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DOI: 10.1148/radiol.2483071288
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(Radiology 2008;248:917-924.)
© RSNA, 2008

Genitourinary Imaging

Semiquantitative Assessment of MR Imaging in Prediction of Efficacy of Gonadotropin-releasing Hormone Agonist for Volume Reduction of Uterine Leiomyoma: Initial Experience1

Shigeo Okuda, MD, Koichi Oshio, PhD, MD, Hiroshi Shinmoto, MD, Akihiro Tanimoto, MD, Hironori Asada, MD, Takuma Fujii, MD, Yasunori Yoshimura, MD, and Sachio Kuribayashi, MD

1 From the Departments of Diagnostic Radiology (S.O., K.O., A.T., S.K.) and Obstetrics and Gynecology (H.A., T.F., Y.Y.), Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; and Department of Radiology, National Defense Medical College, Saitama, Japan (H.S.). Received July 22, 2007; revision requested September 10; revision received November 24; accepted February 27, 2008; final version accepted March 28. Address correspondence to S.O. (e-mail: okuda{at}sc.itc.keio.ac.jp).

Purpose: To prospectively determine if semiquantitative assessment of R2* images and T1-weighted magnetic resonance (MR) images of leiomyomas correlates with the efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment for volume reduction.

Materials and Methods: Internal review board approval and informed consent were obtained for this study. Twenty women (mean age, 36.3 years) with intramyometrial leiomyomas were enrolled in this study. Single-section double-echo dynamic MR imaging was performed before GnRH agonist administration. T2-weighted images were obtained before and after two or three GnRH agonist injections (1.88 mg leuprorelin acetate). The steepest signal intensity (SI) upslope on T1-weighted images and the area under the curve (AUC) on R2* images were determined by using a 16 x 16-voxel matrix that was placed in the center of a leiomyoma. Pearson correlation analysis was performed to compare the percentage of volume reduction with SI upslope and AUC. Unpaired t test was performed to evaluate the difference between leiomyomas with AUC and SI upslope values that were less than or greater than the mean.

Results: Percentage of volume reduction ranged from 6.2% to 51.1%. The mean AUC and mean SI upslope were 39.2 and 9.83% per second, respectively. There was a significant correlation between the AUC and the percentage of volume reduction (r = 0.81, P < .001), although no significant correlation was observed between the SI upslope and the percentage of volume reduction. A significant difference in percentage of volume reduction was observed in leiomyomas by using mean AUC as a cutoff value (P = .003).

Conclusion: AUC on R2* images correlates with the efficacy of GnRH agonist before initiation of treatment for volume reduction of leiomyoma.

© RSNA, 2008