Raj Das MBBS,BMedSc, Presenter: Nothing to Disclose

Michael Gonsalves MBBS, Abstract Co-Author: Nothing to Disclose

Anna Maria Belli, Abstract Co-Author: Nothing to Disclose

Ioannis Vlahos MBBS, Abstract Co-Author: Researcher, Siemens AG Consultant, Siemens AG Consultant, General Electric Company Consultant, Medicsight, Inc

To assess whether the anatomic location of uterine fibroids, results in variable rates of percentage volume reduction on MRI assessment post uterine artery embolisation (UAE).

Single center retrospective analysis in a uterine fibroid treatment tertiary center. MRI assessment prior and 6 months following bilateral UAE with polyvinyl alcohol particles as a primary agent. Dual radiologist consensus opinion with multiplanar MR measurements of up to 6 fibroids per patient. Fibroid types were categorized as: 1) Subserosal (narrow pedicle – contact with myometrium <25%); 2) Subserosal (wider pedicle - contact of 25-50% with myometrium); 3) Intramuscular. Submucosal fibroids were excluded due to their relative low incidence.  Percentage volume reduction/change was measured and compared between all 95 fibroids according to fibroid type and then analysed on a per patient basis.  

95 fibroids in 20 patients were assessed with 11 subserosal (SS) (<25% contact with myometrium), 15 subserosal (25-50% contact) and 69 intramuscular (IM) in location. Mean time from UAE to follow-up MRI was 5.6 months. On a per fibroid basis no significant difference in percentage volume reduction was demonstrated between SS (<25% pedicle), SS (25-50% pedicle) and IM fibroids (Mann-Whitney U tests). On a per patient basis, evaluation of patients exhibiting both types of fibroid demonstrated no significant difference in volume reduction between fibroid types (p=0.48). Assessment of narrow pedicle subserosal fibroids (<25%) (n=11) (mean reduction 52.3% (95% CI 37.8-66.8%) against all other fibroid types (n=84) [SS 25-50% mean reduction 24.6% (95% CI 12.5-36.7%) and IM fibroid mean reduction 32.2% (95% CI 25.1-39.2%)] demonstrated a significant difference in volume reduction (p=0.017) (Mann-Whitney U test).  

Recent evidence has shown a non-significant difference or decreased response of subserosal fibroids to UAE. The preferential response of narrow pedicle subserosal fibroids has been demonstrated in this small study and may be due to their more tenuous blood supply and decreased ability to recruit new vessels. This may aid the radiologist and gynecologist in patient selection and follow-up for UAE procedures. 

Patients are increasingly choosing UAE over conventional surgery for symptomatic fibroids; narrow pedicle subserosal fibroids have demonstrated a favourable volume reduction on MRI at 6 months.

Das, R, Gonsalves, M, Belli, A, Vlahos, I, MRI Assessment of Leiomyoma Volume Changes Following Uterine Artery Embolisation: Correlation with Uterine Fibroid Anatomic Location.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010693.html