Comparison of MRI and Sonography in the Preliminary Evaluation for Fibroid Embolization

Spielmann, Audrey L.; Keogh, Ciarán; Forster, Bruce B.; Martin, Michael; Machan, Lindsay

doi:10.2214/ajr.05.1476

Cited by 70 publications

(21 citation statements)

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“…Spielmann et al (12) within his study upon 49 patients with leiomyomas compared MR imaging and US prior to performing UFE in terms of uterine and leiomyoma volume, leiomyoma location, and total number of leiomyomas. The study found out a significant contradiction in uterine size, leiomyoma location, as well as number of leiomyomas between the two imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

Aly

Abdullah²,

Botros³

2018

The Egyptian Journal of Hospital Medicine

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Background: uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short and midterm outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures. Aim of the Work: t this study aimed to review and illustrate the role of MR imaging in the pre-and post-procedural assessment for uterine fibroid patients undergoing uterine artery embolization. Patients and Methods: the current study was carried out in Radiodiagnosis Department, Faculty of Medicine, Ain shams University and specialized private radiology centers during the period between April 2017 and December 2017. It included 30 patients that were referred from gynecology clinic with their ultrasonographic reports to Radiodiagnosis Department, body imaging unit with a view to carry-out pelvic MRI with contrast. Results: imaging follow-up via pelvic MRI with contrast was obtained in 30 patients at 3, 6 months after treatment. The mean uterine volume was reduced by 25% (standard deviation was SD 0.03763) 3 months after treatment and was further reduced by a mean of 30% (SD 0.02638) by six months after treatment. Post-procedural subtraction MRI revealed mean myoma enhancement to be 5.6 + 0.5 SI in contrast to 133.4 + 18.3 SI prior to UFE. The mean dominant fibroid volume reduced by 34 % (SD 0.09247) after 3 months, 44 % (SD 0.05994) after 6 months. A cumulative reduction in both uterine and dominant leiomyoma mean volume from baseline to 6 months post -UAE was evident with significant interval changes between 3, 6 months follow up (p 0.000) Conclusion: the MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities was typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE. Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work.

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Section: Discussionmentioning

confidence: 99%

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

Aly

Abdullah²,

Botros³

2018

The Egyptian Journal of Hospital Medicine

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“…Although MRI is reported to be the superior imaging modality and provides additional clinical information when used in women undergoing UAE, it is expensive and not readily available in all units. [14] Furthermore, a policy of routine MRI use in SA public hospitals prior to UAE is likely to increase costs (directly and indirectly) and waiting times for treatment.…”

Section: Discussionmentioning

confidence: 99%

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

et al. 2017

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RESEARCHBackground. Symptomatic uterine fibroids have a significant impact on women's health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels (p=0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus. The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital Uterine fibroids, also known as leiomyomas, are the most commonly occurring benign tumours of the uterus.[1] Symptomatic fibroid tumours have a major negative impact on the woman's quality of life and reproductive potential.[2] Great health disparities exist worldwide, with African black women experiencing earlier debilitating symptoms and more varied responses to treatment compared with their white counterparts. [3,4] The economic burden of treating symptomatic women is substantial. A recent total cost estimate (direct and indirect) by Soliman et al.[5] in a 2015 systematic review, ranges from USD11 717 -USD25 023 per patient per year after diagnosis or surgery. The true economic impact on South African (SA) public health systems is likely to be higher than the average estimates owing to high disease burden, limited access to treatment, longer waiting times for surgery, low hysterectomy uptake and the presence of severe symptoms among African black women. [4] Surgical management (hysterectomy or myomectomy) has traditionally been the mainstay of treatment (Fig. 1). Recently, umbilical artery embolisation (UAE) and magnetic resonanceguided high-intensity focused ultrasound (MR-g HIFU) has emerged as both an attractive and effective treatment.[6] UAE has proven to be safe and an e...

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“…Özellikle tedavisi farklı olan difüz adenomyozisin myomdan ayırımı MR ile kolayca yapılabilir [30,31]. UAE adayları işlem öncesinde işlem başarısı ve komplikasyonları etkileyeceği için, yerleşim, boyut, pedikül varlığı ve adenomyozis açısından MRG ile değerlendirme yapılmalıdır (Resim 2).…”

Section: Uterin Arter Embolizasyonu (Uae)unclassified

“…Erken dönemde T2A görüntülerde heterojen intensite izlenirken zamanla likefaksiyon nekrozunun belirginleşmesiyle T2 sinyali artar. UAE sonrası myomlarda %42-83 arasında değişen oranlarda boyut azalması bildirilmiştir [31]. Uterus boyutlarında ise %43-58 oranlarında değişen azalmalar bildirilmiştir.…”

Section: Uterin Arter Embolizasyonu (Uae)unclassified

Uterin Myomlarda Radyolojik Görüntüleme

Değirmenci¹,

Kara²

2015

Trd Sem

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Comparison of MRI and Sonography in the Preliminary Evaluation for Fibroid Embolization

Abstract: MRI provided considerable additional information compared with sonography and affected clinical decision making in a substantial number of patients. MRI should be considered in all patients being evaluated for uterine artery embolization.

Cited by 70 publications

References 24 publications

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

Uterin Myomlarda Radyolojik Görüntüleme

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