Cone Beam CT with Automatic vessel Detection Software versus Conventional 2D Fluoroscopy with Overlay for Prostate Artery Embolization: A Comparison of Prostatic Artery Catheterization Time and Radiation Exposure

Abstract

Abstract Purpose To evaluate the effect of cone-beam computed tomography (CT) with automatic vessel detection software on prostate artery catheterization and fluoroscopy time in prostate artery embolization (PAE). Methods Fifty patients undergoing PAE for BPH were enrolled in this prospective study. Twenty-five PAEs were performed using automatic vessel detection software with syngo embolization guidance (study) and were compared with 25 PAEs performed using conventional two-dimensional (2D) fluoroscopy with overlay (control). PAE was performed using 300–500 μm trisacryl gelatin spherical particles. The primary outcome parameters were prostatic artery catheterization time and fluoroscopy time. Results Bilateral PAE was achieved in 24/25 cases in both groups. The median right and left prostatic artery catheterization times were similar between the two groups, (p = 0.473 and p = 0.659, respectively). The median fluoroscopy time (28.0 and 42.0 minutes, p = 0.046) and total procedure time (70.0 and 118.0 minutes, p < 0.001) were shorter in the study group. The median total dose area product (DAP) was not significantly different. However, the median CBCT DAP (11406 vs. 6248, p < 0.001) was higher in the study group, while median fluoroscopy DAP (7371 vs. 8426, p < .049) was higher in the control group. Median digital subtraction angiography (DSA), CBCT, and fluoroscopy DAP accounted for 27%, 45%, and 29% of the total DAP in the study group and 32%, 29%, and 39% in the control group (p < 0.001), respectively. All complications were Clavien–Dindo Grade 1. Conclusion Although CBCT with automatic vessel detection software had no significant effect on time-to-prostatic artery catheterization and total radiation exposure, it reduced the fluoroscopy time and procedure time.