Symptomatic Fibroleiomyomata: MR Imaging of the Uterus before and after Uterine Arterial Embolization

TLDR

The study aimed to characterize MR imaging changes in uterine fibroleiomyomata following uterine arterial embolization and to identify pretreatment imaging predictors of procedural success. MR imaging was performed on 31 patients before and 3 months after UAE, with up to five fibroleiomyomata per patient (125 total) assessed for volume, location, signal intensity, and vascularity using T1/T2‑weighted and dynamic gadolinium‑enhanced sequences and region‑of‑interest curves. UAE produced significant reductions in uterine and fibroleiomyoma volumes, hemorrhagic infarction‑like signal changes, and vascularity, with submucosal location and pre‑embolization hypervascularity predicting greater volume reduction and procedural success, demonstrating that pretreatment MR imaging can forecast UAE outcomes.

Abstract

To determine the magnetic resonance (MR) imaging features of uterine fibroleiomyomata after uterine arterial embolization (UAE) and identify pretreatment MR imaging features that may be predictive of successful UAE.T1- and T2-weighted and dynamic gadolinium-enhanced T1-weighted images were obtained before and 3 months after UAE in 31 patients. Up to five fibroleiomyomata (total of 125) were evaluated for volume, location, signal intensity characteristics, and vascularity. Region-of-interest curves were used to assess the vascular enhancement pattern of each fibroleiomyoma and adjacent myometrium. Each patient completed a questionnaire on symptoms 3 months after UAE.UAE resulted in significant reductions in mean uterine volume (from 588.6 to 393.1 cm(3)) and mean fibroleiomyoma volume (from 69.4 to 41.4 cm(3)) (P <.005). After UAE, lesions showed signal intensity changes consistent with hemorrhagic infarction. The vascularity of fibroleiomyomata was decreased (P <.001), with no significant change in myometrial vascularity. Submucosal location was a strong positive predictor of fibroleiomyoma volume reduction (P < 001). When a reduction in vascularity was the measure of success, hypervascularity was a strong indicator of success (P <. 005).MR imaging is useful for quantitative assessment of signal intensity and morphologic changes before and after UAE. Pretreatment MR imaging findings may help predict the success of the procedure.