Jean-Pierre Jacques Pelage MD, Presenter: Nothing to Disclose

Remi Brouard, Abstract Co-Author: Nothing to Disclose

Denis Jacob MD, Abstract Co-Author: Nothing to Disclose

Mourad Boudiaf MD, Abstract Co-Author: Nothing to Disclose

Martine Abitbol MD, Abstract Co-Author: Nothing to Disclose

Olivier Le Dref MD, Abstract Co-Author: Nothing to Disclose

Roland Rymer MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate residual fibroid perfusion in women treated with uterine artery embolization for symptomatic fibroids. To correlate uterine and fibroid volume reductions and clinical improvement with residual fibroid perfusion.

From october 2001, of the 254 women treated with uterine artery embolization for symptomatic fibroids, 79 (mean age 44.9 years) had a gadolinium-enhanced pelvic magnetic resonance imaging (MRI) performed 24 hours after embolization to evaluate residual fibroid perfusion. Limited uterine artery embolization was performed using tris-acryl microspheres larger than 500 microns in all women. MRI was performed after 24 hours only in case of unilateral embolization, ovarian artery supply to the fibroids or arterial spasm. Clinical evaluation and MRI were then obtained at 6 months, 12 and 24 months after embolization to assess patient outcome, volume reduction and residual fibroid perfusion.

Most women presented with menorrhagia and had multiple fibroids. In the group of 40 women who completed the first follow-up (mean 194 days), the 24 hour-MRI, demonstrated complete devascularization of all the fibroids in 29 women (73%). All women with complete fibroid devascularization had significant clinical improvement whereas menstrual bleeding was significantly heavier and longer in women with at least one fibroid with incomplete infarction. In this group of 11 women, 4 had no improvement after embolization and 4 had recurrence of symptoms after 6-19 months with 3 requiring a second embolization. Of interest, no difference in uterine and dominant fibroid volume reductions was found between patients with complete vs incomplete fibroid infarction.

Long-term clinical improvement after uterine artery embolization depends on fibroid infarction and not on fibroid shrinkage. Residual fibroid perfusion measured 24 hours after embolization is a good predictor of clinical response.

J.P.P.: Research grants and consultant: Biocompatibles, Biosphere Medical, Boston Scientific and Research grants: Nycomed

Pelage, J, Brouard, R, Jacob, D, Boudiaf, M, Abitbol, M, Le Dref, O, Rymer, R, et al, , Perfusion of Uterine Fibroids Evaluated Using Gadolinium-enhanced Magnetic Resonance Imaging Performed 24 Hours after Arterial Embolization Is a Predictor of Clinical Outcome.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4407377.html