Résumé
Considering the growing interest of practitioners and patients for prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH), and the evidence of efficacy and safety of this treatment, we wanted to understand why this procedure does not work in some patients, and especially to find out some predictive factors of the clinical success of the procedure. We tried to use dynamic contrast enhanced MRI to identify which patient might respond to embolization therapy. Material and method: consecutive patients who underwent unilateral or bilateral prostatic artery embolization between April 2017 and September 2020 at Nimes university hospital were included in this study. Exclusion criteria were as follows: prostatic artery embolization performed for prostatic adenocarcinoma, missing clinical or imaging follow-up data after embolization, missing clinical data about the low urinary tract symptoms (LUTS) before embolization, failed catheterization of at least one prostatic artery (absence of prostatic artery, anatomic variant that avoid catheterization, artery too thin to be catheterized), no MRI with dynamic contrast enhanced sequences before embolization. PAE was considered a clinical success if the IPSS score decreased of at least 25% compared to the baseline IPSS score or if the QoL scale increased of at least one point compared to the baseline score or in case of removal of bladder catheter for patients with indwelling bladder catherization. The primary endpoint was the difference of the values of the 9 main perfusion parameters between patients of the "clinical success" and of the "clinical failure" groups. Results: 54 patients were included in the analysis, 43 patients were classified as “clinical success” and 11 patients as clinical “failure”. The patient age at time of the procedure was significantly higher in the failure group, and 2 perfusion parameters : the area under the perfusion curve AUC and the transfer constant Ktrans, was significantly higher in the success group. Conclusion: perfusion parameters given by DCE-MRI, combined with the age of the patient, can be used, with a very strong correlation, to predict the clinical success before PAEin the context of BPH.