Chen WANG, Kun LİANG, Jiasheng QIN, Xin SHU, Lihua YUAN, Jianfei DONG
Diagnostic and Interventional Radiology - 2026;32(4):463-472
PURPOSE To evaluate whether baseline multiparametric magnetic resonance imaging (mpMRI)-defined prostate morphological phenotypes are associated with changes in the International Prostate Symptom Score (DeltaIPSS) and maximum urinary flow rate (DeltaQmax) following prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). METHODS This retrospective single-center study included patients who underwent technically successful PAE with preprocedural mpMRI performed within 8 weeks of intervention. Prostate morphology was classified as glandular-dominant, stromal-dominant, or mixed phenotype based on the predominant nodule signal characteristics on T2-weighted imaging (T2WI), with supplemental assessment using diffusion-weighted and contrast-enhanced sequences when available. Symptomatic and functional outcomes-DeltaIPSS and DeltaQmax-were assessed at 3, 6, 12, and 24 months post-procedure. Associations between morphology and outcomes were evaluated using multivariable regression and subgroup analysis. RESULTS A total of 152 patients (mean age, 70.0 +/- 9.9 years) who underwent technically successful PAE were included in the study, all of whom had preprocedural MRI performed within 8 weeks prior to the intervention. All MRI-defined morphological phenotypes demonstrated improvements in the Qmax and IPSS after PAE. The glandular-dominant phenotype exhibited the most pronounced and earliest response, with peak improvements at 6 months (DeltaQmax: 10.45 mL/s; DeltaIPSS: 14.11 points) and sustained benefits through 24 months (DeltaQmax: 8.78 mL/s; DeltaIPSS: 13.04 points). Stromal-dominant and mixed phenotypes showed smaller, delayed improvements, typically peaking at 12 months. Morphology-related phenotype differences remained statistically significant at 24 months in unadjusted comparisons, particularly between glandular and stromal phenotypes, although DeltaIPSS differences were attenuated in multivariable models (24-month beta: 0.104, P = 0.547). Glandular morphology was consistently associated with a greater DeltaQmax across all timepoints (e.g., 24-month beta: 0.450, P < 0.001) and significantly interacted with baseline symptom severity (IPSS >= 20) to predict enhanced 24-month DeltaIPSS (interaction beta: 0.349, P = 0.045). Subgroup analyses stratified by prostate volume (< 80 vs. >= 80 mL) corroborated these findings, with glandular morphology consistently outperforming that of stromal and mixed phenotypes. CONCLUSION Baseline MRI-defined prostate morphology, assessed primarily on T2WIs, was significantly associated with clinical outcomes after PAE; glandular-dominant morphology was linked to larger and more sustained improvements in both the Qmax and IPSS. Therefore, MRI-based phenotypes offer a practical imaging biomarker for patient stratification, warranting prospective validation.
