Role of MR Imaging of Uterine Leiomyomas before and after Embolization

Abstract

Leiomyoma, the most common uterine neoplasm, is composed of smooth muscle with varying amounts of fibrous connective tissue. Most leiomyomas are asymptomatic, but patients may present with abnormal uterine bleeding or bulk-related symptoms. Over the past decade, uterine fibroid embolization (UFE) has been an effective minimally invasive treatment for symptomatic patients. Magnetic resonance (MR) imaging is the most accurate imaging technique for detection and evaluation of leiomyomas and therefore has become the imaging modality of choice before and after UFE. As leiomyomas enlarge, they may outgrow their blood supply, resulting in various forms of degeneration that change their appearance. Leiomyomas are classified as submucosal, intramural, or subserosal. Submucosal and subserosal leiomyomas may be pedunculated, thus simulating other conditions. Understanding the MR imaging appearance of leiomyomas allows differentiation from other entities. The superior tissue contrast of MR imaging allows diagnosis of leiomyomas with a high level of confidence, ultimately leading to a decrease in the number of surgeries performed and thus reducing healthcare expenditures. MR imaging findings that influence the planning of UFE include the location, size, number, and vascular supply of leiomyomas. In addition, MR imaging can be used to assess the success of UFE and evaluate for potential complications.

The contribution of Magnetic Resonance Imaging in the differential diagnosis between leiomyoma typical, atypical and uterine sarcomas: Personal experience

“…A particular subtype of leiomyomas is represented by cellular leiomyomas which are composed of compact smooth muscle cells and by a poor or absent connective component [4] . The uterine sarcomas are rare tumors representing approximately 1% of female genital neoplasms and 3%-7% of all uterine cancers [5] .…”

“…[8] Adenomyosis and malformation of mullerian ducts [4] high levels of total LDH, and/or isoforms (3, 4 and/or 5) …”

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

“…Another session of embolization was planned however patient experienced symptomatic relief following first session of UFE with no indication for further interventionCurrently, there is conflicting data in the literature in regards to fibroid enhancement as a predictor of UAE response. Deshmukh et al (14) argued that UFE is not considered the most treatment choice for patients with non-enhancing symptomatic leiomyomas at pre-procedural imaging, as these de-vascularized leiomyomas are less likely to reduce in size following treatment concomitant with less symptomatic improvement. Thus, hysterectomy or myomectomy may be better options especially if the patient's complaint is likely due to bulk effect.…”

Preprocedural MRI and MRA in planning fibroid embolization

“…Practical relevance to UAE: Hypovascular fibroids may not show volume reduction with UAE, and therefore symptom relief is less likely (19). Fibroids with high T2-weighted SI and intense gadolinium enhancement tend to respond better to UAE, whereas fibroids with increased T1-weighted SI and less gadolinium uptake may not shrink significantly following UAE.…”