147 - Qualitative Grading of Prostatic Artery Visualization on CTA and Association with Clinical Outcomes After Prostatic Artery Embolization

Purpose: Accurate assessment of prostatic arteries (PA) is essential prior to prostate artery embolization (PAE). However, measurement of PA caliber on CTA is limited by vessel size and resolution. This study investigated whether a qualitative PA visualization grading system on CTA correlates with clinical outcomes after PAE.

Materials and Methods: A retrospective chart review was conducted on patients who underwent PAE between March 2012 and October 2023 with available pre-procedure CTA and follow-up clinical outcomes. Each PA was scored on a 0–4 scale according to distal extent of visualization: 0 = not seen, 1 = proximal only, 2 = to gland edge, 3 = branching at gland level, 4 = branching within gland. Scores from both sides were summed (0–8) and categorized as poor (0–3), moderate (4–5), or well-visualized (6–8). Prostate volume was calculated by the ellipsoid method. Clinical outcomes included International Prostate Symptom Score (IPSS) at baseline, 3–6 months, and 12 months. Associations between PA score, prostate volume, and symptom improvement were assessed with linear regression, Kruskal-Wallis, and pairwise Wilcoxon tests.

Results: A total of 134 patients were included. Mean prostate volume was 121.0 ± 58.7 cc. Baseline IPSS was 21.3 ± 7.0. Median PA visualization score was 5 (Q1-3: 4-7); 24 patients (17.9%) had poor, 51 (38.1%) moderate, and 59 (44.0%) well-visualized CTAs. At 3–6 months, higher PA scores were associated with greater IPSS reduction (p = 0.027). Pairwise analysis showed significant difference between poor and well groups (p = 0.018), but not between poor vs moderate (p = 0.093) or moderate vs well (p = 0.427). At 12 months, there was a trend toward greater IPSS improvement in the well-visualized group, although the overall difference did not reach significance (p = 0.077) and no statistically significant difference was found in pairwise comparisons. Linear regression demonstrated a significant positive correlation between prostate volume and PA visualization score (p < 0.001).

Conclusion: A qualitative grading system for PA visualization on CTA may stratify patients undergoing PAE and correlate with early IPSS improvement. If validated in larger cohorts, this approach could serve as a practical tool for pre-procedure planning and patient selection.