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Abdominal Imaging

, Volume 35, Issue 1, pp 118–128 | Cite as

Spectrum of imaging findings on MRI and CT after uterine artery embolization

  • Sachit K. VermaEmail author
  • Carin F. Gonsalves
  • Oksana H. Baltarowich
  • Donald G. Mitchell
  • Anna S. Lev-Toaff
  • Diane Bergin
Article

Abstract

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.

Keywords

CT Embolization Fibroid MRI Uterine artery 

References

  1. 1.
    Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. (1995) Arterial embolization to treat uterine myomata. Lancet 346:671–672CrossRefPubMedGoogle Scholar
  2. 2.
    Spies JB, Scialli AR, Jha RC, et al. (1999) Initial results from uterine fibroid embolization for symptomatic leiomyomata. J Vasc Interv Radiol 10:1149–1157CrossRefPubMedGoogle Scholar
  3. 3.
    Spies JB, Spector A, Roth AR, et al. (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100:873–880CrossRefPubMedGoogle Scholar
  4. 4.
    Katsumori T, Nakajima K, Tokuhiro M (2001) Gadolinium-enhanced MR imaging in the evaluation of uterine fibroids treated with uterine artery embolization. AJR Am J Roentgenol 177:303–307PubMedGoogle Scholar
  5. 5.
    Pelage JP, Guaou NG, Jha RC, Ascher SM, Spies JB (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230: 803–809CrossRefPubMedGoogle Scholar
  6. 6.
    Nicholson TA, Pelage JP, Ettles DF (2001) Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology. J Vasc Interv Radiol 12:443–446CrossRefPubMedGoogle Scholar
  7. 7.
    DeSouza NM, Williams AD (2002) Uterine arterial embolization for leiomyomas and volume changes at MR imaging and relation to clinical outcome. Radiology 222:367–374CrossRefPubMedGoogle Scholar
  8. 8.
    Okizuka H, Sugimura K, Takemori M, et al. (1993) MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr 17:760–766CrossRefPubMedGoogle Scholar
  9. 9.
    Verma SK, Bergin D, Gonsalves CF, et al. (2008) Submucosal fibroids becoming endocavitary following uterine artery embolization: risk assessment by MRI. AJR Am J Roentgenol 190:1220–1226CrossRefPubMedGoogle Scholar
  10. 10.
    Katsumori T, Akazawa K, Mihara T (2005) Uterine artery embolization for pedunculated subserosal fibroids. AJR Am J Roentgenol 184:399–402PubMedGoogle Scholar
  11. 11.
    Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW (1999) Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis and treatment. Radiographics 19:1179–1197PubMedGoogle Scholar
  12. 12.
    Marret H, Alonso AM, Cottier JP, et al. (2003) Leiomyoma recurrence after uterine artery embolization. J Vasc Interv Radiol 14:1395–1399PubMedGoogle Scholar
  13. 13.
    Spies JB (2003) Uterine artery embolization for fibroids: understanding the technical causes of failure. J Vasc Interv Radiol 1:11–14Google Scholar
  14. 14.
    Ghai S, Rajan DK, Benjamin MS, Asch MR, Ghai S (2005) Uterine artery embolization for leiomyomas: pre- and postprocedural evaluation with US. Radiographics 25:1159–1172CrossRefPubMedGoogle Scholar
  15. 15.
    Kim SK, Lim HK, Kim YH, et al. (2003) Hepatocellular carcinoma treated with radio frequency ablation: spectrum of imaging findings. Radiographics 23:107–121CrossRefPubMedGoogle Scholar
  16. 16.
    Goodwin SC, McLucas B, Lee M, et al. (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165CrossRefPubMedGoogle Scholar
  17. 17.
    Bradley EA, Reidy JF, Forman RG, Jarosz J, Brause PR (1998) Transcatheter uterine artery embolisation to treat large uterine fibroids. J Obstet Gynecol 105:235–240Google Scholar
  18. 18.
    Stein LA, Valenti D (2000) Soft-tissue case 36: ischemic necrosis of a large uterine fibroid after embolization. Can J Surg 43:410, 467PubMedGoogle Scholar
  19. 19.
    Abulafia O, Sherer M (1999) Transcatheter uterine artery embolization for management of symptomatic uterine leiomyomas. Obstet Gynecol Surv 54:745–753CrossRefPubMedGoogle Scholar
  20. 20.
    Goodwin SC, Vedantham S, McLucas B, Forno AE, Perrella R (1997) Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 8:517–526CrossRefPubMedGoogle Scholar
  21. 21.
    Granot I, Dekel N, Segal I, et al. (1998) Is hydrosalpinx fluid cytotoxic? Hum Reprod 13:1620–1624CrossRefPubMedGoogle Scholar
  22. 22.
    Godfrey CD, Zbella EA (2001) Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 98:950–952CrossRefPubMedGoogle Scholar
  23. 23.
    Torigian DA, Siegelman ES, Terhune KP, et al. (2005) MRI of uterine necrosis after uterine artery embolization for treatment of uterine leiomyomata. AJR Am J Roentgenol 184:555–559PubMedGoogle Scholar
  24. 24.
    Atri M, Reinhold C, Mehio AR, et al. (2000) Adenomyosis: US features with histologic correlation in an in vitro study. Radiology 215:783–790PubMedGoogle Scholar
  25. 25.
    Siskin GP, Tublin ME, Stainken BF, Dowling K, Dolen EG (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177:297–302PubMedGoogle Scholar
  26. 26.
    Jha RC, Takahama J, Imaoka I, et al. (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. AJR Am J Roentgenol 181:851–856PubMedGoogle Scholar
  27. 27.
    Chrisman HB, Saker MB, Ryu RK, et al. (2000) The impact of uterine fibroid embolization on resumption of menses and ovarian function. J Vasc Interv Radiol 11:699–703CrossRefPubMedGoogle Scholar
  28. 28.
    Kroencke TJ, Scheurig C, Kluner C, et al. (2006) Uterine fibroids: contrast-enhanced MR angiography to predict ovarian artery supply—initial experience. Radiology 241:181–189CrossRefPubMedGoogle Scholar
  29. 29.
    de Blok S, de Vries C, Prinssen HM, Blaauwgeers HL, Jorna-Meijer LB (2003) Fatal sepsis after uterine artery embolization with microspheres. J Vasc Interv Radiol 14:779–783PubMedGoogle Scholar
  30. 30.
    Schoepf UJ, Costello P (2004) CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 230:329–337CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sachit K. Verma
    • 1
    Email author
  • Carin F. Gonsalves
    • 1
  • Oksana H. Baltarowich
    • 1
  • Donald G. Mitchell
    • 1
  • Anna S. Lev-Toaff
    • 1
    • 2
  • Diane Bergin
    • 1
    • 3
  1. 1.Department of RadiologyThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of RadiologyGalway University HospitalGalwayIreland

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