title: Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study.
abstract: OBJECTIVE
  To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3-month follow-up.
  
  
  METHODS
  Premenopausal patients with symptomatic, intramural uterine fibroids were included in this prospective case-control study. Seventeen patients who qualified for preoperative UPA treatment were pair-matched with patients of similar age (± 5 years) and fibroid volume (± 10% of volume) who qualified for UAE. Patients undergoing UPA treatment received 5 mg/24 h of oral UPA for 3 months. UAE was performed in patients bilaterally by an interventional radiologist. To estimate dominant fibroid volume, Virtual Organ Computer-aided AnaLysis (VOCAL™) was used. The VOCAL program was also used to calculate three-dimensional power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Dominant fibroid volumes and VI, FI and VFI values were assessed before commencement of UPA treatment or UAE procedure and again at 3 months afterwards.
  
  
  RESULTS
  In both the UPA and UAE groups, fibroid volumes decreased significantly after treatment in comparison with baseline volumes obtained prior to treatment. The percentage of fibroid volume reduction after 3 months of UPA therapy (48.1%) was not significantly different from the reduction seen 3 months after the UAE procedure (47.3%). All vascular indices decreased significantly after treatment by UPA or UAE. The percentage reduction in VI and VFI 3 months after UAE (95.4% for both) was significantly greater than the percentage reduction in patients after 3 months of UPA therapy (51.5% and 62.5%, respectively); however the difference in FI reduction between treatment groups did not reach significance (54.3% for UAE and 30.9% for UPA). No significant side-effects were observed in either treatment group.
  
  
  CONCLUSIONS
  Fibroid treatment by UPA therapy results in a decrease in fibroid volume, comparable with that after UAE, and decreases fibroid vascularization, although to a lesser extent than does UAE.
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Czuczwar
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Wozniak
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Szkodziak
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Milart
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Wozniakowska
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Wrona
authors.affiliation: 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Paszkowski
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007889:Leiomyoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D009649:Norpregnadienes / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055357:Uterine Artery Embolization; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D009649:Norpregnadienes; C555622:ulipristal acetate
keywords: fibroids; power Doppler; ulipristal acetate; ultrasound; uterine artery embolization; vascularity indices