Can measurement of apparent diffusion coefficient before treatment predict the response to uterine artery embolization for adenomyosis?

Yaewon Park, Yae Won Park, Park Y, Kim MD, Man Deuk Kim, Dae Chul Jung, Lee SJ, Shin Jae Lee, Kim G, Gyoungmin Kim, Gyoung Min Kim, Sung Il Park, Park SI, Jong Yun Won, Do Yun Lee, Lee DY
European radiology · 2014 · vol. 25(5) , pp. 1303–1309 · doi:10.1007/s00330-014-3504-3 · PMID:25481638 · W2010959409
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This prospective study found that a pre-treatment apparent diffusion coefficient (ADC) threshold of <1.147 × 10(-3) mm(2)/s predicted successful uterine artery embolization response in adenomyosis patients with 83.3% sensitivity and 84.2% specificity.

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This prospective study evaluated whether the apparent diffusion coefficient (ADC) measured on pre-treatment diffusion-weighted MRI could predict response to uterine artery embolization (UAE) in 25 patients with symptomatic adenomyosis. After UAE using non-spherical polyvinyl alcohol particles (150–500 μm), follow-up MRI at 3 months defined complete response as ≥90% and incomplete response as <90% of the non-perfusion area with adenomyosis. Patients with complete response had a different mean ADC than those with incomplete response, and an ADC threshold of <1.147 × 10(-3) mm(2)/s yielded sensitivity of 83.3% and specificity of 84.2% for predicting success. The paper’s major limitation is its small sample size (25 patients) and the use of a single follow-up time point (3 months). This paper is centrally about endometriosis/adenomyosis research — it focuses specifically on adenomyosis and uses pre-procedural ADC to predict outcomes after UAE.

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Abstract

ObjectivesTo determine the usefulness of the apparent diffusion coefficient (ADC) in predicting response to uterine artery embolization (UAE) for symptomatic adenomyosis.MethodsA prospective study was performed on 25 patients who underwent diffusion-weighted (DW) magnetic resonance imaging (MRI) before UAE between June 2011 and December 2012. All patients underwent 3-month follow-up MRI after UAE using non-spherical polyvinyl alcohol (PVA) particles ranging from 150 to 500 μm. Quantitative measurement of the ADC was performed for each adenomyosis. Complete response and incomplete response were defined as ≥ 90 % or < 90 %, respectively, of the non-perfusion area with adenomyosis at the follow-up MRI. The ADC values were compared between patients who achieved complete or incomplete response which was assessed according to the MRI findings after UAE.ResultsNineteen patients showed complete response, and six showed incomplete response. The ADC value ranged from 0.842 to 1.346 × 10(-3) mm(2)/s (mean 1.075 ± 0.117). The mean ADC was 1.043 ± 0.237 in the complete response group and 1.176 ± 0.429 in the incomplete response group (0.012). Using a threshold of <1.147 × 10(-3) mm(2)/s, the sensitivity and specificity of the ADC to predict success after UAE were 83.3 % and 84.2 %.ConclusionThe ADC of adenomyosis may potentially predict a successful response to UAE for adenomyosis.Key points• Pre-procedural MRI might help clinicians predict response of UAE in adenomyosis • ADC might help predict UAE outcomes in adenomyosis • MR predictors might be used to counsel patients with symptomatic adenomyosis.
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Methods

A prospective study was performed on 25 patients who underwent diffusion-weighted (DW) magnetic resonance imaging (MRI) before UAE between June 2011 and December 2012. All patients underwent 3-month follow-up MRI after UAE using non-spherical polyvinyl alcohol (PVA) particles ranging from 150 to 500 μm. Quantitative measurement of the ADC was performed for each adenomyosis. Complete response and incomplete response were defined as ≥ 90 % or < 90 %, respectively, of the non-perfusion area with adenomyosis at the follow-up MRI. The ADC values were compared between patients who achieved complete or incomplete response which was assessed according to the MRI findings after UAE.

Results

Nineteen patients showed complete response, and six showed incomplete response. The ADC value ranged from 0.842 to 1.346 × 10(-3) mm(2)/s (mean 1.075 ± 0.117). The mean ADC was 1.043 ± 0.237 in the complete response group and 1.176 ± 0.429 in the incomplete response group (0.012). Using a threshold of <1.147 × 10(-3) mm(2)/s, the sensitivity and specificity of the ADC to predict success after UAE were 83.3 % and 84.2 %.

Conclusion

The ADC of adenomyosis may potentially predict a successful response to UAE for adenomyosis. KEY POINTS: • Pre-procedural MRI might help clinicians predict response of UAE in adenomyosis • ADC might help predict UAE outcomes in adenomyosis • MR predictors might be used to counsel patients with symptomatic adenomyosis. - Appears in Collections: - 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers - Yonsei Authors - Kim, Gyoung Min(김경민) https://orcid.org/0000-0001-6768-4396 Kim, Man Deuk(김만득) https://orcid.org/0000-0002-3575-5847 Park, Sung Il(박성일) Park, Yae Won(박예원) https://orcid.org/0000-0001-8907-5401 Won, Jong Yun(원종윤) https://orcid.org/0000-0002-8237-5628 Lee, Do Yun(이도연) Lee, Shin Jae(이신재) Jung, Dae Chul(정대철) https://orcid.org/0000-0001-5769-5083 Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Diffusion Magnetic Resonance Imaging Uterine Artery Embolization Adenomyosis Adult Contrast Media Diffusion Magnetic Resonance Imaging Female Humans Image Enhancement Meglumine Myometrium Myometrium Organometallic Compounds Polyvinyl Alcohol Polyvinyl Alcohol Prospective Studies Sensitivity and Specificity Treatment Outcome Uterine Artery Embolization

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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chemicals 1
methylbenzyl alcohol

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