Sonographic evaluation of prostatic artery embolization:Far beyond size measurements

• 作者: Anastasia Anagnostopoulou Andreas Dimakis Hippocrates Moschouris Katerina Malagari Konstantinos Stamatiou
• 来源期刊: 世界放射学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Prostatic artery embolization Benign prostatic hyperplasia Ultrasound Contrast-enhanced ultrasound INFARCTION Strain elastography Shear-wave elastography
• 年，卷（期）: 2020,（8）
• 页码范围: 172-183
• 页数: 12页
• 分类号: R73

摘要

Prostatic artery embolization(PAE)has gained acceptance as a minimally invasive,safe and effective treatment of symptomatic benign prostatic hyperplasia.Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes.In this context,ultrasonography(US)has a central and multifaceted role.Gray-scale US is routinely utilized for measurement of significant outcome parameters(prostatic volume,intra-vesical prostatic protrusion and post-void residual volume)before and after PAE.Improvement of these parameters may become more obvious onemonth post-PAE,or later.Contrast-enhanced US(CEUS)with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts(as enhancement defects)immediately post-PAE and monitor their resolution over time.The volume of prostatic infarcts can also be measured and compared to prostatic volume.Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and(at least in some patients)of clinical success.CEUS can also be performed intraoperatively in the angio-suite,for on-site evaluation of the ischemic effect;a variation of this technique,with intraarterial(instead of intravenous)administration of diluted echo enhancer,can also be applied intraoperatively,to map the embolized territory and to prevent non-target embolization.Initial experience with USelastographic techniques(shear-wave and strain elastography)has shown that they can detect and quantify the improvement of tissue elasticity post-PAE,thus providing new insights into the therapeutic mechanisms of this treatment.With utilization of high-end equipment,experience and standardized imaging protocols,US could be the primary modality for imaging evaluation of PAE.