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Turtóczki K, Cho H, Dastaran S, Kaposi PN, Tömösváry Z, Várbíró S, Ács N, Kalina I, Bérczi V. Evaluation of junctional zone differential and ratio as possible markers of clinical efficacy in uterine artery embolisation of adenomyosis. CVIR Endovasc 2024; 7:55. [PMID: 39023689 PMCID: PMC11258104 DOI: 10.1186/s42155-024-00468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Uterine artery embolisation is a recommended method of adenomyosis treatment with good clinical results. Changes in uterine volume and maximal junctional zone thickness (JZmax) after embolisation are thoroughly analyzed in the literature. In contrast changes in other suggested morphological diagnostic markers of adenomyosis (junctional zone differential / JZdiff-and junctional zone ratio / JZratio) are rarely evaluated. This single-centre retrospective study aimed to analyse the changes in morphological parameters used for the MR imaging diagnosis of adenomyosis (including JZdiff and JZratio) after UAE. Clinical effectiveness and safety were also analysed. MATERIALS AND METHODS Patients who underwent UAE for pure adenomyosis from Jan 2008 to Dec 2021 were evaluated. Adenomyosis was diagnosed based on JZmax, JZdiff, and JZratio measured on MR imaging. To assess clinical efficacy, the numerical-analog-quality-of-life (QoL) score was routinely obtained from patients at our centre. MRI morphological data were analysed. Statistical analysis was conducted using Wilcoxon signed-rank test, uni- and multivariate regression models, Pearson product-moment correlation, and Kruskal-Wallis tests. RESULTS From our database of 801 patients who underwent UAE between Jan 2008 to Dec 2021, preprocedural MR images were available in 577 cases and, 15 patients had pure adenomyosis (15/577, 2.6%). Uterine volume, JZmax, and JZdiff decreased significantly after UAE; QoL score increased significantly. A significant correlation was found between QoL change vs. JZmax and JZdiff change. Permanent amenorrhoea and elective hysterectomy 5 years after UAE were both 7.1%. CONCLUSION Change of JZdiff after UAE in adenomyosis is a potential marker of clinical success. UAE is a clinically safe and effective treatment for adenomyosis.
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Affiliation(s)
- Kolos Turtóczki
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary.
| | - Hyunsoo Cho
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary
| | - Sorour Dastaran
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary
| | - Pál N Kaposi
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary
| | - Zoltán Tömösváry
- Department of Obstetrics and Gynecology, Semmelweis University, VIII. Üllői Út 78/A, Budapest, 1082, Hungary
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, VIII. Üllői Út 78/A, Budapest, 1082, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, VIII. Üllői Út 78/A, Budapest, 1082, Hungary
| | - Ildikó Kalina
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary
| | - Viktor Bérczi
- Medical Imaging Centre, Semmelweis University, Üllői Út 78/a VIII. Korányi Sándor Utca 2., Budapest, 1082, Hungary
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Machado P, Tan A, Forsberg F, Gonsalves CF. Evaluation of Uterine Fibroid Vascularity Using Contrast-Enhanced Ultrasound in Comparison with Contrast-Enhanced Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:394-398. [PMID: 38123378 DOI: 10.1016/j.ultrasmedbio.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The aim of the work described here was to assess uterine fibroid vascularity using contrast-enhanced ultrasound (CEUS) as compared with magnetic resonance imaging (MRI). METHODS Forty women diagnosed with symptomatic uterine fibroids scheduled for uterine artery embolization (UAE) were enrolled in this institutional review board-approved study. Before UAE, participants underwent CEUS examination with an Aplio i800 scanner (Canon Medical Systems, Tustin, CA, USA) with curvilinear array (8C1). CEUS was performed using 2.0 mL of the ultrasound contrast agent Lumason (Bracco, Milan, Italy) administered intravenously. Digital CEUS clips were acquired and randomized offline, and fibroids were characterized as hyper- or hypovascular. MRI was used as reference standard for fibroid vascularity and compared with CEUS. Results were analyzed using McNemar's test. RESULTS Forty participants were enrolled in the trial. One patient did not proceed with the UAE procedure and one patient refused pre-procedure MRI because of claustrophobia. Therefore, 38 participants underwent CEUS and MRI examinations before UAE. Hypervascular fibroids were seen on MRI and CEUS in 24 and 26 participants, respectively. Hypovascular fibroids were seen with MRI and CEUS in 14 and 12 participants, respectively. Fibroids characterized as hypovascular in two participants by MRI were characterized as hypervascular by CEUS. CEUS and MRI findings were similar in 36 of 38 participants, corresponding to an accuracy of 95% (p = 0.62). CONCLUSION Contrast-enhanced ultrasound can accurately assess uterine fibroid vascularity, serving as a potential alternative to MRI in determination of the vascularity of uterine fibroids.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Allison Tan
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carin F Gonsalves
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Wu Q, Motaghi M, Tang H, Hazhirkarzar B, Shaghaghi M, Ghadimi M, Baghdadi A, Rezvani R, Mohseni A, Borhani A, Madani SP, Afyouni S, Zandieh G, Kamel IR. Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization. Clin Imaging 2024; 105:110028. [PMID: 38039750 DOI: 10.1016/j.clinimag.2023.110028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To predict the clinical outcome of symptomatic patients with uterine leiomyomas who underwent uterine artery embolization (UAE), based on clinical and radiological features. METHODS Patients with symptomatic uterine leiomyomas who underwent UAE from March 2010 to September 2019 were consecutively included in this retrospective study. Patients with persistent or recurrent symptoms and those who needed repeated UAE, myomectomy, or hysterectomy following the initial treatment were considered to have a poor outcome after UAE. The total and enhancing volume of the dominant leiomyoma in each location and uterine volume were obtained before and after UAE. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the parameters that could predict poor outcome. RESULTS A total of 116 patients (mean age, 45 ± 5 years) were included. Forty-six patients (46/116, 39.7%) showed poor outcome. Cox regression analysis showed higher hazard of poor outcome for younger patients vs. older patients (HR: 0.92, p-value: 0.01), patients with adenomyosis vs. patients without adenomyosis (HR: 2.47, p-value < 0.01), patients with adenomyosis thickness > 2.5 cm before UAE vs. patients without adenomyosis (HR: 4.2, p-value < 0.01) and for patients with intramural fibroid enhancement volume > 440 cm3 compared to patients with no intramural fibroids (p-value: 0.06). Multivariate Cox regression analysis including age, the thickness of adenomyosis, and intramural leiomyoma volume of enhancement before UAE was chosen as the best model to predict the outcome. CONCLUSIONS Pretreatment clinical and MRI features could identify patients with a higher risk for poor outcome after UAE.
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Affiliation(s)
- Qingxia Wu
- Department of Medical Imaging, Henan Key Laboratory of Neurological Imaging, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China; Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roya Rezvani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Borhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seyedeh Panid Madani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ghazal Zandieh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ascher SM, Wasnik AP, Robbins JB, Adelman M, Brook OR, Feldman MK, Jones LP, Knavel Koepsel EM, Patel-Lippmann KK, Patlas MN, VanBuren W, Maturen KE. ACR Appropriateness Criteria® Fibroids. J Am Coll Radiol 2022; 19:S319-S328. [PMID: 36436959 DOI: 10.1016/j.jacr.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Uterine fibroids (leiomyomas or myomas) are the most common neoplasm of the uterus. Though incompletely understood, fibroid etiology is multifactorial, a combination of genetic alterations and endocrine, autocrine, environmental, and other factors such as race, age, parity, and body mass index. Black women have greater than an 80% incidence of fibroids by age 50, whereas White women have an incidence approaching 70%. Fibroid symptoms are protean, and menorrhagia is most frequent. The societal economic burden of symptomatic fibroids is large, 5.9 to 34.3 billion dollars annually. There are a variety of treatment options for women with symptomatic fibroids ranging from medical therapy to hysterectomy. Myomectomy and uterine fibroid embolization are the most common uterine sparing therapies. Pelvic ultrasound (transabdominal and transvaginal) with Doppler and MRI with and without intravenous contrast are the best imaging modalities for the initial diagnosis of fibroids, the initial treatment of known fibroids, and for surveillance or posttreatment imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia.
| | - Ashish P Wasnik
- Panel Vice-Chair, University of Michigan, Ann Arbor, Michigan; Director, Division of Abdominal Radiology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan
| | - Jessica B Robbins
- Panel Chair; Vice Chair, Faculty Development and Enrichment, University of Wisconsin, Madison, Wisconsin
| | - Marisa Adelman
- Technology Assessment Committee, University of Utah, Salt Lake City, Utah; American College of Obstetricians and Gynecologists
| | - Olga R Brook
- Section Chief, Abdominal Imaging; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Krupa K Patel-Lippmann
- Abdominal Imaging Fellowship Director, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael N Patlas
- McMaster University, Hamilton, Ontario, Canada; Editor-in-Chief, Canadian Association of Radiologists
| | - Wendaline VanBuren
- Section Chair, Gynecological Imaging, Department of Radiology Mayo Clinic, Rochester, Minnesota; Chair, Endometriosis Disease-Focused Panel, Society of Abdominal Radiology
| | - Katherine E Maturen
- Specialty Chair; Associate Chair, Ambulatory Care and Strategy, University of Michigan, Ann Arbor, Michigan
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Bellala P, Valakkada J, Ayyappan A, Kumar S. Evidences in Uterine Artery Embolization: A Radiologist's Primer. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1758050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractUterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.
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Affiliation(s)
- Pavankumar Bellala
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Çakır Ç, Kılınç F, Deniz MA, Karakaş S. Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas? Turk J Med Sci 2021; 51:1380-1387. [PMID: 33550765 PMCID: PMC8283489 DOI: 10.3906/sag-2012-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background/aim Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Fatih Kılınç
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Muhammed Akif Deniz
- Department of Internal Medical Sciences, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sema Karakaş
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
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Uterine Artery Embolization of Uterine Leiomyomas: Predictive MRI Features of Volumetric Response. AJR Am J Roentgenol 2021; 216:967-974. [PMID: 33594913 DOI: 10.2214/ajr.20.22906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article was to evaluate MRI features of uterine leiomyomas that predict volumetric response after uterine artery embolization (UAE). MATERIALS AND METHODS. This retrospective study included 75 patients with 212 uterine leiomyomas who were successfully treated between August 2013 and December 2018. To predict uterine volumetric response, age, number of lesions, and baseline uterine volume were assessed. To predict leiomyoma volumetric response, a multivariate regression analysis was performed to evaluate six predictive factors: location, baseline leiomyoma volume, signal intensity on T1-weighted and T2-weighted MRI, heterogeneity of signal intensity on T2-weighted MRI, and vascularity on subtraction imaging (SI). A five-variable predictive ROC model was developed to evaluate the diagnostic accuracy of the signal intensity ratio on T2-weighted MRI, enhancement ratio, heterogeneity ratio on T2-weighted MRI, location, and baseline leiomyoma volume in predicting at least 40% leiomyoma volumetric response. RESULTS. Age, number of leiomyomas, and baseline uterine volume were not predictive of uterine volumetric response. A submucosal location was the best predictive factor of leiomyoma volumetric response, and it showed 32.2% more leiomyoma volumetric response compared with a nonsubmucosal location (p < .001). Hyperintensity on T2-weighted MRI was the second best predictive factor of leiomyoma volumetric response, and it showed 16.9% more volumetric response compared with hypointense leiomyomas (p = .013). A small baseline leiomyoma volume (< 58 cm3) was associated with 10.2% more leiomyoma volumetric response compared with larger leiomyomas (p = .01). Leiomyomas that were hyperintense on SI showed 7.9% more leiomyoma volumetric response compared with those that were hypointense (p = .014). The five-variable ROC model showed high diagnostic accuracy with an AUC of 0.85, sensitivity of 82%, and specificity of 71%. CONCLUSION. A submucosal location, hyperintensity on T2-weighted MRI, small baseline leiomyoma volume (< 58 cm3), and hyperintense leiomyoma on subtraction imaging are the main independent favorable predictors of leiomyoma volumetric response after UAE. An accurate predictive ROC model was developed that may help in selecting patients suitable for UAE. Quantitative assessment of heterogeneity on T2-weighted MRI showed promising results as a predictor of volumetric response, and further research in this area using texture analysis and radiomics is suggested.
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Single-System Experience With Outpatient Transradial Uterine Artery Embolization: Safety, Feasibility, Outcomes, and Early Rates of Return. AJR Am J Roentgenol 2021; 216:975-980. [PMID: 33534624 DOI: 10.2214/ajr.20.23343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess feasibility and rate of patients returning to the hospital when a same-day discharge protocol is used for patients undergoing transradial uterine artery embolization (UAE) for symptomatic fibroids. MATERIALS AND METHODS. A total of 374 patients who underwent transradial UAE with a same-day discharge protocol between April 2013 and June 2019, with documented follow-up, were included in this single-health-system retrospective study. Angiographic images and procedural reports were reviewed for technical success (defined as bilateral embolization). Electronic medical records were reviewed for patient and fibroid characteristics, adverse events, clinical success (defined as documented improvement in symptoms or patient satisfaction), and unplanned clinic visits, emergency department visits, and readmissions within 30 days of UAE. Univariate and multivariate analyses were used to identify risk factors for unplanned visits. RESULTS. Eight (2.1%) patients required conversion to inpatient stay (mean length of stay, 1.4 days; range, 1-3 days). The median postprocedure observation time was 3.7 hours (range, 1.1-12.5 hours). Technical success was achieved in 94.7% of patients, with 2.4% requiring crossover to the femoral artery for access. Clinical success was achieved in 86.0% of patients, with 6-month reductions in uterus and dominant leiomyoma volume of 30.4% and 42.9%, respectively. Rates of unplanned clinic visits, emergency department visits, and readmissions were 3.2%, 5.1%, and 0.5%, respectively. Patients with submucosal fibroids or pain as an indication for UAE were significantly more likely to have unplanned visits. CONCLUSION. Transradial UAE for symptomatic fibroids can be performed using a same-day discharge protocol with low rates of patients returning to the hospital. Submucosal location and pain as an indication for UAE were predictors of early return.
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Abstract
RATIONALE Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported. PATIENT CONCERNS The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size. DIAGNOSIS Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall. INTERVENTIONS The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy. OUTCOMES The patient recovered well without local recurrence for >1 year. LESSONS Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.
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Affiliation(s)
| | | | | | - Hongbin Wang
- Department of Gynecological Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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