Uterine artery embolization for symptomatic fibroids with imaging follow up

Abstract

The aim of this study was to determine the effectiveness of uterine artery embolization (UAE) as a primary treatment method in treatment of symptomatic fibroids, whether there are any preembolization MRI characteristics of fibroid predictive of reduction in volume and assess reduction in uterine and dominant fibroid volumes using ultrasound (US) and MRI. Study was carried out in total of 32 patients aged 25-49 years (mean 40.9 years). Uterine and dominant fibroid volume were determined using US and MRI before UAE, MRI and US at 3 months and US alone at 6 and 12 months post-UAE, supplemented by clinical evaluation at interval of 3, 6 and 12 months. Procedure was carried out through unilateral femoral puncture using poly vinyl alcohol (PVA) particles 355-500 microm in size. All 32 patients had successful procedures. Overall, 25 patients responded, giving a clinical success rate of 78.12%. Mean reduction in volume of uterus and fibroid was 33 and 59.7% and 48.9 and 75.5% on US at 3 and 12 months respectively, and 33.3 and 58.6% on MRI at 3 months. Volume reduction on US and MRI at 3 months was highly correlative. There was no statistical difference in size reduction in volume of fibroids, which were hypointense or hyperintense on T2-weighted image (T2WI) on pre-UAE MRI. Uterine artery embolization leads to good technical success and fibroid volume reduction. Ultrasound alone may be used for follow up of patients post-UAE. Preprocedure signal characteristics on T2WI are not predictors of volume reduction after UAE.

Diffusion‐weighted imaging for prediction of volumetric response of leiomyomas following uterine artery embolization: A preliminary study

“…Two studies have demonstrated that T2 hyperintensity of leiomyomas correlated with higher volumetric response (6, 7). Our study, however, does not show a correlation between relative T2 signal intensity and volume response, similar to Jain et al (10). Discrepancy in our results may be related to differences in T2W imaging parameters (e.g., magnetic field strength, repetition time/echo time), the use of relative signal intensity ratios as opposed to subjective assessment of signal intensity, differences in composition of fibroids included in this study population and small sample sizes.…”

“…Although, studies have shown that size and fibroid location may relate to volume reduction, thus far, no studies have demonstrated significant correlation between degree of enhancement and volume reduction (6, 7). Some studies have shown that high T2 signal correlated positively with volume reduction in a small number of patients but other studies have shown no such correlation T2 (6, 7, 10).…”

Uterine Artery Embolization for Symptomatic Fibroids with High Signal Intensity on T2-Weighted MR Imaging

“…Both studies enrolled patients with multiple fibroids; 18 patients with 32 leiomyomas and 11 patients with 45 leiomyomas, respectively. However, others reported no correlation between T2WI SI and leiomyoma volume reduction after UAE (19, 20). Most studies regarding fibroids and T2WI SI have included multiple myomas in each patient.…”

Uterine Fibroids and Adenomyosis: Imaging and Treatment

“…[29][30][31] Some studies have tried to evaluate whether certain MRI characteristics relate to success, with many suggesting high T2-weighted signal intensity is associated with greater volume reduction or improvement of symptoms, 25,[32][33][34][35][36][37] although others have not found statistical significance. 24,38,39 High T1-weighted signal intensity has been proposed to be associated with lower volume reduction, 22,32 although it also has been found not to be associated with lower volume reduction. 26 Many studies report that enhancement is not necessarily associated with greater volume reduction, 24,25,32,39 although one has found significance.…”