The purpose of this study was to prospectively evaluate whether quantitative variables obtained using computed tomography (CT) perfusion and dual-energy CT (DECT) can predict 3-month clinical success after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Thirty-eight men (mean age, 74.1 ± 9.2 [standard deviation (SD)] years; mean prostate volume, 107.7 ± 45.1 [SD] mL) with symptomatic BPH underwent CT perfusion and DECT (venous phase at 80 s; delayed phase at 3 min) before PAE. Quantitative variables included the perfusion integrated total enhancement (ITE), delayed-phase iodine charge, and venous-to-delayed iodine charge ratio. Clinical success was defined as the removal of an indwelling catheter or a reduction of at least 25 % in the International Prostate Symptom Score (IPSS) and/or an improvement of at least one point in quality of life (QoL) after three months. Statistical analyses included group comparisons, receiver-operating characteristic (ROC) analysis, and targeted multivariable logistic regression analysis.

Clinical success was achieved in 31/38 patients (82 %). Patients with successful PAE had a significantly greater ITE (0.117 ± 0.175 [SD]) and a higher venous-to-delayed iodine charge ratio (0.886 ± 0.138 [SD]) than those with failed PAE (0.051 ± 0.020 [SD], and 0.650 ± 0.096 [SD], respectively; P = 0.018 and P < 0.001, respectively. Venous-to-delayed iodine charge ratio yielded 81 % sensitivity (95 % confidence interval [CI]: 62–93), 100 % specificity (95 % CI: 59–100) and an area under the ROC curve (AUC) of 0.931 (95 % CI: 0.850–1.000) to predict clinical success of PAE. In multivariable analysis, the venous-to-delayed iodine charge ratio remained an independent predictor of PAE success ( P = 0.030).

The CT-derived venous-to-delayed iodine charge ratio is a promising noninvasive biomarker for predicting clinical success after PAE in patients with BPH. These findings could improve patient selection and personalize BPH management.