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Li C, He Z, Lv F, Liao H, Xiao Z. Predicting the Prognosis of HIFU Ablation of Uterine Fibroids Using a Deep Learning-Based 3D Super-Resolution DWI Radiomics Model: A Multicenter Study. Acad Radiol 2024:S1076-6332(24)00384-2. [PMID: 38969576 DOI: 10.1016/j.acra.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
RATIONALE AND OBJECTIVES To assess the feasibility and efficacy of a deep learning-based three-dimensional (3D) super-resolution diffusion-weighted imaging (DWI) radiomics model in predicting the prognosis of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. METHODS This retrospective study included 360 patients with uterine fibroids who received HIFU treatment, including Center A (training set: N = 240; internal testing set: N = 60) and Center B (external testing set: N = 60) and were classified as having a favorable or unfavorable prognosis based on the postoperative non-perfusion volume ratio. A deep transfer learning approach was used to construct super-resolution DWI (SR-DWI) based on conventional high-resolution DWI (HR-DWI), and 1198 radiomics features were extracted from manually segmented regions of interest in both image types. Following data preprocessing and feature selection, radiomics models were constructed for HR-DWI and SR-DWI using Support Vector Machine (SVM), Random Forest (RF), and Light Gradient Boosting Machine (LightGBM) algorithms, with performance evaluated using area under the curve (AUC) and decision curves. RESULT All DWI radiomics models demonstrated superior AUC in predicting HIFU ablated uterine fibroids prognosis compared to expert radiologists (AUC: 0.706, 95% CI: 0.647-0.748). When utilizing different machine learning algorithms, the HR-DWI model achieved AUC values of 0.805 (95% CI: 0.679-0.931) with SVM, 0.797 (95% CI: 0.672-0.921) with RF, and 0.770 (95% CI: 0.631-0.908) with LightGBM. Meanwhile, the SR-DWI model outperformed the HR-DWI model (P < 0.05) across all algorithms, with AUC values of 0.868 (95% CI: 0.775-0.960) with SVM, 0.824 (95% CI: 0.715-0.934) with RF, and 0.821 (95% CI: 0.709-0.933) with LightGBM. And decision curve analysis further confirmed the good clinical value of the models. CONCLUSION Deep learning-based 3D SR-DWI radiomics model demonstrated favorable feasibility and effectiveness in predicting the prognosis of HIFU ablated uterine fibroids, which was superior to HR-DWI model and assessment by expert radiologists.
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Affiliation(s)
- Chengwei Li
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China (C.L., H.L.)
| | - Zhimin He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Z.H., F.L., Z.X.)
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Z.H., F.L., Z.X.)
| | - Hongjian Liao
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China (C.L., H.L.)
| | - Zhibo Xiao
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Z.H., F.L., Z.X.).
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Talaie R, Torkian P, Amili O, Aboufirass Y, Rostambeigi N, Jalaeian H, Golzarian J. Particle Distribution in Embolotherapy, How Do They Get There? A Critical Review of the Factors Affecting Arterial Distribution of Embolic Particles. Ann Biomed Eng 2022; 50:885-897. [PMID: 35524027 DOI: 10.1007/s10439-022-02965-6] [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: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.
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Affiliation(s)
- Reza Talaie
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Pooya Torkian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA.
| | - Omid Amili
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, USA
| | | | - Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jafar Golzarian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
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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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4
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Affiliation(s)
| | - Kartik Kansagra
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Tina L Hardley
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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5
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Chua KJ, McLucas B. Pain after uterine artery embolization with intrauterine device in situ. BJR Case Rep 2020; 6:20190128. [PMID: 32922837 PMCID: PMC7465736 DOI: 10.1259/bjrcr.20190128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/09/2020] [Accepted: 03/08/2020] [Indexed: 11/26/2022] Open
Abstract
Uterine artery embolization (UAE) is a minimally invasive option for females with symptomatic leiomyomas. Studies detailing a possible risk with an intrauterine device (IUD) in situ during UAE are limited. A 43-year-old female (Gravida 2, Para 2) underwent UAE with an IUD in situ. On post-procedure day 2, the patient presented with severe lower abdominal pain and mild leukocytosis. Following removal of her IUD, the patient experienced immediate pain relief. Caution is given to clinicians who wish to perform UAE with an IUD in situ.
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Affiliation(s)
- Katherine Jane Chua
- Department of Obstetrics & Gynecology, Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - Bruce McLucas
- Department of Obstetrics & Gynecology, University of California – Los Angeles, Los Angeles, CA, USA
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6
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Samanci C, Önal Y. Shearwave elastographic evaluation of uterine leiomyomas after uterine artery embolization: preliminary results. Turk J Med Sci 2020; 50:426-432. [PMID: 32093446 PMCID: PMC7164750 DOI: 10.3906/sag-1908-171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background/aim We aimed to investigate the role of Shearwave Elastography (SWE) in the evaluation of response to uterine artery embolization (UAE) in patients with uterine leiomyomas. Materials and methods SWE images of the dominant uterin leiomyomas were obtained before and 1.5 months after performing UAE in 33 women suffering from symptoms due to leiomyomas (menometrorrhagia, bulk related symptoms, pelvic pain). Leiomyomas were also evaluated by 2 observers for location and longest diameter in axial plane. Interobserver agreement in the quantitative SWE analysis was calculated using intraclass correlation coefficients. Results Thirty-three women (mean age, 39.7 years; range, 31–48 years) were examined with SWE 1.5 months after UAE. After treatment, 3 patients (9.1%) had fever, 1 patient had nausea and 29 patients (87.9%) had no complications. The post UAE stiffness measurements of leiomyomas (mean SWE ± SD = 13.34 ± 3.9kPa) were significantly lower than the pre UAE measurements (mean SWE ± SD = 17.16 ± 4.8kPa) (P < 0.001). There was excellent agreement between the 2 blinded observers in SWE measurements. Conclusion SWE values of leiomyomas after UAE significantly decreased. SWE, with its high reproducibility, could become a useful tool in the follow up of uterin leiomyomas after UAE.
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Affiliation(s)
- Cesur Samanci
- Department of Radiology, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, İstanbul, Turkey
| | - Yilmaz Önal
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
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Mailli L, Auyoung EY, Angileri SA, Ameli-Renani S, Ratnam L, Das R, Chun JY, Das S, Manyonda I, Belli AM. Predicting the Fibroid-Migratory Impact of UAE: Role of Pre-embolization MRI Characteristics. Cardiovasc Intervent Radiol 2019; 43:453-458. [PMID: 31650245 PMCID: PMC6997258 DOI: 10.1007/s00270-019-02348-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
Aim To investigate potential factors on MR imaging that could be used to predict migration of uterine fibroids post-UAE. Methods and Materials We retrospectively reviewed patients referred for UAE having pre-procedural and 6 months post-procedural MRI, at a tertiary centre, over a 1-year period. Pre- and post-UAE images were reviewed in 64 women by two radiologists to identify the sub-type, dimensions, and infarction rate of each dominant fibroid. The shortest distance between the fibroid and the endometrial wall was measured to determine intramural fibroid movement. Paired sample T tests and two-sample T tests were used to compare between pre- and post-embolization variations and between migrated and non-migrated intramural fibroids, respectively. After preliminary results suggested potential predictors of intramural fibroids migration, we tested our findings against the non-dominant intramural fibroids in the same patients. Results Review of images revealed 35 dominant intramural fibroids, of which eight migrated to become submucosal fibroids, while five were either partially or completely expelled. These 13 migrated fibroids had a shorter pre-procedural minimum endometrial distance (range 1–2.4 mm) and greater maximum fibroid diameter (range 5.1–18.1 cm), when compared to non-migrating fibroids. On image reassessment, the migrated non-dominant intramural fibroids had a minimum endometrial distance and maximum fibroid diameter within the same range. Conclusion Intramural fibroids with a minimum endometrial distance less than 2.4 mm and a maximum fibroid diameter greater than 5.1 cm have a high likelihood of migrating towards the endometrial cavity after UAE.
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Affiliation(s)
- Leto Mailli
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK.
| | - Eric Y Auyoung
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Salvatore A Angileri
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Seyed Ameli-Renani
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Lakshmi Ratnam
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Raj Das
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Joo-Young Chun
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Sourav Das
- Department of Obstetrics and Gynaecology, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Isaac Manyonda
- Department of Obstetrics and Gynaecology, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Anna-Maria Belli
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
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8
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Ludwig PE, Huff TJ, Shanahan MM, Stavas JM. Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature. Br J Radiol 2019; 93:20190551. [PMID: 31573326 DOI: 10.1259/bjr.20190551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Females with symptomatic leiomyomas (fibroids) wishing to maintain fertility are faced with difficult treatment choices. These include uterine fibroid embolization (UFE), myomectomy, hormonal therapy, MRI high intensity focused ultrasound, and myolysis. This review focuses on UFE, one of the most commonly accepted minimally invasive procedural choices among patients with symptomatic fibroids wishing to retain the option of becoming pregnant in the future, and makes comparisons to myomectomy which has historically been the surgical choice for fertility-preserving fibroid treatment. Pubmed and Google Scholar searches using keywords such as: uterine artery embolization, uterine fibroid embolization, pregnancy, complications, infertility were performed between Jan 1, 2019 and May 10, 2019. Publications were chosen based on their inclusion of information pertaining to fertility or pregnancy after UFE without being limited to single case reports.Randomized controlled trials comparing myomectomy and UFE are limited due to study size and confounding variables, but through registry data and familiarity with referring clinicians, UFE has gained wide acceptance. Healthy pregnancies following UFE have been sporadically reported but the actual fertility rate after UFE remains uncertain. Conversely, low birth weight, miscarriage and prematurity have been associated with UFE. Despite inherent risks of possible fertility issues after UFE, the procedure remains an option for females with clinically symptomatic fibroids who desire pregnancy. However, additional research regarding rates of conception and obstetrical risks of infertility following UFE is necessary.
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Affiliation(s)
- Parker E Ludwig
- Creighton University School of Medicine, Omaha, United States
| | - Trevor J Huff
- Creighton University School of Medicine, Omaha, United States
| | - Meaghan M Shanahan
- Creighton University School of Medicine, Omaha, United States.,Creighton University School of Medicine, Department of Obstetrics and Gynecology, Omaha, United States
| | - Joseph M Stavas
- Creighton University School of Medicine, Omaha, United States.,Creighton University School of Medicine, Department of Radiology, Omaha, United States
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9
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Melnyk A, Vani K, Rindos NB. Post-Uterine Fibroid Embolization Sepsis: A Case Report and Review of the Literature. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandra Melnyk
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kavita Vani
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Noah B. Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
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10
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Mohr-Sasson A, Spira M, Rahav R, Manela D, Schiff E, Mazaki-Tovi S, Orvieto R, Sivan E. Ovarian reserve after uterine artery embolization in women with morbidly adherent placenta: A cohort study. PLoS One 2018; 13:e0208139. [PMID: 30496259 PMCID: PMC6264507 DOI: 10.1371/journal.pone.0208139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate ovarian reserve in women after preservative cesarean delivery using uterine artery embolization due to morbidly adherent placenta. Study design A historical cohort study including all women admitted to a single tertiary care center, with morbidly adherent placenta that had preservative cesarean delivery with bilateral uterine artery embolization. Inclusion criteria included gestational age >24 weeks, singleton pregnancy and placenta increta / percreta. Exclusion criteria included maternal age > 43 years old and cesarean hysterectomy. Control group included women attending the infertility clinic due to male factor or single women conceiving via sperm donation, matched by age. Blood samples were collected on day 2–5 of menstruations for hormonal profile and Anti Mullarian Hormone (AMH) levels. Primary outcome was ovarian reserve evaluated by the levels of AMH. Results 59 women underwent preservative cesarean delivery using uterine artery embolization during the study period. 21 women met inclusion criteria (33.9%) and were matched controls (n = 40). Circulating levels of E2 and FSH did not differ significantly between the two groups (p = 0.665, p = 0.396, respectively). AMH was lower in the study group (median 0.8 IQR 0.44–1.80) compared to the controls (median 2.08 IQR 1.68–3.71) (p = 0.001). This finding was consistent in linear multivariate regression analysis where the group of cesarean delivery using bilateral artery embolization due to placenta accrete was significantly predictive for the levels of AMH (B = -1.308, p = 0.012). Conclusion Women post preservative cesarean delivery using uterine artery embolization due to placenta accrete have lower ovarian reserve compare to controls matched by age.
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Affiliation(s)
- Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Spira
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Rahav
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dafna Manela
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Eyal Schiff
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Sivan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Guida M, Maffucci D, Iannuzzi G, Giordano M, Luciano G, Di Benedetto L, Cantarella R, Rescigno A, Giugliano L. Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report. Int J Womens Health 2018; 10:745-750. [PMID: 30538584 PMCID: PMC6254590 DOI: 10.2147/ijwh.s182131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM). Debate exists about persistence of fertility in women after UAE. Adverse effects of this technique can modify both uterine echostructure, inducing necrosis and infarction, endometrial atrophy and uterine artery rupture, and ovarian reserve, causing persistent amenorrhea. Ovarian reserve appears to be affected by UAE in pre-menopausal women. However, younger ovaries (according to biological ovarian age) exhibit a greater capacity for recovery after ovarian damage. Therefore, larger studies are needed for more conclusive results. Case report A 28-year-old woman was admitted to our department due to life-threatening uterine bleeding, resulting in tachycardia, pallor, and sweating. The patient came with a history of two spontaneous miscarriages. After sonography and computed tomography, AVMs were identified at uterine fundus and anterior wall. Conclusion The pathogenesis of infertility after UAE is not yet known. The peculiarity of this case was that, only few months later, the patient became pregnant and gave birth to a live fetus at 37 weeks with cesarean delivery.
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Affiliation(s)
- M Guida
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - D Maffucci
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Iannuzzi
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - M Giordano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Luciano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - L Di Benedetto
- Università degli studi di Roma "La Sapienza" - Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale - Facoltà di Medicina e Psicologia Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - R Cantarella
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - A Rescigno
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - L Giugliano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
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12
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Tian X, Kong T, Zhu P, Kang Z, Lei L, Tang X, Wang L. Engineering embolic microparticles from a periodically-pulsating charged liquid meniscus. Chem Eng Sci 2018. [DOI: 10.1016/j.ces.2018.02.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Uterine fibroid embolization efficacy and safety: 15 years experience in an elevated turnout rate center. Radiol Med 2018; 123:385-397. [PMID: 29357038 DOI: 10.1007/s11547-017-0843-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis. METHODS/MATERIALS 255 patients (aged 26-55) with symptomatic UF, indication for surgery, followed in our center (2000-2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150-900 μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2-7 years). RESULTS Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47 min (average fluoroscopy: 10:50 min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24 h). Follow-up at 2 years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients. CONCLUSIONS UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.
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14
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Torre A, Fauconnier A, Kahn V, Limot O, Bussierres L, Pelage JP. Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol 2016; 27:2850-2859. [DOI: 10.1007/s00330-016-4681-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
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15
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Abstract
Fibroid disease is common and causes significant health problems in women of childbearing age. Over the past several years, uterine artery embolization (UAE) has emerged as a minimally invasive treatment for symptomatic uterine myomata. Embolotherapy is effective in relieving myoma-related symptoms in 80% to 90% of patients. It requires shorter hospitalizations than traditional surgical therapies for myoma disease and is associated with faster recovery and lower complication risks than surgery. Patient selection, the UAE procedure, and post-UAE management are reviewed.
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Lee SJ, Kim MD, Kim GM, Won JY, Park SI, Lee DY. Uterine artery embolization for symptomatic fibroids in postmenopausal women. Clin Imaging 2015; 40:106-9. [PMID: 26372352 DOI: 10.1016/j.clinimag.2015.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) for symptomatic fibroids in postmenopausal women. MATERIALS AND METHODS Among 900 cases who underwent UAE between 2007 and 2013, a total of 9 postmenopausal women with symptomatic fibroids (n=6) and fibroid with adenomyosis (n=3) were included in this retrospective study. Ages ranged from 49 to 55years (median of 52). The embolic agent was nonspherical polyvinyl alcohol particles. We evaluated 18 uterine arteries in nine patients and compared the size of the uterine artery relative to inferior mesenteric artery (IMA) in preprocedural magnetic resonance (MR) angiography. Magnetic resonance imaging (MRI) was performed before and 3months after UAE. Predominant fibroid and uterine volumes were calculated from MR images. RESULTS Urinary frequency was the most common symptom, observed in seven patients (77.8%). Of two patients (22.2%) with vaginal bleeding from submucosal myomas, one patient had been on hormone replacement therapy (HRT). One patient underwent UAE due to growing leiomyoma after HRT. All of the 18 uterine arteries were bigger than the corresponding IMAs in MR angiography. Contrast-enhanced MRI revealed complete necrosis of the predominant fibroid in all patients. Eight (88.9%) of the nine participants demonstrated resolution of symptoms. The mean predominant fibroid and uterine volume reduction rates were 39.7% and 36.9%, respectively. CONCLUSIONS In postmenopausal women, UAE was effective to treat symptomatic fibroids, and it could be considered as an alternative treatment to hysterectomy.
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Affiliation(s)
- Shin Jae Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Man Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Gyoung Min Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Yoon Won
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Il Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yun Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Literature review of outcomes and prevalence and case report of leiomyosarcomas and non-typical uterine smooth muscle leiomyoma tumors treated with uterine artery embolization. Eur J Obstet Gynecol Reprod Biol 2015; 191:130-7. [DOI: 10.1016/j.ejogrb.2015.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 12/11/2022]
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McLucas B, Voorhees WD. The effectiveness of combined abdominal myomectomy and uterine artery embolization. Int J Gynaecol Obstet 2015; 130:241-3. [DOI: 10.1016/j.ijgo.2015.03.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/05/2015] [Accepted: 05/18/2015] [Indexed: 11/16/2022]
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Abstract
OBJECTIVE To estimate the incidence of clinical failure after uterine leiomyoma embolization and identify possible risk factors. METHODS One hundred seventy-six consecutive women undergoing uterine leiomyoma embolization were followed prospectively for a median of 48 months (range 12-84 months) to estimate the occurrence of clinical failure, defined as persistence or recurrence of leiomyoma symptoms, and any subsequent invasive treatment. Cumulative failure and reintervention rates were estimated by survival analysis and log-rank tests according to baseline patient characteristics. Multivariable Cox proportional hazards analysis was performed to adjust for confounders. RESULTS Overall, there were 18 failures at a median of 36 months (range 3-84 months). The cumulative failure rate increased steadily over time, 3% at 1 year, 7% at 3 years, 14% at 5 years, and 18% at 7 years. Of the 18 failures, 11 had reintervention, including six hysterectomies, four myomectomies, and one repeat uterine leiomyoma embolization, at a median of 56 months (range 15-84 months). The cumulative reintervention rate was 0 at 1 year, 3% at 3 years, 7% at 5 years, and 15% at 7 years. Women aged 40 years or younger had a higher failure risk (hazard ratio [HR] 5.89, 95% confidence interval [CI] 2.50-20.02, P=.023) compared with older women. A history of previous myomectomy was also associated with an increased failure risk (HR 3.79, 95% CI 2.07-13.23, P=.037). CONCLUSION The 7-year cumulative rates of clinical failure and reintervention after uterine leiomyoma embolization were 18% (95% CI 8.2-27.8) and 15% (95% CI 5.2-24.8), respectively. The failure risk was higher for younger patients and for those with a prior myomectomy. LEVEL OF EVIDENCE III.
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Abstract
Strong evidence for both safety and effectiveness of uterine fibroid embolization has been generated since the procedure's introduction. This review will focus on the key articles representing the best evidence to summarize the outcomes from uterine embolization. This review will attempt to answer three important questions associated with uterine embolization. First, does uterine embolization relieve symptoms caused by uterine fibroids? Second, how well does the improvement in symptoms and quality of life after uterine embolization compare with standard surgical options for fibroids? Finally, how durable is the improvement in fibroid-related symptoms and quality of life after embolization?
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Affiliation(s)
- James B Spies
- Department of Radiology, Georgetown University Hospital, Washington, District of Columbia
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Siddiqui N, Nikolaidis P, Hammond N, Miller FH. Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging. ACTA ACUST UNITED AC 2014; 38:1161-77. [PMID: 23471598 DOI: 10.1007/s00261-013-9990-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance (MR) imaging has become the preferred method in assessing the uterus and pelvis prior to and following uterine artery embolization (UAE). The multiplanar imaging capabilities, increased spatial and contrast resolution, anatomic detail and assessment of fibroid viability that MR provides over ultrasound allows for accurate pre-treatment planning and post-treatment assessment. The purpose of this article is to demonstrate the use of MR in the selection of patients, anatomic evaluation and procedural planning before UAE, describe the use of MR in evaluating treatment response after UAE and illustrate the use of MR in identifying post-UAE complications. An understanding of these principles is essential in guiding appropriate therapy, determining treatment effectiveness and identifying associated complications before and after UAE.
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Affiliation(s)
- Nasir Siddiqui
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL, 60611, USA
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Stuart S, Mayo JR, Ling A, Schulzer M, Klass D, Power MA, Roberton BJ, Wan JM, Liu DM. Retrospective study of the impact of fellowship training on two quality and safety measures in uterine artery embolization. J Am Coll Radiol 2014; 11:471-6. [PMID: 24529983 DOI: 10.1016/j.jacr.2013.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/13/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To measure the impact of 1-year interventional fellowship training on fluoroscopic time and contrast media utilization in uterine artery embolization (UAE). MATERIALS AND METHODS Retrospective single institution analysis of 323 consecutive UAEs performed by 12 interventional fellows using a standardized protocol. Fluoroscopy time and contrast media volume were recorded for each patient and correlated with stage of fellowship training. Preprocedure uterine volume (using MRI or ultrasound) was used as a measure of procedural complexity. Regression analysis was conducted per trainee factoring in duration of training, procedure number, supervising radiologist, uterine volume, and outcome variables of fluoroscopy time and contrast media volume. RESULTS Median number of patients treated per trainee was 27 (range, 16-43) with mean fluoroscopic time 24.5 minutes (range, 4-90 min) and mean contrast volume 190 mL (range, 50-320 mL). Increasing uterine volume had no significant effect (P > .05) on fluoroscopic time but significantly increased (P < .001) contrast media volume. Significant training effect was identified with decrease in fluoroscopic time (P < .001) and decrease in contrast volume (P = .02) over training. Over the course of a 1-year fellowship, these summed to a decrease of 12 minutes in UAE fluoroscopy time and 17 mL less contrast. CONCLUSION A significant (P < .05) training effect that is clinically relevant was demonstrated over the course of a yearlong interventional radiology fellowship program in performance of a standardized protocol for UAE. This data supports fellowship training as a basis for UAE credentialing and privileging.
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Affiliation(s)
- Sam Stuart
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - John R Mayo
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Alden Ling
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Michael Schulzer
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Darren Klass
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Mark A Power
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | | | - J M Wan
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - David M Liu
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada.
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Lopera J, Suri R, Kroma GM, Garza-Berlanga A, Thomas J. Role of Interventional Procedures in Obstetrics/Gynecology. Radiol Clin North Am 2013; 51:1049-66. [DOI: 10.1016/j.rcl.2013.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparative study in 323 patients. J Vasc Interv Radiol 2013; 24:772-8. [PMID: 23566524 DOI: 10.1016/j.jvir.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the effectiveness, safety, and complications of uterine artery embolization (UAE) in women with large fibroid tumors. MATERIALS AND METHODS From January 2005 to February 2011, 323 patients underwent UAE for symptomatic uterine leiomyomas without adenomyosis and were included in this study. Patients were divided into two groups: those with a large tumor burden (group 1; n = 63), defined as a dominant tumor with a longest axis of at least 10 cm or a uterine volume of at least 700 cm(3); and the control group (group 2; n = 260). Tumor infarction and volume reduction were calculated based on magnetic resonance imaging findings. Symptom status was assessed with a visual analog scale. Postprocedure complications and repeat interventions were recorded. The data were analyzed with appropriate statistical tests. RESULTS No significant differences were seen between the two groups in volume reduction of dominant tumors (46.5% in group 1 vs 52.0% in group 2; P = .082) or percentage volume reduction of the uterus (40.7% in group 1 vs 36.3% in group 2; P = .114). Also, no significant differences were seen between the two groups regarding satisfaction scores at immediate or midterm follow-up (P = .524 and P = .497) or in the presence of procedure-related complications (P = .193). CONCLUSIONS UAE outcomes in large fibroid tumors were comparable to those in smaller tumors, without an increased risk of significant complications. Tumor size may not be a key factor in predicting successful outcomes of UAE.
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David M, Kröncke T. Uterine Fibroid Embolisation - Potential Impact on Fertility and Pregnancy Outcome. Geburtshilfe Frauenheilkd 2013; 73:247-255. [PMID: 26633901 PMCID: PMC4647484 DOI: 10.1055/s-0032-1328318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.
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Affiliation(s)
- M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - T Kröncke
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
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Complication Rates and Effectiveness of Uterine Artery Embolization in the Treatment of Symptomatic Leiomyomas: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2012; 199:1153-63. [DOI: 10.2214/ajr.11.8362] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pinto E, Trovão A, Leitão S, Pina C, Mak FK, Lanhoso A. Conservative laparoscopic approach to a perforated pyomyoma after uterine artery embolization. J Minim Invasive Gynecol 2012; 19:775-9. [PMID: 23084686 DOI: 10.1016/j.jmig.2012.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
Abstract
We describe a conservative laparoscopic approach to treatment of a perforated pyomyoma after uterine artery embolization. A 36-year-old woman came to our emergency department 8 weeks after undergoing uterine artery embolization. She reported painful abdominal cramps. Physical examination revealed fever, tachycardia, hypotension, abdominal pain with rebound tenderness and pain during bimanual examination. Ultrasonography showed a fundal/subserosal leiomyoma and a moderate amount of fluid in the abdominal cavity. Because the patient desired preservation of the uterus, a laparoscopic approach was used for drainage and lavage of a perforated pyomyoma. The patient had an uneventful recovery and remained well at follow-up visits. Second-look diagnostic laparoscopy enabled treatment of the adhesions formed and revealed patent fallopian tubes. Surgery has been the primary approach to pyomyoma. However, hysterectomy leads to irreversible sterility and myomectomy can be difficult to perform. Therefore, there is need for a less invasive intervention in women who seek conservative treatment. Recently, computed tomography-guided drainage was successfully performed in two patients with pyomyoma. To our knowledge, this is the first report of a successful conservative laparoscopic approach to pyomyoma.
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Affiliation(s)
- Evelin Pinto
- Department of Gynecology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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Pundir J, Chandraharan E, Chui D. Profuse and persistent vaginal discharge following fibroid embolisation. J OBSTET GYNAECOL 2012; 32:404-5. [PMID: 22519499 DOI: 10.3109/01443615.2012.658890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J Pundir
- Department of Obstetrics and Gynaecology, Conquest Hospital, St Leonards-on-Sea, UK.
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Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial. Cardiovasc Intervent Radiol 2012; 35:1041-52. [DOI: 10.1007/s00270-012-0388-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/25/2012] [Indexed: 11/25/2022]
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Mara M, Horak P, Kubinova K, Dundr P, Belsan T, Kuzel D. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38:823-31. [PMID: 22413922 DOI: 10.1111/j.1447-0756.2011.01782.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Several atypical hysteroscopy findings have been described in association with uterine artery embolization (UAE). The purpose of this study was to evaluate the types and frequency of these findings in the largest published series of patients. MATERIAL AND METHODS Premenopausal patients after bilateral UAE for symptomatic intramural fibroid underwent subsequent hysteroscopic examination 3-9 months following UAE. The uterine cavity was examined with focus on specific post-embolization changes. Biopsy of endometrium was obtained and evaluated together with a biopsy of abnormal foci if present. RESULTS UAE was performed in a total of 127 women with an average size of dominant fibroid 63.1 mm in diameter and an average patient age of 35.1 years. Even though the majority of patients were asymptomatic at the time of hysteroscopy (78.0%), the post-embolization hysteroscopic examination was normal in only 51 patients (40.2%). The most frequent abnormalities included tissue necrosis (52 women, 40.9%), intracavitary myoma protrusion (45 women, 35.4%), endometrium 'spots' (22.1%), intrauterine synechiae (10.2%) and 'fistula' between the uterine cavity and intramural fibroid (6.3%). Histopathological examination showed normal, secretory or proliferative endometrium in 83.5% patients. Necrosis and/or hyalinization prevailed in the results of biopsy of abnormal loci (45 cases, 35.4%). CONCLUSION Frequency of abnormal hysteroscopic findings several months after UAE for primary intramural myomas is high. Alarmingly high is the percentage of patients with a histopathologically verified necrosis. Performing hysteroscopy in selected patients after UAE is necessary before eventual surgical re-intervention, especially in women with reproductive plans.
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Affiliation(s)
- Michal Mara
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
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Carrillo TC. Uterine Artery Embolization in the Management of Symptomatic Uterine Fibroids: An Overview of Complications and Follow-up. Semin Intervent Radiol 2011; 25:378-86. [PMID: 21326579 DOI: 10.1055/s-0028-1102997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Uterine artery embolization (UAE) evolved as a treatment for symptomatic uterine fibroids in the early 1990s, after initially being used as a temporizing measure prior to hysterectomy or myomectomy. Since that time, over 100,000 UAEs have been performed. Technical success rates have been quoted ranging from 94 to 99%. The overall incidence of major complications associated with the procedure is low, the majority of which can be prevented. Knowledge of the potential complications and the measures that can be taken to avoid these complications is essential. Furthermore, because UAE is a relatively new procedure, no standardized recommendations for patient follow-up exist. Common practice for patient follow-up includes both clinic visits at increasing time intervals postprocedure, as well as telephone follow-up, and imaging follow-up when necessary. As symptomatic improvement is subjective, some institutions have developed standardized questionnaires to better assess patient improvement postprocedure. Aggressive pain control is a crucial component of follow-up, as uncontrolled pain can result in readmission and patient dissatisfaction.
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Affiliation(s)
- Tami C Carrillo
- Department of Radiology, University of Illinois at Chicago Hospital, Chicago, Illinois
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Kirby JM, Burrows D, Haider E, Maizlin Z, Midia M. Utility of MRI Before and After Uterine Fibroid Embolization: Why to Do It and What to Look For. Cardiovasc Intervent Radiol 2010; 34:705-16. [DOI: 10.1007/s00270-010-0029-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 10/20/2010] [Indexed: 01/02/2023]
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Hysterectomy-current methods and alternatives for benign indications. Obstet Gynecol Int 2010; 2010. [PMID: 20798870 PMCID: PMC2926674 DOI: 10.1155/2010/356740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 11/18/2022] Open
Abstract
Hysterectomy is the commonest gynecologic operation performed not only for malignant disease but also for many benign conditions such as fibroids, endometrial hyperplasia, adenomyosis, uterine prolapse, dysfunctional uterine bleeding, and cervical intraepithelial neoplasia. There are many approaches to hysterectomy for benign disease: abdominal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH) where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, total laparoscopic hysterectomy (TLH) where the laparoscopic procedures include uterine artery ligation, and subtotal laparoscopic hysterectomy (STLH) where there is no vaginal component and the uterine body is removed using a morcelator. In the last decades, many new techniques, alternative to hysterectomy with conservation of the uterus have been developed. They use modern technologies and their results are promising and in many cases comparable with hysterectomy. This paper is a review of all the existing hysterectomy techniques and the alternative methods for benign indications.
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Allison SJ, Wolfman DJ. Sonographic Evaluation of Patients Treated with Uterine Artery Embolization. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cult.2010.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Uterine fibroid embolization imaging: interventionalist's perspective. Ultrasound Q 2009; 25:185-94. [PMID: 19956051 DOI: 10.1097/ruq.0b013e3181c47de4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Uterine fibroid embolization (UFE) is a minimally invasive and well-accepted form of treatment for patients with symptoms from fibroids. Imaging is routinely performed before the procedure for various reasons and after the procedure in cases with either complications or incomplete response to UFE. The interventionalists performing the procedure require specific information from these imaging studies. This article describes the imaging workup of patients referred for UFE, specifically the information from these imaging examinations before the procedure that are necessary to the interventionalist and the complications seen after the procedure.
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Bradley LD. Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol 2009; 201:127-35. [PMID: 19646564 DOI: 10.1016/j.ajog.2009.01.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 12/18/2008] [Accepted: 01/16/2009] [Indexed: 11/30/2022]
Abstract
Benign uterine fibroids, or leiomyomas, are the most common tumors found in gynecologic practice. Symptomatic fibroids present with menorrhagia, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. Traditional treatment has relied on surgery because long-term medical therapies have demonstrated only minimal response. Uterine fibroid embolization (UFE) using particulate emboli to occlude the uterine arteries, thereby disrupting the blood supply to fibroids and leading to devascularization and infarction, has been reported to be effective in alleviating fibroid-related symptoms. UFE is a safe, effective, and durable nonsurgical alternative to hysterectomy.
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Affiliation(s)
- Linda D Bradley
- Department Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
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Hovsepian DM, Siskin GP, Bonn J, Cardella JF, Clark TW, Lampmann LE, Miller DL, Omary RA, Pelage JP, Rajan D, Schwartzberg MS, Towbin RB, Walker WJ, Sacks D. Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata. J Vasc Interv Radiol 2009; 20:S193-9. [DOI: 10.1016/j.jvir.2009.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 02/16/2004] [Indexed: 11/28/2022] Open
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Uterine artery embolization along with the administration of methotrexate for cervical ectopic pregnancy: technical and clinical outcomes. AJR Am J Roentgenol 2009; 192:1601-7. [PMID: 19457824 DOI: 10.2214/ajr.08.1921] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the technical and clinical outcomes of uterine artery embolization (UAE) along with the administration of methotrexate (MTX) for cervical ectopic pregnancy with vaginal bleeding as an alternative nonsurgical treatment to control bleeding and preserve fertility. MATERIALS AND METHODS Eight patients (age range, 24-37 years; mean age, 30.1 years) with cervical ectopic pregnancy were treated with UAE using gelatin sponge particles to control vaginal bleeding. In seven patients, the administration of MTX was performed before, after, or before and after UAE. The follow-up periods after UAE ranged from 4 to 46 months (median, 8 months). We evaluated the UAE technique, clinical outcomes, complications, and fertility. RESULTS In all patients, UAE could control active vaginal bleeding on gynecologic examination. In six patients, the cervical ectopic pregnancy was dramatically resolved. In the other two patients presenting with both fetal heartbeat before UAE and persistent high HCG levels, active vaginal rebleeding was observed. The rebleeding was successfully controlled by a second UAE procedure. No major complication related to UAE was detected. The uterus could be preserved in all patients. In seven patients, normal menses resumed within 2 months after UAE. In only one patient, amenorrhea continued 8 months after UAE. In all three patients who could be followed for 2 years or more, three had subsequent successful natural pregnancies, and two patients had live births. CONCLUSION UAE along with the administration of MTX is effective in treating cervical ectopic pregnancy with vaginal bleeding while allowing the preservation of fertility.
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Abstract
Although the vast majority of uterine leiomyomata are supplied solely by the uterine arteries, myomata have been reported to recruit additional blood supply, especially from the ovarian arteries. This report describes a patient with vascular supply to uterine leiomyomata from a non-gonadal source. The collateral supply was identified during uterine artery embolization as originating from an aortoiliac hemorrhoidal artery emanating from the inferior mesenteric artery. The aberrant vessel was selectively embolized during a follow-up procedure, which produced successful anatomical and clinical results.
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Affiliation(s)
- Bruce McLucas
- University of California at Los Angeles, Department of Obstetrics and Gynecology, Los Angeles, CA, USA.
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Henriksen KM, Chater S, Sellar R. The impact of transcatheter arterial embolization on pain scoring and analgesic dosing in a patient with metastatic renal cell carcinoma. J Pain Symptom Manage 2009; 37:e6-9. [PMID: 19268810 DOI: 10.1016/j.jpainsymman.2008.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 09/27/2008] [Indexed: 10/21/2022]
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Abstract
Last years, calibrated microspheres have proven their superiority in targeting embolization over non spherical particles in many applications. For the very near future they represent the best tool for controlling drug delivery in chemoembolization, under the two conditions that they would be image detectable and that the "dosimetry" would be tailored to pathological process.
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Affiliation(s)
- A Laurent
- Assistance Publique, Hôpitaux de Paris, Hôpital Lariboisière, Department of Interventional Neuroradiology, Paris, France.
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Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. J Vasc Interv Radiol 2008; 19:1007-16; quiz 1017. [PMID: 18589314 DOI: 10.1016/j.jvir.2008.03.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To investigate whether uterine artery embolization (UAE) is a cost-effective alternative to hysterectomy for patients with symptomatic uterine fibroids, the authors performed an economic evaluation alongside the multicenter randomized EMMY (EMbolization versus hysterectoMY) trial. MATERIALS AND METHODS Between February 2002 and February 2004, 177 patients were randomized to undergo UAE (n = 88) or hysterectomy (n = 89) and followed up until 24 months after initial treatment allocation. Conditional on the equivalence of clinical outcome, a cost minimization analysis was performed according to the intention to treat principle. Costs included health care costs inside and outside the hospital as well as costs related to absence from work (societal perspective). Cumulative standardized costs were estimated as volumes multiplied with prices. The nonparametric bootstrap method was used to quantify differences in mean (95% confidence interval [CI]) costs between the strategies. RESULTS In total, 81 patients underwent UAE and 75 underwent hysterectomy. In the UAE group, 19 patients (23%) underwent secondary hysterectomies. The mean total costs per patient in the UAE group were significantly lower than those in the hysterectomy group ($11,626 vs $18,563; mean difference, -$6,936 [-37%], 95% CI: -$9,548, $4,281). The direct medical in-hospital costs were significantly lower in the UAE group: $6,688 vs $8,313 (mean difference, -$1,624 [-20%], 95% CI: -$2,605, -$586). Direct medical out-of-hospital and direct nonmedical costs were low in both groups (mean cost difference, $156 in favor of hysterectomy). The costs related to absence from work differed significantly between the treatment strategies in favor of UAE (mean difference, -$5,453; 95% CI: -$7,718, -$3,107). The costs of absence from work accounted for 79% of the difference in total costs. CONCLUSIONS The 24-month cumulative cost of UAE is lower than that of hysterectomy. From a societal economic perspective, UAE is the superior treatment strategy in women with symptomatic uterine fibroids.
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McLucas B, Chespak L, Kaminsky D. Myoma necrosis following Gelfoam embolization of uterine myomata. MINIM INVASIV THER 2008; 17:200-4. [PMID: 18666018 DOI: 10.1080/13645700701627522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to assess the risk and clinical significance of purulent necrosis following Gelfoam uterine artery embolization in the minimally invasive management of uterine leiomyomata. This study compares the incidence of purulent necrosis in leiomyomata affecting women who underwent Gelfoam embolization with those who had embolization with traditional particles. From January 20 to May 26, 2005, 54 patients were embolized for symptomatic fibroids. Forty-three were embolized with traditional particles, 11 with Gelfoam alone. Of the Gelfoam group, four women suffered purulent necrosis of leiomyomata, whereas in the traditional particle group, only one patient experienced this complication (p = 0.005). The women in the Gelfoam group were generally younger than those in the particle group (p = 0.00014). The average gravida and parity of the Gelfoam group were less than for the particle group--(p = 0.221) and (p = 0.041), respectively. The total uterine volume was similar for both groups. Within the Gelfoam 50% shaded block group there was no significant difference in fertility, age, total uterine volume, largest fibroid size, or number of pledglets used (P > 0.05) when comparing women with and without purulent necrosis. The average time from embolization to onset of symptomatic purulent necrosis was 11 days. All four patients with purulent necrosis of leiomyomata were successfully treated with myomectomy (three abdominal, one vaginal). Notwithstanding the small numbers in the series, patients embolized with Gelfoam appear to be at higher risk for development of post-embolization purulent necrosis of leiomyomata than patients who are embolized with traditional particles.
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Affiliation(s)
- Bruce McLucas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90024, USA.
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Submucosal Fibroids Becoming Endocavitary Following Uterine Artery Embolization: Risk Assessment by MRI. AJR Am J Roentgenol 2008; 190:1220-6. [DOI: 10.2214/ajr.07.3312] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Laurent A, Pelage JP, Wassef M, Martal J. Fertility after bilateral uterine artery embolization in a sheep model. Fertil Steril 2008; 89:1371-83. [PMID: 17531994 DOI: 10.1016/j.fertnstert.2007.03.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 03/16/2007] [Accepted: 03/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of bilateral uterine artery embolization (UAE) upon fertility in sheep. DESIGN Prospective study. SETTING University-based interventional radiology, pathology, and reproductive physiology units. ANIMAL(S) Nineteen control ewes, 10 ewes embolized with polyvinyl alcohol particles (PVA group), and 10 ewes embolized with Tris-acryl gelatin microspheres (TGMS group). INTERVENTION(S) Bilateral UAE was performed with 600- to 1,000-mum PVA particles or 700- to 900-mum TGMS particles. Animals of three groups were synchronized and naturally inseminated. MAIN OUTCOME MEASURE(S) For each ewe, a hormonal follow-up was performed throughout the gestation. Gestation duration, number and weight of newborns, and fertility and gestation rates were recorded. RESULT(S) Mean number of estrus before insemination and gestation duration were not different between groups. There were 47 living newborns: 26 control, 9 PVA, and 12 TGMS. Overall birth weight of newborns was 3.7 +/- 0.9 kg for controls, 3.6 +/- 1.1 kg for TGMS, and 2.2 +/- 0.7 kg for PVA (which was statistically significant vs. control). In the PVA group, there was a statistically significant decrease of fertility rate and gestation rate vs. controls, but this was not the case in the TGMS group. CONCLUSION(S) Particles of PVA decrease fertility in sheep and lead to intrauterine growth retardation.
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Affiliation(s)
- Alexandre Laurent
- Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France.
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Hehenkamp WJK, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic Uterine Fibroids: Treatment with Uterine Artery Embolization or Hysterectomy—Results from the Randomized Clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 2008; 246:823-32. [DOI: 10.1148/radiol.2463070260] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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48
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Uterine Artery Embolization in Patients with Symptomatic Diffuse Leiomyomatosis of the Uterus. J Vasc Interv Radiol 2008; 19:279-84. [DOI: 10.1016/j.jvir.2007.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 10/15/2007] [Accepted: 10/15/2007] [Indexed: 02/06/2023] Open
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49
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Hehenkamp WJK, Volkers NA, Bartholomeus W, de Blok S, Birnie E, Reekers JA, Ankum WM. Sexuality and body image after uterine artery embolization and hysterectomy in the treatment of uterine fibroids: a randomized comparison. Cardiovasc Intervent Radiol 2008; 30:866-75. [PMID: 17671809 PMCID: PMC2039794 DOI: 10.1007/s00270-007-9121-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n = 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE.
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Affiliation(s)
- Wouter J K Hehenkamp
- Department of Gynaecology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Thurkow AL, Admiraal CF, Emanuel MH, van Kesteren PJM, Veersema S. Submucous myomas: diagnosis and therapy. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0340-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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