Uterine Artery Embolization for Leiomyomas: Pre- and Postprocedural Evaluation with US

Abstract

Transabdominal and transvaginal ultrasonography (US) are commonly used to assess the uterus and pelvis prior to and following uterine artery embolization (UAE) for symptomatic leiomyomas (fibroids). Preprocedural US may help identify relative contraindications for UAE, whereas postprocedural US can help determine the quality and quantity of fibroid involution and help identify any complications associated with the procedure. The consulting radiologist should be familiar with certain typical postprocedural US findings, which might otherwise be improperly interpreted, leading to unnecessary intervention. Magnetic resonance (MR) imaging or computed tomography will frequently provide the most accurate information in UAE patients with certain pathologic conditions, and early study results suggest that MR imaging may be helpful in predicting treatment response. Nevertheless, US is a readily available first-line imaging modality and a well-accepted method for both pre- and postprocedural evaluation of patients who undergo UAE. A proper understanding of the US findings in this patient population allows objective determination of treatment response and detection of most of the commonly recognized complications that are associated with UAE.

Imaging Fibroids Pre and Post Uterine Artery Embolisation

“…12). This appearance has been well described in other tumours treated with radiofrequency ablation or chemoembolisation (Ghai et al 2005) and can be seen from 1 month after UAE. This appearance does not necessarily signify infection and it is important to correlate with clinical and laboratory findings.…”

Uterine-sparing management of pyomyoma after uterine fibroid embolization

“…In terms of imaging findings, patients with pyomyoma usually showed an enlarged, irregular uterus, heterogeneous tissue appearance, free pelvic fluid, and foci of gas on US, CT or MRI [4], [5], [6], [7], [8], [9], [10], [11], [12]. Nevertheless, these findings can be observed in cases after UFE and are considered a normal process following tissue infarction-desiccation [15]. Though this necrosis-related cavitation can appear up to 1-month postembolization, it could occur as early as 10 days in cases diagnosed with pyomyoma [16].…”

Efficacy of Ovarian Artery Embolization for Uterine Fibroids

“…All patients had a baseline pre-embolization contrast agenteenhanced pelvic MR as well as pelvic ultrasound (US), which were reviewed. Uterine volume and dominant fibroid volume were recorded from both modalities according to the formula for a prolate ellipsoid [11,12]. Location and type of dominant fibroid was recorded as per UAE reporting standards based on multiplanar, multisequence imaging completed with and without intravenous gadolinium [13].…”