Case of the Month: Prostate Embolization

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A CT angiogram of a male patient presented to the 3DQ Lab with benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland which is common in aging men. This enlargement may cause lower urinary tract symptoms (LUTS) which include frequent urination and the inability to empty the bladder.

The clinical team requested 3D visualization of the prostate and pelvic vasculature to aid in planning a prostatic artery embolization (PAE). PAE is a minimally invasive procedure that uses iliac artery access near the groin to deliver tiny particles into the arteries supplying the prostate, reducing blood flow. This leads to gradual shrinkage of the prostate, alleviating urinary symptoms caused by the enlargement. As a non-surgical option, PAE provides effective symptom relief with fewer risks, making it a suitable alternative for patients unable to undergo surgery.

A CT angiogram of the pelvis with IV contrast was acquired, providing high-resolution images of both bony and soft tissue structures. A 3DQ Lab technologist segmented the prostate and pelvic arteries and created targeted views of the anatomy. Prostate volume was calculated based on the segmentation, revealing a significantly enlarged prostate measuring approximately 262 mL. For context, a normal prostate volume is typically less than 30 mL. Such an enlargement of the prostate might put pressure on the bladder making it difficult to urinate and empty the bladder. Volume calculation also provides baseline data for assessing treatment outcomes, such as post-embolization shrinkage.

Targeted views of the anatomy included Curved Planar Reformations (CPRs) of the iliac arteries for evaluation of the vessel pathways in three dimensions. These images provide a view of the vessel’s path and potential obstructions, enhancing the interventional team’s ability to plan catheterization routes and anticipate complications.

Imaging revealed severe atherosclerosis and stenosis in the iliac arteries, complicating catheter navigation. Atherosclerosis, the buildup of fatty deposits inside artery walls, and stenosis, the abnormal narrowing of blood vessels, restrict catheter movement, posing potential challenges during the procedure.

The imaging provided was aimed to streamline the anatomical assessment and enhance the catheterization strategy for the PAE procedure.

Below is the imaging provided to the interventional team.

Learn more about techniques highlighted in this article:

Batching

Computed Tomography (CT)

Curved Planar Reformations (CPRs)

Maximum Intensity Projection (MIP)

Segmentation