Uterine Artery Embolization for Symptomatic Adenomyosis with or without Uterine Leiomyomas with the Use of Calibrated Tris-acryl Gelatin Microspheres: Midterm Clinical and MR Imaging Follow-up
Received 5 October 2006; received in revised form 12 April 2007; accepted 16 April 2007.
Purpose
To evaluate clinical and magnetic resonance (MR) imaging results after uterine artery embolization (UAE) in women with symptomatic adenomyosis with or without uterine leiomyomas.
Materials and Methods
Thirty-eight women with symptomatic adenomyosis with or without uterine leiomyomas were treated with UAE with calibrated tris-acryl gelatin microspheres. Based on MR findings, women were categorized as having pure adenomyosis (group A; n = 15), adenomyosis dominance with fibroid tumors (group B; n = 14), or fibroid tumor dominance with adenomyosis (group C; n = 9).
Results
Heavy menstrual bleeding, pain, and bulk-related symptoms at last follow-up at a median of 16.5 months (range, 3–38 months) were compared with baseline symptoms. With follow-up MR imaging at a median of 12 months (range, 3–36 months), changes in uterine volume, leiomyoma volume, junctional zone thickness, and contrast enhancement of adenomyosis were assessed. After embolization, adenomyosis infarction could be depicted on contrast medium–enhanced MR in 44.1% of cases. Median reductions of uterine volume, fibroid tumor volume, and junctional zone thickness were 44.8%, 77.1%, and 23.9%, respectively. In group A, three patients needed additional surgery after UAE, in addition to two in group B and one in group C. In the remaining 32 patients, except for one patient in group C, all preexisting symptoms (eg, bleeding, pain, bulk-related symptoms) improved or resolved after UAE. Overall, 84.2% of women were satisfied with the results of UAE.
Conclusion
In this study, midterm results (at a median of 16.5 months) showed that UAE in symptomatic adenomyosis with or without uterine leiomyomas is effective. Hysterectomy was avoided in the vast majority of patients. MR imaging showed reduction of uterine volume and junctional zone thickness.
aDepartment of Radiology, St. Elisabeth Ziekenhuis, Tilburg University, Tilburg, The Netherlands
bDepartment of Obstetrics and Gynecology, St. Elisabeth Ziekenhuis, Tilburg University, Tilburg, The Netherlands
cDepartment of Medical Psychology, Tilburg University, Tilburg, The Netherlands
dDepartment of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany.
Address correspondence to P.N.M.L., Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
1 P.N.M.L. and T.J.K. are consultants to Biosphere Medical, Inc., the makers of the embolic material used in this study, but did not receive any support from the company. None of the other authors have identified a conflict of interest.
ABSTRACT