MRI May Predict Midterm Symptom Recurrence after Uterine Artery Embolization for Adenomyosis

Uterine artery embolization (UAE) for adenomyosis has been shown to result in short term symptom relief but may recur after longer follow-up periods. The purpose of this study was to evaluate the relationship between the post-UAE percentage of necrosis and symptom recurrence at midterm follow-up.

This retrospective study analyzed the percentage of necrosis of uterine adenomyosis on contrast-enhanced MR imaging in 50 women who underwent the procedure for symptomatic adenomyosis. Three dimensional reconstruction software was used to measure the volumes of adenomyosis on the baseline scan and the necrotic volume at the 3 month follow up scan, as defined by non-enhancement on T1-weighted post contrast images. Adenomyosis-related symptoms were assessed using an oral questionnaire at baseline and up to 48 months post-procedure.

During the follow up period, symptom recurrence occurred in 24% (12 of 50) of women. Women with < 34.3% necrosis after UAE had a sevenfold higher risk of symptom recurrence compared with patients with > 34.3% necrosis. Initial uterine volume and the type of adenomyosis (focal or diffuse) did not show significant relationships with recurrence. The study was limited by a small number of patients at a single institution. The distribution of the percentage of necrosis found in the patients was heavily skewed in that 38 out of 50 women had > 34% necrosis.

Comment:

The findings suggest that midterm symptom prognosis after UAE for adenomyosis can be predicted by MR imaging at 3 months post-procedure based on percentage of necrosis. This may have implications for early patient management, aggressive imaging, and appropriate counseling. However, the number of limitations in the study warrant further investigation with larger patient populations and additional MRI analysis of necrotic volumes at later intermediate follow up periods.


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A 40-year-old woman who underwent UAE for symptomatic adenomyosis. (a) Sagittal T2-weighted MR image obtained before UAE shows focal junctional zone thickening of the uterus. (b) Sagittal T2-weighted MR image obtained 3 months after UAE shows decreased size of adenomyosis and the uterus. The volume of adenomyosis was calculated semiautomatically to be 142.580 cm3. (c) Sagittal contrast-enhanced T1-weighted MR image obtained 3 months after UAE shows partial necrotic area without enhancement. The volume of necrosis was calculated semiautomatically to be 65.477 cm3. The percentage of necrosis was 45.9%


Citation: Bae, S. H. et al. Uterine Artery Embolization for Adenomyosis: Percentage of Necrosis Predicts Midterm Clinical Recurrence. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2015.04.026


Author: Laura Traube, MD, MPH, Fellow in Interventional Radiology, UCLA Medical Center