Uterine Artery Embolization for Pure Adenomyosis: Predictive Factors Affecting Outcomes

PURPOSE: To identify factors associated with postprocedural necrosis after uterine artery embolization (UAE) for pure adenomyosis. MATERIALS AND METHODS: This study included patients who underwent UAE for pure symptomatic adenomyosis between January 2011 and May 2025. Adenomyosis characteristics, including T2-weighted signal intensity, adenomyosis morphology (Types I and II), and focal versus diffuse location, were evaluated using preprocedural magnetic resonance (MR) imaging. Contrast-enhanced MR imaging was used to assess adenomyosis necrosis 3 months after UAE. Symptom severity scores (SSSs) and health-related quality of life (HRQOL) were evaluated before and 3 months after the procedure. Univariate and multivariate analyses were performed to identify factors associated with incomplete necrosis of the adenomyotic tissue. RESULTS: Of the 147 patients (mean age, 42.7 years [SD ± 4.2]) who underwent UAE for adenomyosis, 116 (78.9%) exhibited complete necrosis. In multivariate analysis, Type II adenomyosis (odds ratio [OR], 10.492; 95% CI, 3.492-31.523; P < .001) and heterogeneous T2 signal intensity (OR, 4.003; 95% CI, 1.565-10.242; P = .003) were significant predictive factors for incomplete necrosis. The rates of incomplete necrosis were 13.6% (17/125) for Type I adenomyosis and 63.6% (14/22) for Type II adenomyosis. The postprocedural SSS and HRQOL scores were significantly improved in patients with complete necrosis compared with those with incomplete necrosis. CONCLUSIONS: Type II morphology arising from the subserosa and a heterogeneous T2 signal are associated with an increased risk of incomplete necrosis after UAE. Incorporating these features into preprocedural counseling may help improve clinical outcomes.