title: Can (1)H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?
abstract: OBJECTIVE
  Absence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6 months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether (1)H MR spectroscopy ((1)H MRS) can also indicate the success of UAE.
  
  
  METHODS
  20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5 T) were acquired pre-, 24-h and 6 months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p < 0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed.
  
  
  RESULTS
  Choline was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6 months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6 months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6 months (mean/min/max 396.5/84.1/997.5 cm(3), p = 0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6 months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/-230.6/382.6 cm(3), p = 0.15). The negative minimum value indicates fibroid growth.
  
  
  CONCLUSIONS
  This study has demonstrated the potential of (1)H MRS to provide an additional marker of the success of UAE.
authors.affiliation: Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. gillian.macnaught@ed.ac.uk.
authors.forename: Gillian
authors.initials: G
authors.lastname: Macnaught
authors.affiliation: Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK. a.radiology@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Ananthakrishnan
authors.affiliation: Radiology Department, Wishaw General Hospital, 50 Netherton Street, Wishaw, ML2 0DP, UK. laurahinksman@nhs.net.
authors.forename: L
authors.initials: L
authors.lastname: Hinksman
authors.affiliation: Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK. reddi.yadavali@nhs.net.
authors.forename: R
authors.initials: R
authors.lastname: Yadavali
authors.affiliation: Radiology Department, Stobhill Hospital, 133 Balornock Road, Glasgow, G21 3UW, UK. Fiona.Bryden@ggc.scot.nhs.uk.
authors.forename: F
authors.initials: F
authors.lastname: Bryden
authors.affiliation: Radiology Department, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK. Sue.Lassman@ggc.scot.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Lassman
authors.affiliation: Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK. moirasim9@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Ritchie
authors.affiliation: School of Mathematics and Statistics, University Gardens, University of Glasgow, Glasgow, G12 8QW, UK. k.gallacher.3@research.gla.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Gallacher
authors.affiliation: Interventional Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. c.hay@nhs.net.
authors.forename: C
authors.initials: C
authors.lastname: Hay
authors.affiliation: Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK. jon.moss@ggc.scot.nhs.uk.
authors.forename: J G
authors.initials: JG
authors.lastname: Moss
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D005260:Female; D005780:Gelatin / Q000008:administration & dosage; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D009929:Organ Size; D010865:Pilot Projects; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000180:Acrylic Resins; C496735:trisacryl gelatin microspheres; D005780:Gelatin
keywords: MR spectroscopy; Uterine artery embolisation; Uterine fibroids