Impact of pelvic magnetic resonance imaging findings in the indication of uterine artery embolization in the treatment of myoma

Abstract

Objectives: To assess the impact of pelvic magnetic resonance imaging (MRI) findings in the indication for uterine-artery embolization in women with fibroids, as well as the correlation between MRI and ultrasound (US) examinations for diagnosing adenomyosis. Material and methods:A retrospective observational study was performed through the analysis of the medical records of 263 women referred for uterine-artery embolization as treatment for fibroids after undergoing US and MRI examinations. To compare uterine volume and fibroid measurement in US and MRI, the Wilcoxon test was used; for the number of fibroids, the McNemar test was used. The kappa coefficient was used to evaluate the correlation between US and MRI findings for diagnosing adenomyosis. Results:The mean age of patients was 37.9 ± 6.8 years and 191 (72.6%) were nulliparous. Forty-three patients with adenomyosis associated with fibroid were diagnosed by MRI; US indicated the presence of adenomyosis in 12 (4.56%) women. There was agreement between MRI and US in the diagnosis of adenomyosis in 218/263 (82.9%) patients (p < 0.05). In the US examination, the mean uterine volume was lower (389 ± 340.8 cm³) than that observed in MRI (472.2 ± 415.9 cm³; p < 0.001). Regarding the number of fibroids, MRI showed a greater number of patients with multiple fibroids (68.8% vs. 57.4%, MRI and US, respectively; p < 0.001). Conclusions:In women with fibroids referred for uterine-artery embolization, MRI findings led to the revision of the initial diagnosis in 17.1% cases. US showed a lower sensitivity for diagnosing adenomyosis than MRI.

Deep learning-accelerated T2-weighted imaging versus conventional T2-weighted imaging in the female pelvic cavity: image quality and diagnostic performance

“…Leiomyoma in the uterus is a frequent finding, with a prevalence of 4.5%-68.6% in women of reproductive age (3,4). MRI can provide information such as the number, location, and size of leiomyomas for treatment planning (5)(6)(7). Furthermore, because leiomyomas have characteristic MRI features, they can be differentiated from other lesions on MRI.…”

Diagnostic imaging in gynecology

“…The gynecological imaging "gold standards" are ultrasound (US), computed tomography (CT) and magnetic resonance imaging 1 (MRI). These methods are useful for determining the site of origin of a pelvic mass and to characterize the adnexal lesions [3][4][5][6][7][8][9][10].…”

Non-invasive therapeutic use of High-Intensity Focused Ultrasound (HIFU) with 3 Tesla Magnetic Resonance Imaging in women with symptomatic uterine fibroids

“…Larger target volumes are usually covered with multiple heating episodes repeated over time. This is opposite to uterine artery embolization, where the effect is very fast and usually causes many suddenly appearing, unwanted side-effects [5,9,10].…”

“…Laparoscopic myomectomy and the increasing use of robotic technology for endoscopic procedures could also improve patient outcomes, including decreased recovery time [6]. However, since UAE and MRI guided HIFU are newer techniques compared to surgical myomectomy, it is likely that the increased provider experience coupled with technical innovations could result in significant improvement as these technologies mature [5][6][7].…”

“…It is important to note that as many as 27% of patients undergoing myomectomy may have recurrent fibroids within 10 years after surgery [3]. Several treatment options are now available for women with symptomatic uterine fibroids, ranging from surgical treatment such as hysterectomy and myomectomy, to minimally invasive laparoscopic techniques, uterine arteries embolization (UAE) or medical therapy [4,5]. In current clinical practice, uterus-conserving therapy is the standard of care for premenopausal patients with localized myomas.…”