitigate the risk of nontarget embolization. During treatment, it can allow for the interventionalist to identify duplicated prostatic arterial supply or contralateral perfusion, which may be useful when evaluating a treatment failure.
authors: Department of Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Rd., Alexandria, VA 22304. Electronic address: sbagla@alexandriaradiology.com.
authors: Sandeep
authors: S
authors: Bagla
authors: Kenneth S
authors: KS
authors: Rholl
authors: Keith M
authors: KM
authors: Sterling
authors: Arletta
authors: A
authors: van Breda
authors: Dimitrios
authors: D
authors: Papadouris
authors: James M
authors: JM
authors: Cooper
authors: Arina
authors: A
authors: van Breda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001158:Arteries; D054893:Cone-Beam Computed Tomography; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000098:blood supply* / Q000000981:diagnostic imaging; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000628:therapy*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014768:Virginia
keywords: AUA; American Urological Association; BPH; DSA; LUTS; PA; PAE; benign prostatic hyperplasia; digital subtraction angiography; lower urinary tract symptoms; prostatic artery; prostatic artery embolization