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WenTao J, GuoFu Z, TianPin W, ShiJia W, HaiYan Z, WenTao L. Nomogram for predicting the long-term outcomes of uterine artery embolization for adenomyosis. Eur J Radiol 2022; 148:110183. [DOI: 10.1016/j.ejrad.2022.110183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
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Rees CO, Nederend J, Mischi M, van Vliet HAAM, Schoot BC. Objective measures of adenomyosis on MRI and their diagnostic accuracy-a systematic review & meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1377-1391. [PMID: 33682087 DOI: 10.1111/aogs.14139] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) diagnosis of adenomyosis is considered the most accurate non-invasive technique, but remains subjective, with no consensus on which diagnostic parameters are most accurate. We aimed to systematically review the literature on how adenomyosis can be objectively quantified on MRI in a scoping manner, to review the diagnostic performance of these characteristics compared with histopathological diagnosis, and to summarize correlations between measures of adenomyosis on MRI and clinical outcomes. MATERIAL AND METHODS We searched databases Pubmed, Embase, and Cochrane for relevant literature up to April 2020 according to PRISMA guidelines. We included studies that objectively assessed adenomyosis on MRI, and separately assessed studies investigating the diagnostic performance of MRI vs histopathology for inclusion in a meta-analysis. The QUADAS-2 tool was used for risk of bias, with many studies showing an unclear or high risk of bias. RESULTS Eighty studies were included, of which 14 assessed the diagnostic performance of individual MRI parameters, with four included in the meta-analysis of diagnostic accuracy. Common MRI parameters were: junctional zone (JZ) characteristics, such as maximum JZ thickness-pooled sensitivity 71.6% (95% CI 46.0%-88.2%), specificity 85.5% (52.3%-97.0%); JZ differential-pooled sensitivity 58.9% (95% CI 44.3%-72.1%), specificity 83.2% (95% CI 71.3%-90.8%); and JZ to myometrial ratio-pooled sensitivity 63.3% (95% CI 51.9%-73.4%), specificity 79.4% (95% CI 42.0%-95.4%); adenomyosis lesion size, uterine morphology (pooled sensitivity 42.9% (95% CI 15.9%-74.9%), specificity 87.7%, (95% CI 37.9-98.8) and changes in signal intensity-eg, presence of myometrium cysts; pooled 59.6% (95% CI 41.6%-75.4%) and specificity of 96.1% (95% CI 80.7%-99.3%). Other MRI parameters have been used for adenomyosis diagnosis, but their diagnostic performance is unknown. Few studies attempted to correlate adenomyosis MRI phenotype to clinical outcomes. CONCLUSIONS A wide range of objective parameters for adenomyosis exist on MRI; however, in many cases their individual diagnostic performance remains uncertain. JZ characteristics remain the most widely used and investigated with acceptable diagnostic accuracy. Specific research is needed into how these objective measures of adenomyosis can be correlated to clinical outcomes.
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Affiliation(s)
- Connie O Rees
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, the Netherlands.,Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Massimo Mischi
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Benedictus C Schoot
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, the Netherlands.,Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
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Yajima R, Kido A, Kurata Y, Fujimoto K, Nakao KK, Kuwahara R, Nishio N, Minamiguchi S, Mandai M, Togashi K. Diffusion-weighted imaging of uterine adenomyosis: Correlation with clinical backgrounds and comparison with malignant uterine tumors. J Obstet Gynaecol Res 2021; 47:949-960. [PMID: 33511748 DOI: 10.1111/jog.14621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
AIM To elucidate correlation between signal intensity on diffusion-weighted images (SI-DWI) and clinical backgrounds for uterine adenomyosis and to compare SI-DWI of adenomyosis and malignant uterine tumors. METHODS This study examined 46 adenomyosis patients diagnosed using magnetic resonance imaging and 25 patients with surgically confirmed malignant uterine myometrial tumor. First, adenomyosis cases were classified visually into high-intensity and low-intensity groups based on the SI-DWI compared with that of normal uterine myometrium. Secondly, correlation was assessed between SI-DWI of adenomyosis and patient clinical background information such as age, menopausal status, menstrual cycle and dysmenorrhea severity. Third, quantitative comparison was made of low-intensity adenomyosis (LIA), high-intensity adenomyosis (HIA) and malignant tumor groups for the signal intensity ratio (SIR) on DWI and the apparent diffusion coefficient (ADC). Their diagnostic performance was evaluated using logistic regression analysis and receiver operating characteristic (ROC) analysis. RESULTS The 46 adenomyosis cases were classified as 26 low-intensity and 20 high-intensity cases. Significant correlation was found only for menstrual cycle phases. HIA had significantly lower SIR and higher ADC than malignant tumor. The ADC of HIA was significantly higher than that of LIA. The combination of SIR and ADC showed excellent diagnostic performance (area under ROC curve, 0.99). CONCLUSION There is a variation in signal intensity on DWI of uterine adenomyosis and it is associated with menstrual cycle phase. Adenomyosis with high signal intensity on DWI can be differentiated from malignant lesions by its lower signal intensity on DWI and higher ADC than that found for malignant uterine tumors, however overlaps exist.
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Affiliation(s)
- Ryo Yajima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Kuwahara
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Naoko Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kim MD. Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases. Korean J Radiol 2020; 20:1462-1473. [PMID: 31544371 PMCID: PMC6757003 DOI: 10.3348/kjr.2019.0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/14/2019] [Indexed: 12/04/2022] Open
Abstract
Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.
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Affiliation(s)
- Man Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Wang Y, Lyu W, Xu W, Yu Y. Asherman syndrome in adenomyosis treated with uterine artery embolization: incidence predictive factors. Radiol Med 2020; 125:437-443. [PMID: 32020527 DOI: 10.1007/s11547-020-01136-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/16/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate Asherman syndrome (AS) related to potential factors during uterine artery embolization (UAE) treatment of adenomyosis. MATERIALS AND METHODS This is a retrospective analysis of 195 women with adenomyosis who underwent UAE treatment from 2009 to 2016. All preoperative and intraoperative risk-related potential factors of AS were recorded. And AS events were carefully monitored during follow-up (range, 0-15 months). Potential risk-related factors of AS events were determined via univariate and multivariate logistic regression analyses. RESULTS The rate of AS events after UAE for adenomyosis was 12.82% (25/195). The univariate and multivariate analyses revealed the association of low vascularity with a significant risk for AS (P = 0.019). CONCLUSION Patients with low vascularity of adenomyosis at the time of UAE are more likely to have AS. And adenomyosis patients with low vascularity should be carefully selected to undergo UAE treatment.
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Affiliation(s)
- Yaguang Wang
- Department of Radiology, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Street, Hefei, 230022, PA, People's Republic of China.,Department of Radiology, Women and Children Health Care Hospital Affiliated Hospital, Anhui Medical University, 15 Yimin Street, Hefei, 230022, PA, People's Republic of China
| | - Weifu Lyu
- Department of Radiology, The First Affiliated Hospital, University of Science and Technology of China, 17 Lujiang Street, Hefei, 230022, PA, People's Republic of China
| | - Wencui Xu
- Department of Radiology, Women and Children Health Care Hospital Affiliated Hospital, Anhui Medical University, 15 Yimin Street, Hefei, 230022, PA, People's Republic of China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Street, Hefei, 230022, PA, People's Republic of China.
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Zheng R, Zeng D, Wan TT, Guo WB, Guo Y, Liu MJ. Predisposing factors for predicting the therapeutic response of adenomyosis after uterine artery embolization: serum CA125 levels and accompanying endometriosis. ACTA ACUST UNITED AC 2019; 24:364-371. [PMID: 30373724 DOI: 10.5152/dir.2018.17479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify predisposing factors that could help predict the therapeutic response of adenomyosis after uterine artery embolization (UAE). METHODS This was a retrospective, single-center study of patients admitted to the hospital for adenomyosis between 2013 and 2015. Sixty-eight patients with adenomyosis who underwent UAE with tris-acryl gelatin microspheres were divided into two groups based on their therapeutic response (complete or incomplete necrosis of lesions), and pre- and postprocedural pelvic magnetic resonance imaging (MRI) data. Patients were followed up for 12 months after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the symptom relief criteria. Improvement rates in both groups were analyzed and compared. Multivariate logistic regression analysis was used to identify the predisposing factors from retrospectively gathered baseline data that might affect the therapeutic response, including MRI features, clinical symptoms, biochemical index, and accompanying diseases of adenomyosis. Then, a prognostic model was established, and the receiver operating characteristic (ROC) curve of identified factors was drawn to determine their predictive value. RESULTS Following UAE, 46 patients (67.6%) showed complete necrosis, while 22 patients (32.4%) showed incomplete necrosis. At 12-month follow-up, dysmenorrhea symptom improvement was seen in 94.7% of complete necrosis and 50% of incomplete necrosis group (P < 0.001); menorrhagia symptom improvement was seen in 96.2% of complete necrosis and 57.1% of incomplete necrosis groups (P = 0.004). Multivariate logistic regression analysis determined serum cancer antigen 125 (CA125) levels (odds ratio [OR], 1.006; 95% confidence interval [CI], 1.002-1.010; P = 0.005) and accompanying endometriosis (OR, 6.869; 95% CI, 1.881-25.016; P = 0.004) as predisposing factors. The areas under the ROC curve of CA125, endometriosis, and these two indicators combined were 0.785, 0.708, and 0.845, which corresponded to sensitivities of 95.5%, 66.7%, and 68.2% and specificities of 52.2%, 80.0%, and 87.0% at optimal cutoff values, respectively. CONCLUSION Symptom relief of dysmenorrhea and menorrhagia for patients with complete necrosis was significantly better than that for patients with incomplete necrosis. Serum CA125 levels and accompanying endometriosis can effectively distinguish complete necrosis from incomplete necrosis.
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Affiliation(s)
- Rui Zheng
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dan Zeng
- Department of Radiology, Huangpu Division, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting-Ting Wan
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen-Bo Guo
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming-Juan Liu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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de Bruijn AM, Lohle PN, Huirne JA, de Vries J, Twisk M, Hehenkamp WJ. Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Adenomyosis: Protocol for the Randomized QUESTA Trial. JMIR Res Protoc 2018; 7:e47. [PMID: 29496654 PMCID: PMC5856934 DOI: 10.2196/resprot.8512] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Background Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce symptoms and improve quality of life. However, randomized controlled trials are lacking. Objective With this study, we aim to evaluate the impact of UAE on Health-Related Quality of Life (HRQOL) in a randomized comparison to hysterectomy in patients with symptomatic adenomyosis. Methods This is a multicenter non-blinded randomized controlled trial comparing UAE and hysterectomy. Eligible patients are symptomatic premenopausal women without the desire to conceive and who have symptomatic magnetic resonance imaging (MRI)–confirmed pure adenomyosis or dominant adenomyosis accompanied by fibroids. After obtaining informed consent, patients will be randomly allocated to treatment in a 2:1 UAE versus hysterectomy ratio. The primary objective is HRQOL at 6 months following the assigned intervention. Secondary outcomes are technical results, pain management, clinical outcomes, HRQOL, and cost effectiveness during 2 years of follow-up. In addition, transvaginal ultrasound (TVUS) and MRI will be performed at regular intervals after UAE. Results Patient enrollment started November 2015. The follow-up period will be completed two years after inclusion of the last patient. At the time of submission of this article, data cleaning and analyses have not yet started. Conclusions This trial will provide insight for caretakers and future patients about the effect of UAE compared to the gold standard hysterectomy in the treatment of symptomatic adenomyosis and is therefore expected to improve patients’ wellbeing and quality of life. Trial Registration Netherlands Trial Register NTR5615; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5615 (Archived by WebCite at http://www.webcitation.org/6xZRyXeIF)
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Affiliation(s)
- Annefleur Machteld de Bruijn
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Paul Nm Lohle
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Judith Af Huirne
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Medical and Clinical Psychology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Moniek Twisk
- Department of Gynecology, Medical Center Zuiderzee, Lelystad, Netherlands
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- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Wouter Jk Hehenkamp
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
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8
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de Bruijn AM, Smink M, Lohle PNM, Huirne JAF, Twisk JWR, Wong C, Schoonmade L, Hehenkamp WJK. Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2017; 28:1629-1642.e1. [PMID: 29032946 DOI: 10.1016/j.jvir.2017.07.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 01/13/2023] Open
Abstract
The effect of uterine artery embolization (UAE) on symptomatic adenomyosis was evaluated in a systematic review and meta-analysis. Four groups were evaluated: short-term (< 12 months) pure adenomyosis, short-term adenomyosis with fibroids (combined adenomyosis), long-term (> 12 months) pure adenomyosis, and long-term combined adenomyosis. Improvement of symptoms occurred in 83.1% (872/1,049) of patients. Reported symptom reduction was 4.8% greater in the short-term combined group (P = .169) and 11.4% greater in the long-term combined group (P = .003). Uterine volume was reduced in all patients at 3 months. The effects of UAE on symptom improvement and uterine volume reduction in patients with adenomyosis are encouraging.
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Affiliation(s)
- Annefleur M de Bruijn
- Department of Gynecology, VU Medical Center, De Boelelaan 1117, Amsterdam 1081HV, Netherlands.
| | - Marieke Smink
- Department of Gynecology, Elisabeth Tweesteden ziekenhuis, Tilburg, Netherlands
| | - Paul N M Lohle
- Department of Radiology, Elisabeth Tweesteden ziekenhuis, Tilburg, Netherlands
| | - Judith A F Huirne
- Department of Gynecology, VU Medical Center, De Boelelaan 1117, Amsterdam 1081HV, Netherlands
| | - Jos W R Twisk
- Department of Gynecology, VU Medical Center, De Boelelaan 1117, Amsterdam 1081HV, Netherlands
| | | | | | - Wouter J K Hehenkamp
- Department of Gynecology, VU Medical Center, De Boelelaan 1117, Amsterdam 1081HV, Netherlands
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Uterine Artery Embolization for Symptomatic Adenomyosis: 7-Year Clinical Follow-up Using UFS-Qol Questionnaire. Cardiovasc Intervent Radiol 2017; 40:1344-1350. [PMID: 28516272 PMCID: PMC5541078 DOI: 10.1007/s00270-017-1686-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/02/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to assess clinical outcomes 7 years after uterine artery embolization (UAE) in the treatment of symptomatic adenomyosis. MATERIALS AND METHODS In this prospective cohort study, one specialized hospital in the Netherlands recruited patients with symptomatic adenomyosis or adenomyosis in combination with fibroids for UAE. The 7-year post-intervention outcomes were health-related quality of life (HRQOL), symptom severity scores (SSS), satisfaction, menopause and re-interventions. RESULTS Twenty-nine patients with adenomyosis (15 with fibroids) were treated with UAE between September 2006 and January 2010. The 7-year questionnaire was mailed in November 2016. The mean follow-up was 95 months (SD 9.0) at a mean age of 50 (SD 5.4). Questionnaires were returned by 24/29 patients (83%). The remaining five patients were contacted through telephone. One of these patients was untraceable. Seven years after treatment 5 of 28 patients (18%) underwent a secondary hysterectomy. The HRQOL and SSS scores as measured by UFS-QOL at 3 months after UAE showed significant improvement of -57 points (score: 15) and +40 points (score: 91), respectively. These scores remained comparable stable up unto 7 years. The SSS showed a significant difference of 17 points (0-100) in favor of the adenomyosis in combination with fibroids group (p = 0.020). Menopause was reported by 10/28 patients (36%). Twenty-one of 29 (72%) patients declared to be at least fairly satisfied about UAE. CONCLUSIONS After 7 years of follow-up, in 82% of UAE-treated patients with symptomatic adenomyosis a hysterectomy was avoided.
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Montoliu-Fornas G, Martí-Bonmatí L. Magnetic resonance imaging structured reporting in infertility. Fertil Steril 2016; 105:1421-31. [DOI: 10.1016/j.fertnstert.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
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Wang S, Meng X, Dong Y. The evaluation of uterine artery embolization as a nonsurgical treatment option for adenomyosis. Int J Gynaecol Obstet 2015; 133:202-5. [PMID: 26868068 DOI: 10.1016/j.ijgo.2015.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/29/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of uterine artery embolization (UAE) for the treatment of adenomyosis. METHODS A prospective study was performed at Yuhuangding Hospital, China, between January 2012 and December 2013, enrolling premenopausal patients diagnosed with adenomyosis. All patients were treated with bilateral UAE using 500-700-μm tris-acryl gelatin microspheres. At baseline, and 3, 6, and 12months after UAE, magnetic resonance imaging was used to assess uterine volume and patient-assessed improvements in dysmenorrhea were recorded. Any complications and adverse events were reported. RESULTS In total, 117 patients with adenomyosis were enrolled. The bilateral UAE procedure was successful in 115 (98.3%) patients, who were able to return to normal activity within 1week of treatment. At 12-month follow-up, a median 51.0% reduction in uterine volume from baseline was recorded (P=0.005). Marked and moderate improvements in dysmenorrhea symptoms were reported by 64 (55.7%) and 31 (27.0%) participants, respectively. Pelvic pain of varying intensity was reported by 112 (97.4%) patients but was managed with analgesia. Persistent amenorrhea was experienced by 2 (1.7%) individuals following treatment. Patients did not encounter any new gynecologic or general complications following UAE treatment. CONCLUSION UAE could be considered as a minimally invasive treatment option for patients with adenomyosis. Further research to compare the efficacy and safety of UAE with conventional hysterectomy is warranted.
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Affiliation(s)
- Shaoguang Wang
- Department of Gynecology, Yuhuangding Hospital, Medical College of Qingdao University, Yantai, Shandong 264000, China.
| | - Xiaomei Meng
- Department of Gynecology, Yuhuangding Hospital, Medical College of Qingdao University, Yantai, Shandong 264000, China
| | - Yaozhong Dong
- Department of Gynecology, Yuhuangding Hospital, Medical College of Qingdao University, Yantai, Shandong 264000, China
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