Quantitative CT biomarkers for predicting clinical outcomes after prostatic artery embolization: Results of the prospective pilot EMBOPERF study - 21/05/26
, Djamel Dabli a, Fabien De Oliveira a, Chris Serrand b, Paul Segui a, Tarek Kammoun a, Ghizlane Touimi Ben Jelloun a, Houssem Loukil a, Adrien Zoppardo a, Maxime Pastor a, Joël Greffier a, Florence Longueville a, Jean-Paul Beregi a, Stéphane Droupy c, Julien Frandon aHighlights |
• | The venous-to-delayed iodine charge ratio, as measured with dual-energy CT, shows excellent discrimination in predicting 3-month clinical success of prostatic artery embolization in patients with benign prostatic hyperplasia (AUC, 0.931; sensitivity, 81 %; specificity, 100 %). |
• | The perfusion integrated total enhancement demonstrates good performance (AUC, 0.793) in predicting the clinical success of prostatic artery embolization in patients with benign prostatic hyperplasia. |
• | In multivariable analysis, the venous-to-delayed iodine charge ratio is a significant, independent predictor of the clinical success of prostatic artery embolization in patients with benign prostatic hyperplasia ( P = 0.030). |
Abstract |
Purpose |
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).
Materials and methods |
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.
Results |
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).
Conclusion |
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.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Benign prostatic hyperplasia, Dual-energy CT, Perfusion imaging, Predictive biomarker, Prostatic artery embolization
Abbreviations : AUC, BPH, BV, CI, CT, CTDIvol, DECT, DLP, HU, IPSS, ITE, MRI, PAE, QoL, ROC, SD, TTP
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