To investigate the application value of 3D rotational DSA in prostate artery embolization (PAE).

A total of 73 cases of patients with benign prostatic hyperplasia (BPH) treated with PAE were selected in the Department of Interventional Therapy, The Fifth Affiliated Hospital of Zhengzhou University from August 2016 to June 2020. All patients were accepted conventional two-dimensional DSA (2D-DSA). Subsequently, focusing on the orthotopic blood vessel image, the image was acquired by rotating the C-arm, and the acquired imageswere sent to the 3D workstation to complete the reconstruction of the prostate artery. All pictures were reviewed by two physicians with advanced professional titles in the Department of Interventional Therapy. The number, origin, and anastomotic branch with adjacent arteries of the prostatic arteries in conventional 2D-DSA and 3D rotational DSA imaging were observed.

The Kappa value of 2 doctors in the interventional department reading the film to identify the consistency of the prostate artery was 0.734. 148 prostate arterieswere demonstrated in 142 lateral internal iliac arteries by conventional 2D-DSA and 3D rotational DSA. The 3D rotational DSAdemonstrated 143 (96.62%, 143/148), while the conventional 2D-DSA demonstrated 116 (78.38%, 116/148), the difference was statistically significant (χ² = 22.517, P < 0.001). 28 (18.92%, 28/148) prostate arteries in 26 lateral internal iliac arteries (18.31%, 26/142) were only identified by the 3D rotational DSA, while 4 (2.82%, 4/142) in 4 lateral internal iliac arteries were only identified by the conventional 2D-DSA, the difference was statistically significant (χ² = 20.182, P < 0.001). 6 (4.92%, 6/122) prostate arteries were indentified by the conventional 2D-DSA while excluded by 3D rotational DSA. The origins of 10 prostate arteries in 9 lateral internal iliac arteries (6.16%, 9/146) were only accurately identified by 3D rotational DSA. 57 prostate arteries which were anastomose with adjacent arteries were accurately identified by 3D rotational DSA, which was higher than that of the conventional 2D-DSA (27.59%, 32/116), the difference was statistically significant (χ² = 4.278, P = 0.039). By analysis of 3D rotational DSA image, the optimal projection angle of 143 prostate arteries (the patient's body was inclined to the same side) was 20°~45°, among which, the optimal projection angle of 61 (42.66%, 61/143) prostate arterieswas31°~35°, and then was 26°~30°, which was 38 (26.57%, 38/143).

3D rotational DSA applied in PAE surgery can more clearly identify the number and origin of prostate artery and its complex anatomical structure. Therefore, it is of great significance to improve the effect of embolization.