Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics.
OBJECTIVE
To investigate the patient and magnetic resonance (MR) imaging characteristics associated with clinical failure after uterine artery embolization (UAE).


METHODS
Seventy-eight consecutive patients who underwent UAE were examined. Contrast-enhanced MR imaging was performed before and 4 months after the procedure, and clinical follow-up was performed at 15 months. Patients were divided into success and failure groups strictly on the basis of their clinical outcomes. Clinical follow-up included evaluation of fibroid symptoms and the need for further treatment after UAE. Findings at pre- and postprocedural MR imaging were compared, and data collected included changes in uterine and fibroid volumes, fibroid location, and fibroid perfusion.


RESULTS
Fifty-eight patients were placed into the success group and 20 into the failure group. There were no differences between the baseline characteristics of the two groups. The reduction in uterine and dominant fibroid volumes was greater in the success group compared with the failure group; however, the difference was not statistically significant (success group: [295/845] 34.9% vs [80/282.5] 28.3%, respectively, P=.18; failure group: [317/733] 43.2% vs [114/337.6] 33.9%, P=.32). The reduction in total fibroid volume was greater in the success group than the failure group ([189.6/393.5] 48.2% vs [148.7/439.9] 33.8%, respectively; P=.02) despite the fact that the percentage of fibroids completely infarcted was similar between the two groups ([136/172] 79% vs [41/50] 82%, P=.77). Pedunculated subserosal fibroids were more common in the failure group than in the success group (P<.03) and did not reduce in volume as significantly (53.8% vs 14.7%, respectively; P=.02).


CONCLUSIONS
In general, the reduction in total fibroid volume after embolization is smaller in patients with poor clinical improvement. In addition, these patients have a higher number of pedunculated subserosal fibroids, and these fibroids tend to reduce in volume to a lesser extent.
Toor
Sundeep S
SS
Department of Medical Imaging, University Health Network and University of Toronto, 585 University Ave, NCSB 1C563, Toronto, Ontario Canada M5G 2N2.
Tan
Kongteng T
KT
Simons
Martin E
ME
Rajan
Dheeraj K
DK
Beecroft
J Robert
JR
Hayeems
Eran
E
Sniderman
Kenneth W
KW
D000328:Adult; D001158:Arteries; D016009:Chi-Square Distribution; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D017211:Treatment Failure; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*
D003287:Contrast Media