Computed Tomography for 4-Dimensional Angiography and Perfusion Imaging of the Prostate for Embolization Planning of Benign Prostatic Hyperplasia.
Level 4 - case-series / case-control
Prospective single-arm feasibility case series comparing diagnostic imaging modalities in human subjects without a control group.
PubMed 31211710 · doi:10.1097/RLI.0000000000000582
What was done
Evaluated the feasibility of a dynamic pelvic computed tomography (CT) protocol for 4-dimensional (4D) angiography and quantitative perfusion imaging before prostatic artery embolization (PAE) in 22 consecutive men with benign prostatic hyperplasia (mean age, 67 ± 7 years). Patients received 70 mL of iodinated contrast followed by a 44-second dynamic CT acquisition (70 kVp, 100 mAs, 25 scan cycles). Images were postprocessed into temporal maximum intensity projections (MIP), bone- and calcium-subtracted 4D-CT angiography, and parametric perfusion maps. Findings were compared against intraprocedural cone-beam CT. Outcomes included radiation dose, contrast-to-noise ratio (CNR), prostatic artery visibility on a 1-to-4 Likert scale, and prostate perfusion parameters.
What was found
Average volume CT dose index was 35.7 ± 6.8 mGy and dose length product was 737.4 ± 146.3 mGy·cm. CNR of pelvic vessels on temporal MIP was lower than on cone-beam CT (45 ± 19 vs. 69 ± 27, P < 0.01). Mean visibility score of the prostatic artery was 3.6 ± 0.6 for 4D-CT angiography versus 3.97 ± 0.2 for cone-beam CT (P < 0.001). The prostatic artery was visualized in 100% of 4D-CT examinations (one visible only proximally). Whole-gland CT perfusion parameters were: blood flow 27.9 ± 12.5 mL/100 mL/min, blood volume 2.0 ± 0.8 mL/100 mL, mean transit time 4.5 ± 0.5 s, and flow extraction product 12.6 ± 5.4 mL/100 mL/min, with pronounced interlobar differences in about half the patients.
Why it matters
A single dynamic CT protocol can achieve noninvasive pre-procedural prostatic artery mapping alongside baseline parenchymal perfusion quantification at moderate radiation dose and low contrast volume.
Limits
Small single-center cohort (n = 22) without clinical outcome validation. Cone-beam CT had significantly superior contrast-to-noise ratio and vessel visibility scores compared to 4D-CT.
Cited by
- supports The prostate receives relatively low blood flow compared to other tissues.