title: Effect of Direct Marketing for Uterine Artery Embolization on Rates of Leiomyomas, Incidental Findings, and Management After Pelvic MRI.
abstract: OBJECTIVE
  The aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI.
  
  
  METHODS
  This was an institutional review board-approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years).
  
  
  RESULTS
  There was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306).
  
  
  CONCLUSIONS
  After initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups.
authors.affiliation: Department of Radiology, Stanford University, Stanford, California.
authors.forename: Sheena
authors.initials: S
authors.lastname: Gurwara
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina. Electronic address: brian.allen@duke.edu.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.affiliation: Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Brian
authors.initials: B
authors.lastname: Kouri
authors.affiliation: Portsmouth Naval Medical Center, Portsmouth, Virginia.
authors.forename: M Jennings
authors.initials: MJ
authors.lastname: Clingan
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Melissa
authors.initials: M
authors.lastname: Picard
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: John R
authors.initials: JR
authors.lastname: Leyendecker
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional / Q000706:statistics & numerical data*; D008389:Marketing of Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D018584:Physician Self-Referral / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D014600:Utilization Review
keywords: Leiomyoma; MRI; fibroid embolization; marketing; uterine artery embolization