Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings
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To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy.
A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90–99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention.
In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008).
There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.
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CardioVascular and Interventional Radiology
Volume 36, Issue 3 , pp 676-681
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- 1. Department of Interventional Radiology, Gartnavel General Hospital, 1053, Great Western Road, Glasgow, G12 0YN, UK
- 2. Vital Statistics, 102 Randolph Road, Glasgow, G11 7EE, UK
- 3. Department of Medical Statistics, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- 4. Stobhill Hospital, Glasgow, UK
- 5. Department of Medical Education and Gynaecology, Reproductive and Maternal Medicine, Room 12, Level 4, Walton Building, Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK