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Uterine Fibroid Embolization: The Utility of Aortography in Detecting Ovarian Artery Collateral Supply¹

¹ From the Department of Radiology, Georgetown University Hospital, 3800 Reservoir Rd NW, CG 201, Washington, DC 20007-2113 (A.M.W., F.B., S.Y., J.B.S.); and Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC (R.S.S.). Received May 6, 2006; revision requested July 7; revision received August 7; accepted September 7; final version accepted November 15. A.M.W. supported by a Radiological Society of North America Research & Education Foundation Medical Student Departmental Program Grant. Address correspondence to J.B.S. (e-mail: spiesj{at}gunet.georgetown.edu).

Purpose: To retrospectively determine the sensitivity of ovarian artery (OA) visualization at aortography performed after uterine fibroid embolization (UFE) and, using OA arteriography as the reference standard, compare the extent of arterial flow to the uterus at aortography with selective ovarian arteriography, to establish the utility of aortography and ovarian arteriography in the routine practice of UFE.

Materials and Methods: This study received institutional review board approval with waiver of informed consent and was HIPAA compliant. Retrospective review of 1129 consecutive UFE patients (1072 with aortograms, 57 excluded; mean age, 44 years; range, 21–60 years) was performed to identify all visible OAs. Visible OAs were independently graded by two interventional radiologists according to extent of pelvic arterial flow. If selective arteriography was performed, a second grade was assigned based on assessment of the selective study. Descriptive and summary statistics were used for assessment by the senior observer, and interobserver variability was determined.

Results: Of 1072 UFE patients, 184 (17.2%) had at least one visible OA. Ten (0.8%) patients were identified at aortography with collateral OA supply to more than 10% of the uterus. In total, 251 OAs were visualized, and 157 of these were further evaluated with selective study. Sixty-two (5.8%) patients were identified at selective arteriography as having collateral OA supply. The sensitivity of aortography was approximately 18%. Interobserver concordance was high ( values of 0.81 and 0.90 for aortography and selective study, respectively), but not perfect.

Conclusion: Aortography rarely helps identify patients with substantial residual OA supply to the uterus and is a poor predictor of the extent of that supply, and thus may be of limited utility in routine UFE.

© RSNA, 2007