MR imaging prior to fibroid embolization therapy can discover existing pelvic pathology, including adenomyosis and endometrial lesions. This can result in a decision not to proceed with uterine artery embolization, according to researchers at the Northwestern University Feinberg School of Medicine.
The traditional initial imaging modality for these patients has been ultrasound, which can be limited in aiding the interventional radiologists' decision to embolize, said lead author Dr. Paul Nikolaidis, an assistant professor of radiology at Northwestern.
MRI offers several important advantages over ultrasound: multiplanar imaging capability, a larger field-of-view, better spatial resolution, and increased anatomic detail. The study was presented at the American Roentgen Ray Society meeting in May.
Nikolaidis and colleagues evaluated the use of MRI in 100 women referred for UAE between March and August 2002. Ninety-four women received pelvic MR exams, including multiplanar T2-weighted fast spin-echo imaging as well as pre- and postgadolinium fat-saturated gradient recall echo sequences.
MR detected nonviable fibroids in 20% of the patients. The imaging study indicated UAE would not have been effective in six patients due to either one dominant or several large nonenhancing fibroids. In 11 patients, embolization was not recommended for various reasons including fibroids that were either too large or too small, the presence of adenomyosis or endometrial lesions, and submucosal fibroids that required resection.
MR imaging is unique in its ability to easily assess fibroid enhancement and viability, Nikolaidis said. For example, it can determine whether the fibroids are vascular and whether a reduction in the fibroid's blood supply would be beneficial.
"It is superb in its ability to better classify fibroids according to their exact location, such as submucosal, intramural, or subserosal," he said. "It is also excellent for assessing the presence of other pelvic pathology such as adenomyosis, ovarian pathology, endometriosis, and other endometrial abnormalities."
Nikolaidis and colleagues are working to determine the correlation of long-term outcomes in patients who received UAE and their pre-embolization MR scans, assessing the MR features of uterine fibroids using a variety of sequences, as well as the application of newer techniques such as perfusion imaging.
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