Contrast Enhanced Magnetic Resonance Angiography in the Identification of Prostatic Arterial Anatomy in Patients with Benign Prostatic Hyperplasia: Prospective Comparison with Digital Subtraction Angiography

Background: Prostatic artery embolization (PAE) is emerging as a safe, effective, and minimally invasive therapy for benign prostatic hyperplasia (BPH). The most technically challenging aspect of PAE is identifying the prostatic artery (PA).The purpose of this study was to evaluate the utility of contrast-enhanced magnetic resonance angiography (CE-MRA) for identifying PA anatomy in patients with BPH before PAE, using digital subtraction angiography (DSA) as the reference standard. Methods: A total of 176 patients underwent pelvic CE-MRA at 3.0 Tesla MR systems; DSA was performed within the following 7 days. Two interventional radiologists compared the CE-MRA findings with DSA findings for assessing PA anatomy. The rates of correct identification of the PAs origins and collaterals by CE-MRA were calculated. An exact McNemar’s test was used to compare the detection rates of the PAs and the collaterals with DSA versus CE-MRA. A two-sided P value of <0.05 was considered statistically significant. Findings: Of the 376 PAs identified by DSA, CE-MRA correctly identified the origins of 369 vessels (98.1%), with a 1.9% false-negative rate and no false-positive results. Of the 57 total collaterals identified by DSA, CE-MRA correctly identified 50 vessels (87.7%), with a 12.3% false-negative rate and no false-positive results. No significant differences were observed between CE-MRA and DSA in the identification of the PAs origins (P = 0.824) and the collaterals (P = 0.327). Interpretation: CE-MRA before PAE can reliably predict the PA anatomy and facilitate procedural planning, and could potentially reduce the number of DSA runsand radiation dose. Clinical Trial Registration Number: ChiCTR1900028819. Funding Statement: This work was supported by grant from the National Natural Science Foundation of China (81471769). Declaration of Interests: The authors have declared that no competing interest exists. Ethics Approval Statement: Our institutional review board approved this prospective single-institution study (the approval number: S2019-313-01). All patients provided written informed consent and volunteered to participate in the pre-procedural evaluation, undergo the PAE procedure, complete the follow-up, and release their data for teaching and research purposes.