RadteraCTA Prostatic Arteries (PAE Planning)
CTA+ ContrastVascularAbdomen & Pelvis
Indications
- Pre-procedural mapping before prostatic artery embolization (PAE) for BPH
- Identify prostatic artery origins, variants, tortuosity and atherosclerosis
- Identify dangerous anastomoses (rectal, vesical, penile) before embolization
Patient prep
- Screen eGFR/contrast allergy
- Consider sublingual nitroglycerin immediately before scanning (vasodilates small pelvic arteries and improves prostatic artery conspicuity) if no contraindication
- IV access 18-20 G; supine, arms up
Contrast
Agentiodinated (e.g. iohexol 350 or iopamidol 370)
RouteIV
Dose≈100-125 mL at 4-5 mL/s with saline flush
TimingBolus tracking in the distal aorta/at the bifurcation, trigger ~120-140 HU; late arterial acquisition
Technique
- Coverage aortic bifurcation (or renal arteries if access planning needed) through the symphysis/lesser trochanters
- Thin 0.5-0.75 mm isotropic recon — prostatic arteries are ~1-2 mm; thin data is the whole game
- Oblique MIP/VR reconstructions reproducing fluoroscopic working angles (ipsilateral anterior oblique ~35-45° with ~10° caudal angulation) to display each prostatic artery origin as the interventionalist will see it
- Document origin, course, accessory prostatic arteries, and anastomoses for each side
Series / Sequences
| # | Series / Sequence | Plane | Thickness | Notes |
|---|---|---|---|---|
| 1 | Late arterial axial source | axial | 0.5-0.75 mm | Pelvic arterial tree |
| 2 | Oblique MIP (fluoro working angles) | oblique | thin-slab MIP | ~35-45° ipsilateral anterior oblique + ~10° caudal per side |
| 3 | 3D VR pelvis | 3D | VR | Internal iliac branching overview |
Key points
- Prostatic artery origin is highly variable (internal pudendal, superior vesical, obturator, gluteal-pudendal trunk) and frequently differs between sides — pre-mapping shortens procedure and fluoroscopy time substantially
- Report dangerous anastomoses to rectal, vesical and penile arteries — they change embolization technique
- Nitroglycerin improves visualization of these small arteries
- Atherosclerotic iliac disease and tortuosity affect access planning — include it in the report
References
• CIRSE Standards of Practice on Prostatic Artery Embolisation (Cornelis et al., CVIR 2020) link
• RadioGraphics: Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment (Picel et al., 2019) link
• Radiopaedia: Prostatic artery embolization link
• RadioGraphics: Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment (Picel et al., 2019) link
• Radiopaedia: Prostatic artery embolization link
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.