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Uterine Fibroid Tumors: Long-term MR Imaging Outcome after Embolization¹

¹ From the Department of Radiology, Georgetown University Hospital, 3800 Reservoir Rd NW, CG 201, Washington, DC 20007-2197. Received January 21, 2003; revision requested April 11; revision received May 28; accepted July 1. Address correspondence to J.B.S. (e-mail: spiesj@gunet.georgetown.edu).

PURPOSE: To assess and report the long-term magnetic resonance (MR) imaging outcomes of fibroid tumors treated with uterine artery embolization (UAE).

MATERIALS AND METHODS: Contrast material–enhanced pelvic MR imaging was performed in 20 patients before UAE, at 3 months after UAE, and then yearly for up to 3 years. Two readers compared the uterine fibroid, dominant (ie, largest) fibroid, and percentage of perfusion measurements from each of these examinations by using intraclass correlations. Seventeen patients underwent contrast-enhanced MR imaging at baseline and 3 months and 3 years after treatment. Among these patients, those with complete infarction were compared with those with incomplete infarction of the dominant fibroid at 3 years to determine extents of infarction, differences in baseline characteristics, degrees of volume reduction of the uterus and fibroid, and extents of symptom change. Comparisons were performed by using t and Pearson ² tests. Differences in proportions, with 95% CIs, were calculated. Each follow-up MR image was also evaluated for the presence of myometrial perfusion defects and new fibroids.

RESULTS: Intraclass correlation coefficients calculated for the two readers (range, 0.974–0.995) and with the MR imaging data (range, 0.966–0.988) were high. Of the 17 patients included in the outcome analysis, the 12 with complete fibroid infarction were more likely not to have enhancing lesions at 3-year follow-up (P = .002) than were those with incomplete infarction. No significant differences in volume or symptom changes between the two groups were detected, but growth of residual perfused portions of the incompletely infarcted fibroids was seen in three patients, two of whom had recurrent symptoms. Four patients developed new fibroids, none of which has caused symptoms. There were no instances of myometrial infarction.

CONCLUSION: Although the small study population prevented the drawing of definitive conclusions, the data suggest that although incomplete fibroid infarction may not affect outcome immediately, regrowth of uninfarcted fibroid tissue may result in symptom recurrence.

© RSNA, 2004

Index terms: Arteries, therapeutic embolization, 854.1264, 854.1266 • Uterine neoplasms, 854.315 • Uterine neoplasms, MR, 854.121411, 854.121412, 854.121416, 854.12143 • Uterine neoplasms, therapy, 854.1264, 854.1266

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