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Stellenwert der Magnetresonanztomographie für Indikationsstellung, Interventionsplanung und Nachsorge bei transarterieller Embolisationsbehandlung des Uterus myomatosus

  • Uterusembolisation
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Zusammenfassung

Zielsetzung

Darstellung des Stellenwerts der Magnetresonanztomographie für die Indikationsstellung, Interventionsplanung und Nachsorge bei der transarteriellen Embolisationsbehandlung des symptomatischen Uterus myomatosus unter Berücksichtigung der aktuellen Literatur sowie eigener Ergebnisse.

Material und Methodik

Retrospektive Auswertung der MRT-Untersuchungen vor und nach Myomembolisation eines Kollektivs von 130 Patientinnen. Darlegung charakteristischer kernspintomographischer Bildbefunde und ihrer Bedeutung für die Indikationsstellung, Durchführung und Nachsorge. Einordnung der Ergebnisse in Zusammenschau mit der Literatur.

Ergebnisse

Die in der Literatur mitgeteilten mittelfristigen Ergebnisse zeigen eine Erfolgsrate des Verfahrens mit Verbesserung myombedingter Beschwerden in 82–94% und Größenreduktion der Myomknoten um durchschnittlich 36–64%. Typische Degenerationsformen von Leiomyomen des Uterus sowie das kernspintomographische Erscheinungsbild relevanter Differenzialdiagnosen werden exemplarisch dargestellt. Die für die Indikationsstellung relevanten Informationen zu Lage, Größe und Zahl der Myomknoten lassen sich kernspintomographisch sicher erheben. Eine Auswertung von 60 Patientinnen des Kollektivs zeigte in 16% der Fälle solitäre Leiomyome. In 47% der Fälle lagen 2–10 Myomknoten und in 37% mehr als 10 Leiomyome vor. Suberserös gestielte Leiomyome stellen eine Kontraindikation des Verfahrens dar und fanden sich in 5% der Fälle. Die MR-Angiographie erwies sich als vorteilhaft zur präinterventionellen Abklärung der pelvinen Gefäßanatomie und kann Kollateralen der Uterusversorgung nachweisen. Kontrastmittelunterstützte Aufnahmen eignen sich zur Kontrolle der erfolgreichen Devaskularisation nach Myomembolisation sowie zur Abklärung von Komplikationen.

Abstract

Aim

To describe the role of magnetic resonance imaging (MRI) in establishing the indication for, planning, and following up uterine artery embolization (UAE) for treating symptomatic leiomyomas of the uterus on the basis of the current literature and our results.

Material and methods

Retrospective analysis of the MRI findings obtained in 130 patients before and after UAE. Presentation of characteristic MRI features and their relevance in establishing the indication for, performing, and following up of UAE. Discussion of the results in conjunction with published data.

Results

The intermediate results of UAE reported in the literature show a successful improvement of leiomyoma-related symptoms in 82–94% of cases and an average reduction of leiomyoma size by 36–64%. The typical MRI appearance of degenerating leiomyomas is presented together with that of relevant differential diagnoses. MRI findings allow for establishing the indication for UAE by providing reliable information on the location, size, and number of uterine leiomyomas. Analysis of 60 patients of our study population showed solitary leiomyoma in 16% of cases, 2–10 leiomyomas in 47%, and over 10 in 37%. Subserosal, pedunculated leiomyomas cannot be treated by UAE; these were present in 5% of the patients. MR angiography is useful in assessing pelvic vascular anatomy before the intervention and identifies collateral vascular supply to the uterus. Contrast-enhanced imaging is suitable for monitoring successful devascularization following embolization and evaluating complications.

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Literatur

  1. Andersen PE, Lund N, Justesen P, Munk T, Elle B, Floridon C (2001) Uterine artery embolization of symptomatic uterine fibroids. Initial success and short-term results. Acta Radiol 42:234–238

    Article  CAS  PubMed  Google Scholar 

  2. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433

    CAS  PubMed  Google Scholar 

  3. Burn PR, McCall JM, Chinn RJ, Vashisht A, Smith JR, Healy JC (2000) Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uterine arteries. Radiology 214:729–734

    CAS  PubMed  Google Scholar 

  4. Colgan TJ, Pron G, Mocarski EJ, Bennett JD, Asch MR, Common A (2003) Pathologic features of uteri and leiomyomas following uterine artery embolization for leiomyomas. Am J Surg Pathol 27:167–177

    Article  PubMed  Google Scholar 

  5. Dudiak CM, Turner DA, Patel SK, Archie JT, Silver B, Norusis M (1988) Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography. Radiology 167:627–630

    CAS  PubMed  Google Scholar 

  6. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F (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 

  7. Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F (2001) Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril 76:588–594

    Article  CAS  PubMed  Google Scholar 

  8. Farquhar CM, Steiner CA (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 99:229–234

    Article  PubMed  Google Scholar 

  9. Golzorian J, Lohle P, Walker W, Lampmann L, Pelage J (2003) Uterine fibroid embolization for large symptomatic fibroids. J Vasc Interv Radiol 14:S40

    Google Scholar 

  10. (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165

    PubMed  Google Scholar 

  11. Hasan F, Arumugam K, Sivanesaratnam V (1991) Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet 34:45–48

    CAS  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

    CAS  PubMed  Google Scholar 

  13. Kawakami S, Togashi K, Konishi I, Kimura I, Fukuoka M, Mori T, Konishi J (1994) Red degeneration of uterine leiomyoma: MR appearance. J Comput Assist Tomogr 18:925–928

    CAS  PubMed  Google Scholar 

  14. Kim JC, Kim SS, Park JY (2000) "Bridging vascular sign" in the MR diagnosis of exophytic uterine leiomyoma. J Comput Assist Tomogr 24:57–60

    Article  CAS  PubMed  Google Scholar 

  15. Kroencke TJ, Gauruder-Burmester A, Enzweiler CN, Taupitz M, Hamm B (2003) Disintegration and stepwise expulsion of a large uterine leiomyoma with restoration of the uterine architecture after successful uterine fibroid embolization: case report. Hum Reprod 18:863–865

    Article  PubMed  Google Scholar 

  16. Kröncke TJ, Gauruder-Burmester A, Hamm B (2002) Transarterielle Embolisation von Uterusmyomen—Eine neue Therapieoption bei symptomatischem Uterus myomatosus. RÖFO Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174:1227–1235

    Google Scholar 

  17. Masui T, Katayama M, Kobayashi S, Nakayama S, Nozaki A, Kabasawa H, Ito T, Sakahara H (2001) Changes in myometrial and junctional zone thickness and signal intensity: demonstration with kinematic T2-weighted MR imaging. Radiology 221:75–85

    CAS  PubMed  Google Scholar 

  18. Matson M, Nicholson A, Belli AM (2000) Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of failure of uterine embolization. Cardiovasc Intervent Radiol 23:393–396

    Article  CAS  PubMed  Google Scholar 

  19. Mehta H, Sandhu C, Matson M, Belli AM (2002) Review of readmissions due to complications from uterine fibroid embolization. Clin Radiol 57:1122–1124

    Article  CAS  PubMed  Google Scholar 

  20. Nikolic B, Spies JB, Abbara S, Goodwin SC (1999) Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. J Vasc Interv Radiol 10:1167–1170

    CAS  PubMed  Google Scholar 

  21. Oguchi O, Mori A, Kobayashi Y, Horiuchi A, Nikaido T, Fujii S (1995) Prediction of histopathologic features and proliferative activity of uterine leiomyoma by magnetic resonance imaging prior to GnRH analogue therapy: correlation between T2-weighted images and effect of GnRH analogue. J Obstet Gynaecol 21:107–117

    CAS  PubMed  Google Scholar 

  22. Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA jr, Vogelzang RL (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

    PubMed  Google Scholar 

  23. Parker WH, Fu YS, Berek JS (1994) Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet Gynecol 83:414–418

    CAS  PubMed  Google Scholar 

  24. Schwartz LB, Diamond MP, Schwartz PE (1993) Leiomyosarcomas: clinical presentation. Am J Obstet Gynecol 168:180–183

    CAS  PubMed  Google Scholar 

  25. Schwartz LB, Zawin M, Carcangiu ML, Lange R, McCarthy S (1998) Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata? Fertil Steril 70:580–587

    Google Scholar 

  26. Scoutt LM, McCarthy SM, Lange R, Bourque A, Schwartz PE (1994) MR evaluation of clinically suspected adnexal masses. J Comput Assist Tomogr 18:609–618

    CAS  PubMed  Google Scholar 

  27. 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 177:297–302

    CAS  PubMed  Google Scholar 

  28. Smith SJ, Sewall LE, Handelsman A (1999) A clinical failure of uterine fibroid embolization due to adenomyosis. J Vasc Interv Radiol 10:1171–1174

    CAS  PubMed  Google Scholar 

  29. Spies JB, Roth AR, Jha RC, Gomez-Jorge J, Levy EB, Chang TC, Ascher SA (2002) Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222:45–52

    PubMed  Google Scholar 

  30. Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100:873–880

    Article  PubMed  Google Scholar 

  31. Stewart EA (2001) Uterine fibroids. Lancet 357:293–298

    Article  CAS  PubMed  Google Scholar 

  32. Torashima M, Yamashita Y, Matsuno Y, Takahashi M, Nakahara K, Onitsuka Y, Ohtake H, Tanaka N, Okamura H (1998) The value of detection of flow voids between the uterus and the leiomyoma with MRI. J Magn Reson Imaging 8:427–431

    CAS  PubMed  Google Scholar 

  33. 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  CAS  PubMed  Google Scholar 

  34. Weinreb JC, Barkoff ND, Megibow A, Demopoulos R (1990) The value of MR imaging in distinguishing leiomyomas from other solid pelvic masses when sonography is indeterminate. AJR Am J Roentgenol 154:295–299

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Radiologie, Universitätsklinikum Charité, Campus Mitte, Humboldt-Universität zu Berlin

    T. J. Kröncke & B. Hamm

  2. Institut für Radiologie, Universitätsklinikum Charité, Campus Mitte, Humboldt-Universität zu Berlin, Schumannstraße 20/21, 10117 , Berlin

    T. J. Kröncke

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Correspondence to T. J. Kröncke.

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Kröncke, T.J., Hamm, B. Stellenwert der Magnetresonanztomographie für Indikationsstellung, Interventionsplanung und Nachsorge bei transarterieller Embolisationsbehandlung des Uterus myomatosus. Radiologe 43, 624–633 (2003). https://doi.org/10.1007/s00117-003-0929-0

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