Yonsei Med J.  2013 Jan;54(1):215-219. 10.3349/ymj.2013.54.1.215.

Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

• Han SC
• Kim MD
• Jung DC
• Lee M
• Lee MS
• Park SI
• Won JY
• Lee DY
• Lee KH

• KMID: 1776941
• DOI: http://doi.org/10.3349/ymj.2013.54.1.215

Abstract

PURPOSE
Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma.
MATERIALS AND METHODS
Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated.
RESULTS
Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient.
CONCLUSION
The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Keyword

Uterine artery embolization; magnetic resonance imaging; degeneration; leiomyoma; uterus

MeSH Terms

Abdominal Pain/therapy
Adult
Female
Follow-Up Studies
Humans
Incidence
Leiomyoma/*complications/epidemiology/*pathology/*surgery
Magnetic Resonance Imaging
Menorrhagia/therapy
Middle Aged
Pregnancy
Retrospective Studies
Treatment Outcome
*Uterine Artery Embolization

Figure

• 

  Fig. 1 A 31-year-old woman who had a normal spontaneous vaginal delivery one year prior. (A) The T1-weighted axial image revealed a 7.0×8.3×6.7 cm leiomyoma (arrows) on the posterior wall of the uterus showing high signal intensity. (B) The T2-weighted sagittal image revealed a heterogenous signal intensity of the leiomyoma. (C) Contrast enhancement was not observed on the gadolinium-enhanced T1-weighted axial image corresponding to B. (D) The follow-up MRI at 18 months demonstrated a 7.4×5.7×6.5 cm leiomyoma, which represents a 29.7% decrease (143 cc from 204 cc) in leiomyoma volume without any treatment.

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