Purpose <p>To investigate whether post-prostate artery embolization (PAE) magnetic resonance imaging (MRI) can predict clinical outcomes at 1 year.</p> Materials and Methods <p>Retrospective study of 63 consecutive patients undergoing microsphere PAE for benign prostatic enlargement. Clinical assessments were performed with the International Prostate Symptom Score (IPSS), quality of life (QoL) scores, and non-invasive urodynamics. MRI was performed at baseline and 3-month post-PAE: intravesical protrusion, prostate volume (PV), and infarction volumes were measured with semi-automated volumetry. Clinical success was defined as (1) a reduction of IPSS to &lt; 9 and QoL score to &lt; 3 or (2) freedom from urinary catheter in catheter-dependent patients. Statistical modeling was performed with multivariate logistic regression.</p> Results <p>Sixty-three patients were included. Median PV 116&#xa0;ml (IQR 85–153); median PV reduction 26% (IQR 19–45) at 3&#xa0;months. Presence of infarction on 3-month MRI was associated with clinical success at 12&#xa0;months (OR = 1.15, 95% CI: 1.04–1.36, <i>p</i> = 0.025). A receiver operator curve analysis of infarct volume returned an area under the curve of 0.77 (CI 0.66–0.89) and indicated that an infarct volume ≥ 5% had a sensitivity of 72% and specificity of 80% to predict clinical success. PV reduction did not show statistically significant correlation with clinical success (<i>p</i> = 0.348, 95% CI: 0.98–1.08). A lower baseline IPSS was correlated with better clinical outcomes (OR 0.78; 95% CI 0.64–0.91; <i>p</i> = 0.003). Other clinical and anatomical variables including intravesical protrusion were not correlated with clinical outcomes.</p> Conclusion <p>Lower baseline IPSS and presence of infarction of &gt; 5% on 3-month post-PAE MRI were associated with better clinical outcomes at 12&#xa0;months.</p> Graphical Abstract <p></p>