Skip to main content
SpringerLink
Log in

Utility of MRI Before and After Uterine Fibroid Embolization: Why to Do It and What to Look For

  • Review/State of the Art
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The utility of magnetic resonance imaging (MRI) in the selection, procedure planning, and follow-up of patients undergoing arterial embolization for uterine fibroids is reviewed. Advantages of MRI over ultrasound include multiplanar imaging capability, a larger field of view, increased spatial resolution, improved anatomic detail, and the ability to detect other pelvic disorders. MRI can assess fibroid viability by detecting contrast agent enhancement. Magnetic resonance angiography has a useful role in evaluation of pelvic vasculature. Magnetic resonance parameters such as T1 and T2 relaxation times and diffusion-weighted characteristics have an emerging role in predicting outcome before and after embolization. MRI may be used to evaluate technical success and to image potential complications after embolization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Nakai A, Togashi K, Kosaka K et al (2008) Do anticholinergic agents suppress uterine peristalsis and sporadic myometrial contractions at cine MR imaging? Radiology 246:489–496

    Article  PubMed  Google Scholar 

  2. Dueholm M, Lundorf E, Hansen ES et al (2002) Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 186:409–415

    Article  PubMed  Google Scholar 

  3. Spielmann AL, Keogh C, Forster BB et al (2006) Comparison of MRI and sonography in the preliminary evaluation for fibroid embolization. AJR Am J Roentgenol 187:1499–1504

    Article  PubMed  Google Scholar 

  4. Omary RA, Vasireddy S, Chrisman HB et al (2002) The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids. J Vasc Interv Radiol 13:1149–1153

    Article  PubMed  Google Scholar 

  5. Volkers NA, Hehenkamp WJ, Spijkerboer AM et al (2008) MR reproducibility in the assessment of uterine fibroids for patients scheduled for uterine artery embolization. Cardiovasc Intervent Radiol 31:260–268

    Article  PubMed  Google Scholar 

  6. Lee JK, Gersell DJ, Balfe DM et al (1985) The uterus: in vitro MR-anatomic correlation of normal and abnormal specimens. Radiology 157:175–179

    PubMed  CAS  Google Scholar 

  7. Yamashita Y, Torashima M, Takahashi M et al (1993) Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology 189:721–725

    PubMed  CAS  Google Scholar 

  8. Shimada K, Ohashi I, Kasahara I et al (2004) Differentiation between completely hyalinized uterine leiomyomas and ordinary leiomyomas: three-phase dynamic magnetic resonance imaging (MRI) vs diffusion-weighted MRI with very small b-factors. J Magn Reson Imaging 20:97–104

    Article  PubMed  Google Scholar 

  9. Harman M, Zeteroğlu S, Arslan H et al (2006) Predictive value of magnetic resonance imaging signal and contrast-enhancement characteristics on post-embolization volume reduction of uterine fibroids. Acta Radiol 47:427–435

    Article  PubMed  CAS  Google Scholar 

  10. Burn PR, McCall JM, Chinn RJ et al (2000) Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uterine arteries. Radiology 214:729–734

    PubMed  CAS  Google Scholar 

  11. DeSouza NM, Williams AD (2002) Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome. Radiology 222:367–374

    Article  PubMed  Google Scholar 

  12. Jha RC, Ascher SM, Imaoka I, Spies JB (2000) Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arterial embolization. Radiology 217:228–235

    PubMed  CAS  Google Scholar 

  13. Okizuka H, Sugimura K, Takemori M et al (1993) MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr 17:760–766

    Article  PubMed  CAS  Google Scholar 

  14. Tamai K, Koyama T, Umeoka S, Saga T, Fujii S, Togashi K (2006) Spectrum of MR features in adenomyosis. Best Pract Res Clin Obstet Gynaecol. 20(4):583–602

    Google Scholar 

  15. Siskin GP, Tublin ME, Stainken BF et al (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177:297–302

    PubMed  CAS  Google Scholar 

  16. Jha RC, Takahama J, Imaoka I et al (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. AJR Am J Roentgenol 181:851–856

    PubMed  Google Scholar 

  17. Kim MD, Kim S, Kim NK et al (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol 188:176–181

    Article  PubMed  Google Scholar 

  18. Worthington-Kirsch RL, Andrews RT, Siskin GP et al (2002) II. Uterine fibroid embolization: technical aspects. Tech Vasc Interv Radiol 5:17–34

    Article  PubMed  Google Scholar 

  19. Rha SE, Byun JY, Jung SE et al (2003) CT and MRI of uterine sarcomas and their mimickers. AJR Am J Roentgenol 181:1369–1374

    PubMed  Google Scholar 

  20. Kitamura Y, Ascher SM, Cooper C et al (2005) Imaging manifestations of complications associated with uterine artery embolization. Radiographics 25(suppl 1):S119–S132

    Article  PubMed  Google Scholar 

  21. Pron G, Bennett J, Common A, Ontario Uterine Fibroid Embolization Collaboration Group et al (2003) The Ontario uterine fibroid embolization trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 79:120–127

    Article  PubMed  Google Scholar 

  22. Tanaka YO, Nishida M, Tsunoda H et al (2004) Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging 20:998–1007

    Article  PubMed  Google Scholar 

  23. Namimoto T, Yamashita Y, Awai K et al (2009) Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 19:2756–2764

    Article  PubMed  Google Scholar 

  24. Takeuchi M, Matsuzaki K, Nishitani H (2009) Hyperintense uterine myometrial masses on T2-weighted magnetic resonance imaging: differentiation with diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr 33:834–837

    Article  PubMed  Google Scholar 

  25. Kilickesmez O, Bayramoglu S, Inci E et al (2009) Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones. Acta Radiol 50:340–347

    Article  PubMed  CAS  Google Scholar 

  26. Tamai K, Koyama T, Saga T et al (2008) The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 18:723–730

    Article  PubMed  Google Scholar 

  27. Spies JB, Roth AR, Jha RC et al (2002) Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222:45–52

    Article  PubMed  Google Scholar 

  28. Katsumori T, Nakajima K, Mihara T (2003) Is a large fibroid a high-risk factor for uterine artery embolization? AJR Am J Roentgenol 181:1309–1314

    PubMed  Google Scholar 

  29. Firouznia K, Ghanaati H, Sanaati M et al (2008) Uterine artery embolization in 101 cases of uterine fibroids: do size, location, and number of fibroids affect therapeutic success and complications? Cardiovasc Intervent Radiol 31:521–526

    Article  PubMed  Google Scholar 

  30. Verma SK, Gonsalves CF, Baltarowich OH et al (2010) Spectrum of imaging findings on MRI and CT after uterine artery embolization. Abdom Imaging 35:118–128

    Article  PubMed  Google Scholar 

  31. Goodwin SC, Bonilla SC, Sacks D, Reporting Standards for Uterine Artery Embolization (UAE) Subcommittee, UAE Task Force Standards Subcommittee, Society of Interventional Radiology Technology Assessment Committee et al (2003) Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J Vasc Interv Radiol 14(9 pt 2):S467–S476

    PubMed  Google Scholar 

  32. McLucas B, Adler L, Perrella R (2001) Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 192:95–105

    Article  PubMed  CAS  Google Scholar 

  33. Katsumori T, Akazawa K, Mihara T (2005) Uterine artery embolization for pedunculated subserosal fibroids. AJR Am J Roentgenol 184:399–402

    PubMed  Google Scholar 

  34. Margau R, Simons ME, Rajan DK et al (2008) Outcomes after uterine artery embolization for pedunculated subserosal leiomyomas. J Vasc Interv Radiol 19:657–661

    Article  PubMed  Google Scholar 

  35. Toor SS, Tan KT, Simons ME et al (2008) Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics. J Vasc Interv Radiol 19:662–667

    Article  PubMed  Google Scholar 

  36. Hricak H, Finck S, Honda G, Goranson H (1992) MR imaging in the evaluation of benign uterine masses: value of gadopentetate dimeglumine–enhanced T1-weighted images. AJR Am J Roentgenol 158:1043–1050

    PubMed  CAS  Google Scholar 

  37. Hovsepian DM, Siskin GP, Bonn J, CIRSE, SIR Standards of Practice Committees et al (2004) Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 15:535–542

    PubMed  Google Scholar 

  38. Nikolaidis P, Siddiqi AJ, Carr JC et al (2005) Incidence of nonviable leiomyomas on contrast material–enhanced pelvic MR imaging in patients referred for uterine artery embolization. J Vasc Interv Radiol 16:1465–1471

    PubMed  Google Scholar 

  39. Naguib NN, Nour-Eldin NE, Hammerstingl RM et al (2008) Three-dimensional reconstructed contrast-enhanced MR angiography for internal iliac artery branch visualization before uterine artery embolization. J Vasc Interv Radiol 19:1569–1575

    Article  PubMed  Google Scholar 

  40. 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 27:557–562

    Article  PubMed  Google Scholar 

  41. 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 251:788–795

    Article  PubMed  Google Scholar 

  42. Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272

    Article  PubMed  CAS  Google Scholar 

  43. 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 11:699–703

    Article  PubMed  CAS  Google Scholar 

  44. Gomez-Jorge J, Keyoung A, Levy EB, Spies JB (2003) Uterine artery anatomy relevant to uterine leiomyomata embolization. Cardiovasc Intervent Radiol 26:522–527

    Article  PubMed  Google Scholar 

  45. Razavi MK, Wolanske KA, Hwang GL et al (2002) Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology 224:707–712

    Article  PubMed  Google Scholar 

  46. Binkert CA, Andrews RT, Kaufman JA (2001) Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids. J Vasc Interv Radiol 12:841–845

    Article  PubMed  CAS  Google Scholar 

  47. Kroencke TJ, Scheurig C, Kluner C et al (2006) Uterine fibroids: contrast-enhanced MR angiography to predict ovarian artery supply—initial experience. Radiology 241:181–189

    Article  PubMed  Google Scholar 

  48. Burbank F (2004) Childbirth and myoma treatment by uterine artery occlusion: do they share a common biology? J Am Assoc Gynecol Laparosc 11:138–152

    Article  PubMed  Google Scholar 

  49. Aziz A, Petrucco OM, Makinoda S et al (1998) Transarterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature. Acta Obstet Gynecol Scand 77:334–340

    Article  PubMed  CAS  Google Scholar 

  50. Shimada K, Ohashi I, Kasahara I et al (2004) Triple-phase dynamic MRI of intratumoral vessel density and hyalinization grade in uterine leiomyomas. AJR Am J Roentgenol 182:1043–1050

    PubMed  Google Scholar 

  51. Kosaka N, Uematsu H, Kimura H et al (2007) Assessment of the vascularity of uterine leiomyomas using double-echo dynamic perfusion-weighted MRI with the first-pass pharmacokinetic model: correlation with histopathology. Invest Radiol 42:629–635

    Article  PubMed  Google Scholar 

  52. Goodwin SC, McLucas B, Lee M et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165

    Article  PubMed  CAS  Google Scholar 

  53. Yousefi S, Czeyda-Pommersheim F, White AM et al (2006) Repeat uterine artery embolization: indications and technical findings. J Vasc Interv Radiol 17:1923–1929

    Article  PubMed  Google Scholar 

  54. Chrisman HB, West D, Corpuz B et al (2005) Primary failure of uterine artery embolization: use of magnetic resonance imaging to select patients for repeated embolization. J Vasc Interv Radiol 16:1143–1147

    Article  PubMed  Google Scholar 

  55. Katsumori T, Kasahara T, Kin Y, Nozaki T (2008) Infarction of uterine fibroids after embolization: relationship between postprocedural enhanced MRI findings and long-term clinical outcomes. Cardiovasc Intervent Radiol 31:66–72

    Article  PubMed  Google Scholar 

  56. Liapi E, Kamel IR, Bluemke DA et al (2005) Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging. J Comput Assist Tomogr 29:83–86

    Article  PubMed  Google Scholar 

  57. Clark TW, Do RK, Kang S et al (2009) Can functional MRI predict volume reduction following uterine fibroid embolization? (abstract 86). J Vasc Interv Radiol 2:S34

    Article  Google Scholar 

  58. Volkers NA, Hehenkamp WJ, Birnie E et al (2006) Uterine artery embolization in the treatment of symptomatic uterine fibroid tumors (EMMY Trial): periprocedural results and complications. J Vasc Interv Radiol 17:471–480

    Article  PubMed  Google Scholar 

  59. Society of Obstetricians, Gynaecologists of Canada (2005) SOGC clinical practice guidelines. Uterine fibroid embolization. No. 150, October 2004. Int J Gynaecol Obstet 89:305–318

    Article  Google Scholar 

  60. Colgan TJ, Pron G, Mocarski EJ et al (2003) Pathologic features of uteri and leiomyomas following uterine artery embolization for leiomyomas. Am J Surg Pathol 27:167–177

    Article  PubMed  Google Scholar 

  61. Gabriel H, Pinto CM, Kumar M et al (2004) MRI detection of uterine necrosis after uterine artery embolization for fibroids. AJR Am J Roentgenol 183:733–736

    PubMed  Google Scholar 

  62. 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 184:555–559

    PubMed  Google Scholar 

  63. Siddiqi AJ, Chrisman HB, Vogelzang RL et al (2006) MR imaging evidence of reversal of uterine ischemia after uterine artery embolization for leiomyomata. J Vasc Interv Radiol 17:1535–1538

    Article  PubMed  Google Scholar 

  64. Volkers NA, Hehenkamp WJ, Smit P et al (2008) Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. J Vasc Interv Radiol 19:1007–1016

    Article  PubMed  Google Scholar 

  65. Wu O, Briggs A, Dutton S et al (2007) Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost–utility analysis of the HOPEFUL study. BJOG 114:1352–1362

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, McMaster University Medical Center, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    John Martin Kirby, David Burrows, Ehsan Haider, Zeev Maizlin & Mehran Midia

Authors
  1. John Martin Kirby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Burrows
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ehsan Haider
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zeev Maizlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehran Midia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Martin Kirby.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirby, J.M., Burrows, D., Haider, E. et al. Utility of MRI Before and After Uterine Fibroid Embolization: Why to Do It and What to Look For. Cardiovasc Intervent Radiol 34, 705–716 (2011). https://doi.org/10.1007/s00270-010-0029-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-010-0029-2

Keywords

Search

Navigation