Korean J Radiol.  2012 Oct;13(5):618-624. 10.3348/kjr.2012.13.5.618.

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

• Chang S
• Kim MD
• Lee M
• Lee MS
• Park SI
• Won JY
• Lee DY
• Lee KH

• KMID: 1392941
• DOI: http://doi.org/10.3348/kjr.2012.13.5.618

Abstract

OBJECTIVE
To evaluate the effectiveness of uterine artery embolization (UAE) for treating symptomatic fibroids with high signal intensity (SI) on magnetic resonance (MR) T2-weighted imaging (T2WI).
MATERIALS AND METHODS
A total of 537 cases, consisting of 14 patients with high SI fibroids on T2WI (T2 high group), were retrospectively included and compared with 28 randomly selected patients with low SI fibroids on T2WI (control group). High SI of a predominant fibroid on T2WI was defined as having the same or higher SI than the myometrium. Patient ages ranged from 28 to 52 years (mean, 38.1 years). All patients underwent MRI before and after UAE. Predominant fibroid and uterine volumes were calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, with 0 being no symptoms and 10 being the baseline, or initial symptoms.
RESULTS
Of the patients in the T2 high group, 13 out of 14 (92.9%) patients demonstrated complete necrosis of the predominant fibroids. The mean volume reduction rates of the predominant fibroids in the T2 high group was 61.7% at three months after UAE, which was significantly higher than the volume reduction rates of 42.1% noted in the control group (p < 0.05). Changes in symptom scores for menorrhagia and dysmenorrhea after UAE (baseline score minus follow-up score) were 4.9 and 7.5 in T2 high group and they were 5.0 and 7.7 in control group, suggesting a significant resolution of symptoms (p < 0.01) in both groups but no significant difference between the two groups.
CONCLUSION
UAE is effective for uttering fibroids showing high SI on T2WI. The mean volume reduction rate of the predominant fibroids three months after UAE was greater in the T2 high group than in the control group.

Keyword

Fibroid uterus; Uterine artery embolization; Magnetic resonance imaging; Radiology, Interventional

MeSH Terms

Adult
Case-Control Studies
Contrast Media/diagnostic use
Female
Humans
Leiomyoma/*therapy
Magnetic Resonance Imaging, Interventional/*methods
Meglumine/diagnostic use
Middle Aged
Organometallic Compounds/diagnostic use
Questionnaires
Retrospective Studies
Treatment Outcome
Uterine Artery Embolization/*methods
Uterine Neoplasms/*therapy

Figure

• 

  Fig. 1 36-year-old woman with uterine leiomyoma. A. Sagittal T2-weighted magnetic resonance (MR) image demonstrates 6.2-cm uterine leiomyoma with high signal intensity. B. Gadolinium-enhanced T1-weighted MR image corresponding to (A) contrast enhancement of fibroid is demonstrated (arrows). C. T2-weighted MR image obtained three months after embolization reveals 40% volume reduction of leiomyoma (arrows). D. Gadolinium-enhanced T1-weighted MR image corresponding to (C) complete necrosis (arrows) of fibroid focal hemorrhage (arrowhead), which is also noted as high signal intensity on non-contrast T1-weighted image (not shown) are demonstrated.

• 

  Fig. 2 39-year-old woman with history of myomectomy on three previous occasions. A. Sagittal T2-weighted magnetic resonance (MR) image demonstrates 9.2-cm uterine leiomyoma with high signal intensity. B. Gadolinium-enhanced T1-weighted MR image reveals uterine leiomyoma with contrast enhancement (arrows). C. T2-weighted MR image obtained three months after embolization reveals 80% volume reduction of fibroid (arrows). D. Histologic examination (original magnification × 100; hematoxylin-eosin stain) in specimen of myomectomy before embolization shows leiomyoma with extensive edematous stroma (arrowheads) and prominent blood vessels (arrows), suggesting increased vascularity.

• 

  Fig. 3 Hematoxylin and eosin staining of expelled leiomyoma demonstrates extensive necrosis, which is consistent with infarcted leiomyoma (original magnification 400 ×).

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