title: Role of uterine artery Doppler in the management of uterine leiomyoma by arterial embolization.
abstract: OBJECTIVE
  To study Doppler changes in the uterine artery immediately following and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of the predominant side of arterial supply to leiomyomas, amount of embolizing material needed and leiomyoma tumor volume at follow-up.
  
  
  METHODS
  The study included 38 patients undergoing UAE for leiomyomas. Uterine artery Doppler was performed transabdominally before, within 6 hours after and 3 months after UAE to determine the peak systolic (PSV) and end-diastolic (EDV) velocities and resistance index (RI). Leiomyoma volume was measured using contrast-enhanced magnetic resonance imaging (MRI) before and 3 months after UAE. The predominant side of arterial supply to the leiomyoma was determined on digital subtraction angiography using the uterine artery diameter and tumor blush after contrast injection. For correlations with leiomyoma volume, the average PSV, EDV and RI of both sides was used, while for prediction of the predominant side of supply and for correlation with the amount of embolizing material needed, separate measurements from each side were used.
  
  
  RESULTS
  Relative to the pre-embolization value, the uterine artery PSV and EDV were significantly reduced (P < 0.05) immediately following UAE, while the RI was significantly elevated (P < 0.05). For prediction of the predominant side of supply, the lowest RI showed the highest accuracy (81.6%). There was no significant correlation between the pre-embolization PSV, EDV or RI and the amount of embolizing material utilized. Immediately post-embolization EDV and RI values were statistically significantly correlated with the 3-month follow-up leiomyoma volume, with RI showing the strongest correlation (P = 0.0400 and 0.0002, rho = 0.34 and - 0.58, respectively). The leiomyoma volume was predicted to have reduced by 38-61% after 3 months if the immediate post-embolization average RI value was between 0.82 and 0.88.
  
  
  CONCLUSIONS
  Pre-interventional Doppler assessment can be used to predict the predominant side of supply to leiomyomas but not the amount of embolizing material needed. Immediate post-interventional Doppler assessment can predict the leiomyoma volume after UAE.
authors.affiliation: Radiology Department, Frankfurt University Hospital, Frankfurt, Germany. nagynnn@yahoo.com
authors.forename: N N N
authors.initials: NN
authors.lastname: Naguib
authors.forename: N-E A
authors.initials: NE
authors.lastname: Nour-Eldin
authors.forename: F
authors.initials: F
authors.lastname: Serag-Eldin
authors.forename: Y Z
authors.initials: YZ
authors.lastname: Mazloum
authors.forename: A F
authors.initials: AF
authors.lastname: Agameya
authors.forename: S
authors.initials: S
authors.lastname: Abou-Seif
authors.forename: A N
authors.initials: AN
authors.lastname: Etaby
authors.forename: T
authors.initials: T
authors.lastname: Lehnert
authors.forename: T
authors.initials: T
authors.lastname: Gruber-Rouh
authors.forename: S
authors.initials: S
authors.lastname: Zangos
authors.forename: H
authors.initials: H
authors.lastname: Ackermann
authors.forename: T J
authors.initials: TJ
authors.lastname: Vogl
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D047368:Tumor Burden; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003287:Contrast Media