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CardioVascular and Interventional Radiology

, Volume 35, Issue 3, pp 515–522 | Cite as

Unenhanced MR Angiography of Uterine and Ovarian Arteries after Uterine Artery Embolization: Differences between Patients with Incomplete and Complete Fibroid Infarction

  • Kensaku MoriEmail author
  • Tsukasa Saida
  • Yoko Shibuya
  • Nobuyuki Takahashi
  • Masanari Shiigai
  • Kayo Osada
  • Nami Tanaka
  • Manabu Minami
Clinical Investigation

Abstract

Purpose

To compare the status of uterine and ovarian arteries after uterine artery embolization (UAE) in patients with incomplete and complete fibroid infarction via unenhanced 3D time-of-flight magnetic resonance (MR) angiography.

Materials and Methods

Thirty-five consecutive women (mean age 43 years; range 26–52 years) with symptomatic uterine fibroids underwent UAE and MR imaging before and within 2 months after UAE. The patients were divided into incomplete and complete fibroid infarction groups on the basis of the postprocedural gadolinium-enhanced MR imaging findings. Two independent observers reviewed unenhanced MR angiography before and after UAE to determine bilateral uterine and ovarian arterial flow scores. The total arterial flow scores were calculated by summing the scores of the 4 arteries. All scores were compared with the Mann-Whitney test.

Results

Fourteen and 21 patients were assigned to the incomplete and complete fibroid infarction groups, respectively. The total arterial flow score in the incomplete fibroid infarction group was significantly greater than that in the complete fibroid infarction group (P = 0.019 and P = 0.038 for observers 1 and 2, respectively). In 3 patients, additional therapy was recommended for insufficient fibroid infarction. In 1 of the 3 patients, bilateral ovarian arteries were invisible before UAE but seemed enlarged after UAE.

Conclusion

The total arterial flow from bilateral uterine and ovarian arteries in patients with incomplete fibroid infarction is less well reduced than in those with complete fibroid infarction. Postprocedural MR angiography provides useful information to estimate the cause of insufficient fibroid infarction in individual cases.

Keywords

Embolization Fibroid MR angiography Ovarian artery Uterine artery 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Reference

  1. 1.
    ACOG Practice Bulletin No. 96 (2008) Clinical management guidelines for obstetrician–gynecologists. Obstet Gynecol 112:387–400CrossRefGoogle Scholar
  2. 2.
    Goodwin SC, Spies JB (2009) Uterine fibroid embolization. N Engl J Med 361:690–697PubMedCrossRefGoogle Scholar
  3. 3.
    Edwards RD, Moss JG, Lumsden MA et al (2007) Uterine–artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:360–370PubMedCrossRefGoogle Scholar
  4. 4.
    Volkers NA, Hehenkamp WJK, Birnie E et al (2007) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial. Am J Obstet Gynecol 196:519.e1–11Google Scholar
  5. 5.
    Yousefi S, Czeyda-Pommersheim F, White AM et al (2006) Repeat uterine artery embolization: indications and technical findings. J Vasc Interv Radiol 17:1923–1929PubMedCrossRefGoogle Scholar
  6. 6.
    Pelage JP, Guaou NG, Jha RC et al (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230:803–809PubMedCrossRefGoogle Scholar
  7. 7.
    Katsumori T, Kasahara T, Kin Y et al (2008) Infarction of uterine fibroids after embolization: relationship between postprocedural enhanced MRI findings and long-term clinical outcomes. Cardiovasc Intervent Radiol 31:66–72PubMedCrossRefGoogle Scholar
  8. 8.
    Kroencke TJ, Scheurig C, Poellinger A et al (2010) Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841PubMedCrossRefGoogle Scholar
  9. 9.
    Kroencke TJ, Scheurig C, Kluner C et al (2006) Uterine fibroids: contrast-enhanced MR angiography to predict ovarian artery supply—initial experience. Radiology 241:181–189PubMedCrossRefGoogle Scholar
  10. 10.
    Mori K, Shiigai M, Ueda T et al (2008) Assessment of the uterine artery before uterine arterial embolization: comparison of unenhanced 3D water-excitation sensitivity-encoding time-of-flight (WEST) and gadolinium-enhanced 3D sensitivity-encoding water-excitation multishot echo-planar (SWEEP) MR angiography. J Magn Reson Imaging 27:557–562PubMedCrossRefGoogle Scholar
  11. 11.
    Naguib NN, Nour-Eldin NE, Lehnert T et al (2009) Uterine artery embolization: optimization with preprocedural prediction of the best tube angle obliquity by using 3D-reconstructed contrast-enhanced MR angiography. Radiology 251:788–795PubMedCrossRefGoogle Scholar
  12. 12.
    Mori K, Saida T, Shibuya Y et al (2010) Assessment of uterine and ovarian arteries before uterine artery embolization: advantages conferred by unenhanced MR angiography. Radiology 255:467–475PubMedCrossRefGoogle Scholar
  13. 13.
    White AM, Banovac F, Yousefi S et al (2007) Uterine fibroid embolization: the utility of aortography in detecting ovarian artery collateral supply. Radiology 244:291–298PubMedCrossRefGoogle Scholar
  14. 14.
    Razavi MK, Rhee J, Sze DY et al (2000) Recanalization of uterine arteries after embolization for symptomatic leiomyomas: evidence on MRA. J Vasc Interv Radiol Suppl 11:286Google Scholar
  15. 15.
    Katsumori T, Kasahara T, Kin Y et al (2007) Magnetic resonance angiography of uterine artery: changes with embolization using gelatin sponge particles alone for fibroids. Cardiovasc Intervent Radiol 30:398–400PubMedCrossRefGoogle Scholar
  16. 16.
    Correll JT, Prentice HR, Wise EC (1945) Biological investigations of a new absorbable sponges. Surg Gynecol Obstet 81:585–589Google Scholar
  17. 17.
    Burn PR, McCall JM, Chinn RJ et al (2000) Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uterine arteries. Radiology 214:729–734PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Kensaku Mori
    • 1
    • 2
    Email author
  • Tsukasa Saida
    • 2
  • Yoko Shibuya
    • 3
  • Nobuyuki Takahashi
    • 2
  • Masanari Shiigai
    • 3
  • Kayo Osada
    • 4
  • Nami Tanaka
    • 4
  • Manabu Minami
    • 2
  1. 1.Department of RadiologyTsukuba Central HospitalUshikuJapan
  2. 2.Department of RadiologyGraduate School of Comprehensive Human Sciences, University of TsukubaTsukubaJapan
  3. 3.Department of RadiologyTsukuba University HospitalTsukubaJapan
  4. 4.Department of Obstetrics and GynecologyTsukuba Central HospitalUshikuJapan

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