Is There a Place for UAE in Adenomyosis?

Part of the Medical Radiology book series (MEDRAD)


Adenomyosis is a benign invasion of endometrium into the myometrium that results in a diffusely enlarged uterus that microscopically exhibits ectopic non-neoplastic endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium. This benign disease has either a focal or diffuse distribution in the uterine wall. Between 60 and 80 % of women with adenomyosis have coexisting pelvic localisations of the disease. Adenomyosis may occur alone, but is more frequently accompanied by fibroids in up to 55 % of cases.


Uterine Artery Uterine Artery Embolization Uterine Fibroid Embolic Agent Junction Zone 


  1. Azziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 16:221–235PubMedGoogle Scholar
  2. Benagiano G, Brosens I (2006) History of adenomyosis. Best Pract Res Clin Obstet Gynaecol 28:1–15Google Scholar
  3. Benson RC, Sneeden VD (1958) Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol 76:1044–1057PubMedGoogle Scholar
  4. Bergeron C, Amant F, Ferency A (2006) A pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:511–521PubMedCrossRefGoogle Scholar
  5. Bird CC, McElin TW, Manalo-Estrella P (1972) The elusive adenomyosis of the uterus-revisited. Am J Obstet Gynecol 112:583–593PubMedGoogle Scholar
  6. Bratby MJ, Walker WJ (2009) Uterine artery embolisation for symptomatic adenomyosis-midterm results. Eur J Radiol 70:128–132PubMedCrossRefGoogle Scholar
  7. Chen C, Liu P, Lu J et al (2002) Uterine arterial embolization in the treatment of adenomyosis. Zhonghua Fu Chan Ke Za Zhi 37:77–79PubMedGoogle Scholar
  8. Chen CL, Li FJ, Liu P et al (2008) The relevance between the effect on dysmenorrhea and the time of surgery of artery embolization in the treatment of adenomyosis. Zhonghua Fu Chan Ke Za Zhi 43:884–887PubMedGoogle Scholar
  9. Chua GC, Wilsher M, Young MP et al (2005) Comparison of particle penetration with non-spherical polyvinyl alcohol versus tris-acryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization. Clin Radiol 60:116–122PubMedCrossRefGoogle Scholar
  10. Dembek CJ, Pelletier EM, Isaacson KB et al (2007) Payer costs in patients undergoing uterine artery embolization, hysterectomy, or myomectomy for treatment of uterine fibroids. J Vasc Interv Radiol 18:1207–1213PubMedCrossRefGoogle Scholar
  11. Duan P, Cheng J, Lin M et al (2008) Intermediate and long term clinical effects of uterine arterial embolization with sodium alginate microspheres in treatment of diffuse adenomyosis. Zhonghua Fu Chan Ke Za Zhi 43:272–275PubMedGoogle Scholar
  12. Dueholm M (2006) Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 20:569–682PubMedCrossRefGoogle Scholar
  13. Dumousset E, Chabrot P, Rabischong B et al (2008) Preoperative uterine artery embolization (PUAE) before uterine myomectomy. Cardiovasc Intervent Radiol 31:512–520CrossRefGoogle Scholar
  14. Dundr P, Mara M, Maskova J et al (2006) Pathological findings of uterine leiomyomas and adenomyosis following uterine artery embolization. Pathol Res Pract 202:721–729PubMedCrossRefGoogle Scholar
  15. Faquhar C, Brosens I (2006) Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:603–616CrossRefGoogle Scholar
  16. Fedele L, Bianchi E, Raffaelli R et al (1997) Treatment of adenomyosis associated menorrhagia with levonorgestrel-releasing intrauterine device. Fertil Steril 68:426–429PubMedCrossRefGoogle Scholar
  17. Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4:312–322PubMedCrossRefGoogle Scholar
  18. Froeling V, Scheurig-Muenkler C, Hamm B et al (2011) Uterine Artery Embolization to treat uterine adenomyosis with or without uterine leiomyomata: results of symptom control and health-related quality of life 40 months after treatment. Cardiovasc Intervent Radiol [Epub ahead of print: 18 Aug, 2011] PMID: 21050565 Google Scholar
  19. Furuhashy M, Miyabe M, Katsumata Y et al (1998) Comparison of complication of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis. Arch Gynecol Obstet 262:69–73CrossRefGoogle Scholar
  20. Goodwin SC, Vedantham S, McLucas B et al (1997) Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 8:517–526PubMedCrossRefGoogle Scholar
  21. Goodwin SC, McLucas B, Lee M et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165PubMedCrossRefGoogle Scholar
  22. Goodwin SC, Spies JB, Worthington-Kirsch R et al (2008) Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol 111:22–33PubMedCrossRefGoogle Scholar
  23. Goodwin SC, Spies JB (2009) Uterine fibroid embolization. N Engl J Med 361:690–697PubMedCrossRefGoogle Scholar
  24. Hehenkamp WJ, Volkers NA, Birnie E et al (2008) Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy-results from the randomized clinical embolisation versus hysterectomy (EMMY) trial. Radiology 246:823–832PubMedCrossRefGoogle Scholar
  25. Hirst A, Dutton S, Wu O et al (2008) A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study. Health Technol Assess 12(5):1–248PubMedGoogle Scholar
  26. Jha RC, Takahama J, Imaoka I et al (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. Am J Roentgenol 181:851–856CrossRefGoogle Scholar
  27. Katsumori T, Kasahara T, Kin Y et al (2007) Magnetic resonance angiography of uterine artery: changes with embolization using gelatine sponge particles alone for fibroids. Cardiovasc Intervent Radiol 30:398–404PubMedCrossRefGoogle Scholar
  28. Kim MD, Won JW, Lee DY et al (2004) Uterine artery embolization for adenomyosis without fibroids. Clin Radiol 59:520–526PubMedCrossRefGoogle Scholar
  29. Kim MD, Kim S, Kim NK et al (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. Am J Roentgenol 188:176–181CrossRefGoogle Scholar
  30. Kitamura Y, Allison SJ, Jha RC et al (2006) MRI of adenomyosis: changes with uterine artery embolization. Am J Roentgenol 186:855–864CrossRefGoogle Scholar
  31. Lohle PN, De Vries J, Klazen CA et al (2007) Uterine artery embolization for symptomatic adenomyosis with or without uterine leiomyomas with the use of calibrated tris-acryl gelatin microspheres: midterm clinical and MR imaging follow-up. J Vasc Interv Radiol 18(7):835–841PubMedCrossRefGoogle Scholar
  32. Lohle PN, Voogt MJ, De Vries J et al (2008) Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol 19(3):319–326PubMedCrossRefGoogle Scholar
  33. McCausland V, McCausland A (1998) The response of adenomyosis to endometrial ablation/resection. Hum Reprod Update 4:350–359PubMedCrossRefGoogle Scholar
  34. Meyers ER, Steege JF (1998) Risk adjustment for complications of hysterectomy: utility of routinely collected administrative data. Prim Care Update Ob Gyns 5:202–203PubMedCrossRefGoogle Scholar
  35. Owolabi TO, Strickler RC (1977) Adenomyosis: a neglected diagnosis. Obstet Gynecol 50:424–427PubMedGoogle Scholar
  36. Pelage JP, Jacob D, Fazel A et al (2005) Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology 234:948–953PubMedCrossRefGoogle Scholar
  37. Peric H, Fraser IS (2006) The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:547–555PubMedCrossRefGoogle Scholar
  38. Popovic M, Puchner S, Berzaczy D et al (2011) Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 22(7):901–909PubMedCrossRefGoogle Scholar
  39. Rabinovici J, Stewart EA (2006) New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:617–636PubMedCrossRefGoogle Scholar
  40. Ravina JH, Herbreteau D, Ciraru-Vigneron N et al (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672PubMedCrossRefGoogle Scholar
  41. Reinhold C, Tafazoli F, Mehio A et al (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19:S147–S160PubMedCrossRefGoogle Scholar
  42. Siskin GP, Tublin ME, Stainken BF et al (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. Am J Roentgenol 177:297–302CrossRefGoogle Scholar
  43. Smeets AJ, Nijenhuis RJ, Boekkooi PF et al (2011) Long-term follow-up of uterine artery embolization for symptomatic adenomyosis. Cardiovasc Intervent Radiol [Epub ahead of print: 30 June, 2011] PMID: 21717251 Google Scholar
  44. Smith SJ, Sewall LE, Handelsman A (1999) A clinical failure of uterine fibroid embolization due to adenomyosis. J Vasc Interv Radiol 10:1171–1174PubMedCrossRefGoogle Scholar
  45. Spies JB, Warren EH, Mathias SD et al (1999) Uterine fibroid embolization: measurement of health-related quality of life before and after therapy. J Vasc Interv Radiol 10:1293–1303PubMedCrossRefGoogle Scholar
  46. Spies JB, Roth AR, Jha RC et al (2002) Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222:45–52PubMedCrossRefGoogle Scholar
  47. Spies JB, Bruno J, Czeyda-Pommersheim F et al (2005a) Long term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol 106(5 Pt 1):933–939PubMedCrossRefGoogle Scholar
  48. Spies JB, Allison S, Flick P et al (2005b) Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study. J Vasc Interv Radiol 16(11):1431–1437PubMedCrossRefGoogle Scholar
  49. Tamai K, Togashy K, Ito T et al (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40PubMedCrossRefGoogle Scholar
  50. Toh CH, Wu CH, Tsay PK et al (2003) Uterine artery embolization for symptomatic uterine leiomyoma and adenomyosis. J Formos Med Assoc 102:701–706PubMedGoogle Scholar
  51. Utsunomiya D, Notsute S, Hayashida Y et al (2004) Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images. Am J Roentgenol 182:399–404CrossRefGoogle Scholar
  52. Valentini AL, Speca S, Gui B et al (2011) Adenomyosis: from the sign to the diagnosis. Imaging, diagnostic pitfalls and differential diagnosis: a pictorial review. Radiol med 116:1267–1287PubMedCrossRefGoogle Scholar
  53. Vercellini P, Ragni G, Trespidi L et al (1993) Adenomyosis: a déjà vu? Obstet Gynecol Surv 48:789–794PubMedCrossRefGoogle Scholar
  54. Vercellini P, Viganò P, Somigliana E et al (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 20:465–477PubMedCrossRefGoogle Scholar
  55. 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 19:1007–1016PubMedCrossRefGoogle Scholar
  56. Voogt MJ, van Stralen M, Ikink ME et al (2011) Targeted vessel ablation for more efficient magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids. Cardiovasc Intervent Radiol [Epub ahead of print: 7 Dec, 2011] PMID: 22146977Google Scholar
  57. Wood C (2001) Adenomyosis: difficult to diagnose, and difficult to treat. Diagn Ther Endosc 7:89–95PubMedCentralPubMedCrossRefGoogle Scholar
  58. Worthington-Kirsch RL, Popky GL, Hutchins FL Jr (1998) Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response. Radiology 208:625–629PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Interventional radiologist, Department of RadiologySt. Elisabeth ZiekenhuisTilburgThe Netherlands

Personalised recommendations