Impact of pelvic magnetic resonance imaging findings in the indication of uterine artery embolization in the treatment of myoma

Objectives: To assess the impact of pelvic magnetic resonance imaging (MRI) findings in the indication for uterine-artery embolization in women with fibroids, as well as the correlation between MRI and ultrasound (US) examinations for diagnosing adenomyosis.

A retrospective observational study was performed through the analysis of the medical records of 263 women referred for uterine-artery embolization as treatment for fibroids after undergoing US and MRI examinations. To compare uterine volume and fibroid measurement in US and MRI, the Wilcoxon test was used; for the number of fibroids, the McNemar test was used. The kappa coefficient was used to evaluate the correlation between US and MRI findings for diagnosing adenomyosis.

The mean age of patients was 37.9 ± 6.8 years and 191 (72.6%) were nulliparous. Forty-three patients with adenomyosis associated with fibroid were diagnosed by MRI; US indicated the presence of adenomyosis in 12 (4.56%) women. There was agreement between MRI and US in the diagnosis of adenomyosis in 218/263 (82.9%) patients (p < 0.05). In the US examination, the mean uterine volume was lower (389 ± 340.8 cm³) than that observed in MRI (472.2 ± 415.9 cm³; p < 0.001). Regarding the number of fibroids, MRI showed a greater number of patients with multiple fibroids (68.8% vs. 57.4%, MRI and US, respectively; p < 0.001).

In women with fibroids referred for uterine-artery embolization, MRI findings led to the revision of the initial diagnosis in 17.1% cases. US showed a lower sensitivity for diagnosing adenomyosis than MRI.

uterine-artery embolizationmagnetic resonance imagingultrasoundadenomyosis

- Baird DD, Dunson DB. Why is parity protective for uterine fibroids? Epidemiology. 2003; 14(2): 247–250. - Malartic C, Morel O, Rivain AL, et al. Evaluation of symptomatic uterine fibroids in candidates for uterine artery embolization: comparison between ultrasonographic and MR imaging findings in 68 consecutive patients. Clin Imaging. 2013; 37(1): 83–90. - Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014; 6: 95–114. - Taran FA, Brown HL, Stewart EA. Racial diversity in uterine leiomyoma clinical studies. Fertil Steril. 2010; 94(4): 1500–1503. - Omary RA, Vasireddy S, Chrisman HB, et al. The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids. J Vasc Interv Radiol. 2002; 13(11): 1149–1153. - Pelage JP, Le Dref O, Soyer P, et al. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology. 2000; 215(2): 428–431. - Chittawar PB, Kamath MS. Review of nonsurgical/minimally invasive treatments and open myomectomy for uterine fibroids. Curr Opin Obstet Gynecol. 2015; 27(6): 391–397. - Early HM, McGahan JP, Scoutt LM, et al. Pitfalls of Sonographic Imaging of Uterine Leiomyoma. Ultrasound Q. 2016; 32(2): 164–174. - Rajan DK, Margau R, Kroll RR, et al. Clinical utility of ultrasound versus magnetic resonance imaging for deciding to proceed with uterine artery embolization for presumed symptomatic fibroids. Clin Radiol. 2011; 66(1): 57–62. - Devlieger R, D'Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003; 9(2): 139–147. - Stamatopoulos CP, Mikos T, Grimbizis GF, et al. Value of magnetic resonance imaging in diagnosis of adenomyosis and myomas of the uterus. J Minim Invasive Gynecol. 2012; 19(5): 620–626. - Laios A, Baharuddin N, Iliou K, et al. Uterine artery embolization for treatment of symptomatic fibroids; a single institution experience. Hippokratia. 2014; 18(3): 258–261. - Stoelinga B, Huirne J, Heymans MW, et al. The estimated volume of the fibroid uterus: a comparison of ultrasound and bimanual examination versus volume at MRI or hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2015; 184: 89–96. - Toor SS, Tan KT, Simons ME, et al. Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics. J Vasc Interv Radiol. 2008; 19(5): 662–667. - Silberzweig JE, Powell DK, Matsumoto AH, et al. Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques. Radiology. 2016; 280(3): 675–692. - Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol. 2016; 23(2): 164–185. - Champaneria R, Abedin P, Daniels J, et al. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010; 89(11): 1374–1384. - Puente JM, Fabris A, Patel J, et al. Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease. Reprod Biol Endocrinol. 2016; 14(1): 60.