title: Degeneration of leiomyoma in patients referred for uterine fibroid embolization: incidence, imaging features and clinical characteristics.
abstract: OBJECTIVE
  Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma.
  
  
  METHODS
  Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated.
  
  
  RESULTS
  Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient.
  
  
  CONCLUSIONS
  The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Han
authors.forename: Man-Deuk
authors.initials: MD
authors.lastname: Kim
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Jung
authors.forename: Myungsu
authors.initials: M
authors.lastname: Lee
authors.forename: Mu Sook
authors.initials: MS
authors.lastname: Lee
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Jong Yun
authors.initials: JY
authors.lastname: Won
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Lee
authors.forename: Kwang Hun
authors.initials: KH
authors.lastname: Lee
mesh_terms: D015746:Abdominal Pain / Q000628:therapy; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007889:Leiomyoma / Q000150:complications* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008595:Menorrhagia / Q000628:therapy; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization