Uterine artery embolization in single symptomatic leiomyoma: do anatomical imaging criteria predict clinical presentation and long-term outcome?
BACKGROUND
Uterine artery embolization (UAE) has proven to be an effective treatment alternative for women suffering from symptomatic uterine leiomyomas. However, long-term clinical evaluation reveals treatment failure in approximately 25% of patients. To cope with the great variability in the extent of leiomyoma disease former studies are based on the simplifying assumption that the largest leiomyoma mainly causes the symptoms.


OBJECTIVE
To evaluate whether anatomical characteristics in women with a single symptomatic leiomyoma influence clinical presentation and outcome after UAE.


METHODS
Ninety-one patients with a single leiomyoma underwent UAE. Age, uterine and fibroid volume, fibroid location, and clinical symptoms (bleeding- and/or bulk-related symptoms) were documented. The need for reinterventions (i.e. repeat UAE, hysterectomy, myomectomy) and unchanged or worsened symptoms after UAE were classified as treatment failure (TF). Contrast-enhanced magnetic resonance imaging (MRI) 48-72 h after UAE was available in 38 women. The rate of fibroid infarction was determined and patients were assigned to one of three groups: complete (100%), almost complete (90-99%), or partial infarction (<90%). Cox regression analysis (CRA) was used to determine the influence of morphological and clinical parameters on outcome.


RESULTS
Follow-up was available in 79/91 (87%) women (median age, 42 years; range, 33-56 years) at a median of 5 years (range, 3.1-9.2 years) after UAE. Anatomical leiomyoma criteria neither connected to specific clinical presentation nor influenced clinical outcome. Younger women showed a higher risk for TF with every year older lowering the risk by the factor of 0.86 (P = 0.024). Subgroup analysis showed predictive value of fibroid infarction with a cumulative survival free from TF of 91% for complete vs. 0% for partial infarction (P < 0.001).


CONCLUSIONS
Even in women with single leiomyomas, anatomical criteria do not specify clinical presentation or predict clinical outcome. Younger patient age and incomplete fibroid infarction relate to higher rates of TF.
Department of Diagnostic and Interventional Radiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
Clemens
C
Koesters
Maciej J
MJ
Powerski
Vera
V
Froeling
Thomas J
TJ
Kroencke
Christian
C
Scheurig-Muenkler
D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000628:therapy*
D003287:Contrast Media
Genital/reproductive; adults; angiography; embolization; outcome analysis; uterus