Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings.
OBJECTIVE
To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy.


METHODS
A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90-99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention.


RESULTS
In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008).


CONCLUSIONS
There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.
Department of Interventional Radiology, Gartnavel General Hospital, 1053, Great Western Road, Glasgow, G12 0YN, UK. ganapathy.ananthakrishnan@nhs.net
Ganapathy
G
Ananthakrishnan
Lilian
L
Murray
Moira
M
Ritchie
Gordon
G
Murray
Fiona
F
Bryden
Sue
S
Lassman
Mary Ann
MA
Lumsden
Jon G
JG
Moss
D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011788:Quality of Life; D019233:Retreatment; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000601:surgery / Q000628:therapy*
D003287:Contrast Media