title: Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome.
abstract: OBJECTIVE
  To determine the effect of partial versus complete leiomyoma infarction on relief of leiomyoma-related symptoms and freedom from invasive reinterventions and to assess if patient age, location of the dominant leiomyoma, number of leiomyomas, or baseline uterine and dominant leiomyoma volume were associated with clinical failure.
  
  
  METHODS
  Study protocol was approved by the institutional review board, and informed consent was obtained. One hundred fifteen consecutive women (median age, 42 years; range, 34-61 years) with symptomatic uterine leiomyomas underwent contrast material-enhanced magnetic resonance (MR) imaging at baseline and 24-72 hours after uterine artery embolization (UAE) to determine the percentage of infarction of leiomyoma tissue (complete = 100%, almost complete = 90%-99%, and partial = 0%-89%). Clinical outcome and frequency of reinterventions were compared for up to 36 months.
  
  
  RESULTS
  One hundred thirteen patients completed at least one clinical follow-up. Twenty-four months after UAE, 50% +/- 15.2 (standard error) of the patients with partial infarction and 80% +/- 13.4 (standard error) of patients with almost complete infarction had undergone no reintervention. No patient with complete infarction needed a second treatment (P < .001). The hazard ratios for reintervention between the complete infarction group and the almost complete and partial infarction groups were 15.88 (95% confidence interval [CI]: 1.22, 2225.54; P = .034) and 73.08 (95% CI: 8.33, 9636.35; P < .001), respectively. There were significant differences in hazard ratios between patients with partial and those with complete infarction for persistence or recurrence of menorrhagia (hazard ratio, 7.45; 95% CI: 2.08, 28.31; P = .002) and bulk-related symptoms (hazard ratio, 5.90; 95% CI: 1.66, 21.92; P = .007). There was no significant correlation between patient age, number of leiomyomas, location of the dominant leiomyoma, or baseline uterine and dominant leiomyoma volume and clinical failure.
  
  
  CONCLUSIONS
  Women with leiomyoma infarction above 90% on contrast-enhanced MR images after UAE show significantly better symptom control and fewer reinterventions than do patients with a lower infarction rate.
authors.affiliation: Department of Radiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553 Berlin, Germany. thomas.kroencke@charite.de
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kroencke
authors.forename: Christian
authors.initials: C
authors.lastname: Scheurig
authors.forename: Alexander
authors.initials: A
authors.lastname: Poellinger
authors.forename: Maike
authors.initials: M
authors.lastname: Gronewold
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
mesh_terms: D000328:Adult; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007238:Infarction / Q000628:therapy*; D007889:Leiomyoma / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000628:therapy*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA