Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis

Objectives To identify imaging predictors for complete necrosis after uterine artery embolisation (UAE) via quantitative measurement of the signal intensity obtained from magnetic resonance imaging (MRI) of a patient with adenomyosis.

The MRIs of 119 patients with uterine adenomyosis, who underwent UAE, were retrospectively evaluated. Each lesion was classified based on its location and morphology on MRI. Thickness and signal intensity were measured in each adenomyosis and in the rectus muscle on the T2-weighted sagittal plane, and the T2-weighted signal intensity ratio (T2SR) was calculated. MR parameters were then compared in patients showing complete response that achieved complete necrosis and incomplete response after UAE via univariate and multivariate analysis. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the predictor using MR parameters for differentiating the complete from the incomplete response.

The complete necrosis rate was 66.4 % (79/119) after UAE for adenomyosis. Univariate and multivariate analysis results indicated that T2SR was associated significantly with complete necrosis (P = 0.012). Symptomatic adenomyosis with T2SR above 0.475 was associated with complete necrosis after UAE (sensitivity = 57.0, specificity = 70.0, area under the ROC curve [AUC] = 0.643).

T2SR of adenomyosis on pre-procedural MRI can be utilised as a predictor for early therapeutic response of UAE in adenomyosis. Key Points • Pre-procedural MRI helps clinicians predict early response of UAE in adenomyosis. • T2SR may help predict UAE outcomes in adenomyosis. • Pre-procedural MRI helps clinicians to select treatment options in adenomyosis. • MR predictors can be used to counsel patients with symptomatic adenomyosis. Similar content being viewed by others Abbreviations - T2SR: - T2 signal intensity ratio - UAE: - uterine artery embolisation - AUC: - area under the ROC curve

Benson RC, Sneeden VD (1958) Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol 76:1044–1057, discussion 1057-1061 Ascher SM, Arnold LL, Patt RH et al (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology 190:803–806 Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40 Farquhar C, Brosens I (2006) Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:603–616 Meyers ER, Steege JF (1998) Risk adjustment for complications of hysterectomy: utility of routinely collected administrative data. Prim Care Update Ob Gyns 5:202–203 Volkers NA, Hehenkamp WJ, Smit P, Ankum WM, Reekers JA, Birnie E (2008) Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Journal of vascular and interventional radiology. J Vasc Interv Radiol 19:1007–1016, quiz 1017 Siskin GP, Tublin ME, Stainken BF, Dowling K, Dolen EG (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177:297–302 Kim MD, Kim S, Kim NK et al (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol 188:176–181 Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA (2011) Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 22:901–909 Goodwin SC, McLucas B, Lee M et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165 Bratby MJ, Walker WJ (2009) Uterine artery embolisation for symptomatic adenomyosis – mid-term results. Eur J Radiol 70:128–132 Pelage JP, Jacob D, Fazel A et al (2005) Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology 234:948–953 Kim MD, Kim YM, Kim HC et al (2011) Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. J Vasc Interv Radiol 22:497–502 Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH (1999) Diffuse and focal adenomyosis: MR imaging findings. Radiographics 19 Spec No:S161–170 Reinhold C, Tafazoli F, Mehio A et al (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19 Spec No:S147–S160 Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B (2010) Uterine artery embolisation for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841 Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA (2009) Long-term quality of life assessment among patients undergoing uterine fibroid embolization. AJR Am J Roentgenol 193:267–271 Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM (2008) Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 246:823–832 Bradley LD (2009) Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol 201:127–135 Jha RC, Takahama J, Imaoka I et al (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. AJR Am J Roentgenol 181:851–856 Kitamura Y, Allison SJ, Jha RC, Spies JB, Flick PA, Ascher SM (2006) MRI of adenomyosis: changes with uterine artery embolization. AJR Am Roentgenol 186:855–864 Cura M, Cura A, Bugnone A (2006) Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol 47:1105–1114 Beilby JO, Farrer-Brown G, Tarbit MH (1971) The microvasculature of common uterine abnormalities, other than fibroids. J Obstet Gynaecol Br Commonw 78:361–368 Schindl M, Birner P, Obermair A, Kiesel L, Wenzl R (2001) Increased microvessel density in adenomyosis uteri. Fertil Steril 75:131–135 Lee JK, Gersell DJ, Balfe DM, Worthington JL, Picus D, Gapp G (1985) The uterus: in vitro MR-anatomic correlation of normal and abnormal specimens. Radiology 157:175–179 Scoutt LM, Flynn SD, Luthringer DJ, McCauley TR, McCarthy SM (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179:403–407

The authors have been supported by the National Cancer Center, South Korea (grant nos. 0910140-1 and 0910140-2). Forty of the 119 patients enrolled in the present study were the same patients described in a previously published paper [13]. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Jung, D.C., Kim, M.D., Oh, Y.T. et al. Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis. Eur Radiol 22, 2044–2049 (2012). https://doi.org/10.1007/s00330-012-2436-z Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-012-2436-z