Canadian Association of Radiologists Journal 66 (2015) 164e170 www.carjonline.org
Vascular and Interventional Radiology / Radiologie vasculaire et radiologie d’intervention
Efficacy of Ovarian Artery Embolization for Uterine Fibroids: Clinical and Magnetic Resonance Imaging Evaluations Jennifer Campbell, MPH, Dheeraj K. Rajan, MD, John R. Kachura, MD, Jeffrey Jaskolka, MD, J. Robert Beecroft, MD, Kenneth W. Sniderman, MD, Martin E. Simons, MD, Kong T. Tan, MD* Division of Interventional Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Abstract Purpose: The objective of the study was to assess the efficacy of ovarian artery embolization (OAE) treatment for symptomatic uterine leiomyomas. Methods: A retrospective review of 17 patients who underwent OAE in conjunction with uterine artery embolization in a 6-year period (2006-2012) was performed. Ten patients had previous failed embolization, while 7 had not received any embolization therapy before. Percent uterine volume change, percent dominant fibroid volume change, and percent dominant fibroid infarction were assessed with magnetic resonance (MR) imaging. Resolution of menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency were evaluated clinically. Change in menopausal state was also an outcome of interest. Results: Mean MR imaging follow-up was performed 3 months post-OAE. MR images showed complete infarction in the majority of cases (64.7%; n ¼ 11), with infarction rates of 90%-100% in 3 cases, 1 case with 30%-50% infarction, and 2 cases with 0%-10% infarction. Average uterine size reduction on MR was 32.3% (95% confidence interval [CI]: 22.5%-42.2%; P < .001). The average size reduction for the dominant fibroid was 42.4% (95% CI: 27.7%-57.0%; P ¼ .01). The mean time to final follow-up visit was 11 months. At this point complete symptom resolution (menorrhagia, dysmenorrhea and bulk-related) was achieved in 82.4% (n ¼ 14) of cases. At the final follow-up 11.8% (n ¼ 2) of cases reported menopause. Conclusions: We observed OAE to be an effective and safe adjunct to uterine artery embolization when hypertrophic ovarian artery(ies) require intervention. However, incomplete fibroid infarction of 23% remains a concern with a potential for long-term treatment failure. In addition, long-term effect on ovarian function is uncertain. Resume Objet : L’etude avait pour objectif d’evaluer l’efficacite de l’embolisation des arteres ovariennes dans le traitement des leiomyomes uterins symptomatiques. Methodes : Un examen retrospectif portant sur 17 patientes ayant subi une embolisation des arteres ovariennes et une embolisation des arteres uterines sur une periode de 6 ans (2006-2012) a ete realise. Dix patientes avaient deja subi une embolisation sans succes, alors que 7 n’avaient jamais rec¸u de traitement par embolisation. Le changement de volume uterin (en pourcentage), le changement de volume du fibromyome dominant (en pourcentage) et l’infarcissement du fibromyome dominant (en pourcentage) ont ete determines au moyen de l’imagerie par resonance magnetique (IRM). La resolution de la menorragie, de la dysmenorrhee (et de la douleur) et des sympt^ omes de gonflement ou de pression, y compris la frequence de miction, a ete evaluee sur le plan clinique. Les changements au chapitre de l’etat menopausique ont aussi ete etudies. Resultats : En moyenne, l’examen d’IRM de suivi a ete realise trois mois apres l’embolisation des arteres ovariennes. Les images ont revele un infarcissement complet chez la plupart des patientes (64,7 %; n ¼ 11) ainsi qu’un taux d’infarcissement de 90 a 100 % chez trois patientes, de 30 a 50 % chez une patiente et de 0 a 10 % chez deux patientes. L’IRM a egalement permis d’observer une reduction moyenne de la taille de l’uterus de 32,3 % (intervalle de confiance de 95 % : 22,5 %-42,2 %; P < 0,001) et une reduction moyenne de la taille du fibromyome dominant de 42,4 % (intervalle de confiance de 95 % : 27,7 %-57,0 %; P ¼ 0,01). L’intervalle moyen avant la derniere visite de suivi etait de
* Address for correspondence: Kong T. Tan, MD, Division of Interventional Radiology, University Health Network, University of Toronto, 585 University Avenue, PMB 1-293, Toronto, Ontario M5G 2N2, Canada.
E-mail address: [email protected] (K. T. Tan).
0846-5371/$ - see front matter Ó 2015 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2014.08.005
Gonadal artery embolization for fibroids / Canadian Association of Radiologists Journal 66 (2015) 164e170
165
cette etape, les sympt^omes (menorragie, dysmenorrhee et gonflement) avaient ete entierement resolus chez 82,4 % (n ¼ 14) des 11 mois. A patientes. Lors du dernier examen de suivi, 11,8 % (n ¼ 2), des patientes ont par ailleurs signale un etat de menopause. Conclusions : Selon nos observations, l’embolisation des arteres ovariennes s’est averee un traitement d’appoint efficace et securitaire a l’embolisation des arteres uterines en presence d’une ou de plusieurs arteres ovariennes hypertrophiques exigeant une intervention. Toutefois, l’infarcissement incomplet du fibromyome chez 23 % des patientes demeure preoccupant en raison de l’eventuel echec du traitement a long terme. De plus, l’effet a long terme de l’embolisation sur la fonction ovarienne est incertain. Ó 2015 Canadian Association of Radiologists. All rights reserved. Key Words: Uterine fibroid; Embolization; Gonadal artery; Magnetic resonance imaging
Uterine artery embolization (UAE) is an acceptable alternative to surgery in the treatment of symptomatic uterine leiomyomata [1]. Current evidence indicates that patients are more satisfied post-UAE compared to postsurgery (hysterectomy or myomectomy). However, UAE has an increased likelihood of requiring a surgical intervention within 2-5 years of the initial procedure [1]. One of the well-documented reasons for UAE failure is collateral supply to perfused fibroids via hypertrophic ovarian arteries [2e4]. In cases where 1 ovarian artery or both ovarian arteries are contributing to the fibroid’s vascular supply, ovarian artery embolization (OAE) may be a minimally invasive alternative to surgical reintervention [3]. OAE is not formally accepted as a treatment option for symptomatic fibroids. The radiation exposure from additional imaging to identify hypertrophic arteries is a hypothesized risk of OAE [2,5]. It has also been postulated that OAE may lead to ovarian failure and premature menopause by impeding blood flow to the ovaries [5,6]. However, Hu et al. [7] have recently demonstrated that this may not necessarily occur. There are limited studies describing outcomes of OAE with corresponding magnetic resonance (MR) findings. The first 2 publications were case reports of selective ovarian artery catheterization and successful embolization [6,8], followed by a report of 6 patients from the United States [9], and then a European study evaluating safety and effectiveness in a sample of 13 patients [10]. Here, we report our clinical experience and corresponding MR findings of 17 patients who received OAE and UAE.
The average age of the patients presenting for treatment of symptomatic fibroids patients in this study group was 45.1 years old (range 29-52 years old). Presenting symptoms included menorrhagia in 94.1% (n ¼ 16), dysmenorrhea/pain in 58.8% (n ¼ 10), bulk and/or pressure symptoms including urinary frequency in 76.5% (n ¼ 13). 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]. All MR images were obtained with a 1.5-T system (Excite; GE Medical Systems, Milwaukee, WI). After an initial localization scan was obtained, the following sequences were performed: axial T1-weighted fast spoiled gradient-echo imaging; sagittal T2-weighted fast spin-echo imaging; sagittal dynamic contrast-enhanced T1-weighted fast spoiled gradient-echo imaging at 0, 30, 60, 90 seconds after the administration of a gadolinium chelate; and axial delayed T1-weighted fast spoiled gradient-echo imaging. In our institution, as part of our standard pretreatment clinical evaluation, all patients were asked if they would agree to ovarian artery embolization should an ovarian artery or arteries supplied the fibroids. They were each consulted about the risk of premature menopause from this procedure, in addition to infertility risk in the group of patients who wished to maintain fertility.
Methods Embolization Technique Patients and Baseline Data Collection Institutional review board approval was granted for this retrospective review of 17 patients who underwent OAE in a 6-year period (2006-2012). There were a total of 456 UAE cases in the same period. The clinical and imaging records of the women treated with OAE were reviewed. Outpatient consultation notes were used to assess presenting symptoms which were categorized as menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency. In addition, patient age, previous history of uterine fibroid interventions, menopausal state, and desire to preserve fertility were recorded.
Informed consent was obtained from all patients. Sterile technique, local anaesthesia, and moderate intravenous sedation were used. Fellowship-trained interventional radiologists with 5-25 years’ experience performed embolization procedures. Urinary bladder Foley catheter was placed routinely. Right common femoral artery access was obtained under sterile technique followed by insertion of a 5-F vascular sheath. Individual uterine artery was selected with Robert’s uterine catheter (COOK Medical, Bloomington, IN). Polyvinyl alcohol (PVA) particles in 250-500 mm (COOK Medical) mixed with contrast was injected into the artery until flow stasis. Postembolization arteriogram was performed to
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J. Campbell et al. / Canadian Association of Radiologists Journal 66 (2015) 164e170
Postprocedure MR images from this visit were accessed to calculate percent dominant fibroid infarction in addition to uterine and dominant fibroid volume changes. Patients also attended additional follow-up visits at 6 months, 1 year, and 2 years postprocedure depending on physician recommendation. Final visit clinical notes describing patient symptom resolution and menopausal state (defined as absent of menstrual cycle) were recorded. Figure 1. Flow diagram summarizing procedure history of reviewed patients. OAE ¼ ovarian artery embolization; UAE ¼ uterine artery embolization.
visualize results. Further embolization was performed if there was rapid flow in the uterine artery. Hemostasis was achieved with manual compression. Patients were medicated for pain control and observed for a minimum of 4 hours postprocedure before discharged home with pain medications. For ovarian artery embolization, a suitable selective catheter was used to cannulate the origin of the ovarian artery. A microcatheter (Progreat, Terumo, Tokyo, Japan) was then advanced further into the ovarian artery. Often the artery was very tortuous and hence the microcatheter would only progress to mid or proximal segment. To minimize the risk of spasm and perforation, we did not attempt to pass the catheter beyond the tortuous segment of the artery. PVA particles were injected (250-500 mm) to complete flow stasis in the ovarian artery. Postprocedure Data Collection Patients were assessed clinically at approximately 3 months postprocedure and imaging with enhanced pelvic MR imaging (MRI) was obtained prior to the clinic visit.
Patient no.
Dominant fibroid characteristics on MR
Uterus (mL)
Dominant fibroid (mL)
1 2 3
Left fundus intramural fibroid Lower anterior intramural fibroid Right lower uterine body intramural fibroid Left abdomen pedunculated fibroid Anterior fundus, 30%. This likely accounted for the initial treatment failures. The remaining 7 patients never received previous embolization therapy. Table 2 summarizes the MR outcome measures. The average MR follow-up time was 3 months for this patient group (range 3-6 months). MRI showed complete infarction in 11 cases, 90%-100% infarction in 2 cases, 30%-50% in 1 case, and 0%-10% infarction in 2 cases. The average uterine volume at the MR follow-up time point was 512 mL, corresponding to a mean uterine volume reduction of 32.3% (95% CI: 22.5%-42.2%). The average dominant fibroid volume was 191 mL after 3 months,
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J. Campbell et al. / Canadian Association of Radiologists Journal 66 (2015) 164e170
Table 2 MR imaging outcome measures Patient
Post-MR infarction %
Uterus % reduction
Dominant fibroid % reduction
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
100 100 100 100 100 90e100 100 100 100 30e50 100 90e100 100 90e100 100 0e10 0e10
39.52 48.05 61.88 13.88 6.41 14.29 52.09 50.00 3.27 16.36 49.18 42.02 20.86 36.97 62.35 1.74 34.25
42.60 58.33 69.04 22.65 28.21 32.56 93.61 23.84 44.44 38.60 26.64 77.30 15.74 54.55 63.65 30.47 75.00
MR ¼ magnetic resonance.
corresponding to a mean dominant fibroid volume reduction of 42.4% (95% CI: 27.7%-57.0%). The measured reduction in uterine and dominant fibroid volume were significant (P < .001 and P ¼ .01, respectively). The average final follow-up time was 11 months (range 3-24 months) and patients had a clinical visit and an US at this time. The average uterine volume on US at the final time point was 357 mL, corresponding to a mean uterine volume reduction of 42.4% (95% CI: 30.0%-54.7%). The average dominant fibroid volume was 87 mL at the final time point, corresponding to a volume reduction of 62.4% (95% CI: 50.9%-73.8%). The measured reduction in uterine and dominant fibroid volume were both significant at this final follow-up (P < .001 and P ¼ .001, respectively). Complete symptom resolution was achieved in the majority of cases (82.4%; n ¼ 14); mean clinic follow-up time was 11 months (range 3-24 months). The 3 cases who reported continuation of symptoms were those with
Vascular and Interventional Radiology / Radiologie vasculaire et radiologie d’intervention
Efficacy of Ovarian Artery Embolization for Uterine Fibroids: Clinical and Magnetic Resonance Imaging Evaluations Jennifer Campbell, MPH, Dheeraj K. Rajan, MD, John R. Kachura, MD, Jeffrey Jaskolka, MD, J. Robert Beecroft, MD, Kenneth W. Sniderman, MD, Martin E. Simons, MD, Kong T. Tan, MD* Division of Interventional Radiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Abstract Purpose: The objective of the study was to assess the efficacy of ovarian artery embolization (OAE) treatment for symptomatic uterine leiomyomas. Methods: A retrospective review of 17 patients who underwent OAE in conjunction with uterine artery embolization in a 6-year period (2006-2012) was performed. Ten patients had previous failed embolization, while 7 had not received any embolization therapy before. Percent uterine volume change, percent dominant fibroid volume change, and percent dominant fibroid infarction were assessed with magnetic resonance (MR) imaging. Resolution of menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency were evaluated clinically. Change in menopausal state was also an outcome of interest. Results: Mean MR imaging follow-up was performed 3 months post-OAE. MR images showed complete infarction in the majority of cases (64.7%; n ¼ 11), with infarction rates of 90%-100% in 3 cases, 1 case with 30%-50% infarction, and 2 cases with 0%-10% infarction. Average uterine size reduction on MR was 32.3% (95% confidence interval [CI]: 22.5%-42.2%; P < .001). The average size reduction for the dominant fibroid was 42.4% (95% CI: 27.7%-57.0%; P ¼ .01). The mean time to final follow-up visit was 11 months. At this point complete symptom resolution (menorrhagia, dysmenorrhea and bulk-related) was achieved in 82.4% (n ¼ 14) of cases. At the final follow-up 11.8% (n ¼ 2) of cases reported menopause. Conclusions: We observed OAE to be an effective and safe adjunct to uterine artery embolization when hypertrophic ovarian artery(ies) require intervention. However, incomplete fibroid infarction of 23% remains a concern with a potential for long-term treatment failure. In addition, long-term effect on ovarian function is uncertain. Resume Objet : L’etude avait pour objectif d’evaluer l’efficacite de l’embolisation des arteres ovariennes dans le traitement des leiomyomes uterins symptomatiques. Methodes : Un examen retrospectif portant sur 17 patientes ayant subi une embolisation des arteres ovariennes et une embolisation des arteres uterines sur une periode de 6 ans (2006-2012) a ete realise. Dix patientes avaient deja subi une embolisation sans succes, alors que 7 n’avaient jamais rec¸u de traitement par embolisation. Le changement de volume uterin (en pourcentage), le changement de volume du fibromyome dominant (en pourcentage) et l’infarcissement du fibromyome dominant (en pourcentage) ont ete determines au moyen de l’imagerie par resonance magnetique (IRM). La resolution de la menorragie, de la dysmenorrhee (et de la douleur) et des sympt^ omes de gonflement ou de pression, y compris la frequence de miction, a ete evaluee sur le plan clinique. Les changements au chapitre de l’etat menopausique ont aussi ete etudies. Resultats : En moyenne, l’examen d’IRM de suivi a ete realise trois mois apres l’embolisation des arteres ovariennes. Les images ont revele un infarcissement complet chez la plupart des patientes (64,7 %; n ¼ 11) ainsi qu’un taux d’infarcissement de 90 a 100 % chez trois patientes, de 30 a 50 % chez une patiente et de 0 a 10 % chez deux patientes. L’IRM a egalement permis d’observer une reduction moyenne de la taille de l’uterus de 32,3 % (intervalle de confiance de 95 % : 22,5 %-42,2 %; P < 0,001) et une reduction moyenne de la taille du fibromyome dominant de 42,4 % (intervalle de confiance de 95 % : 27,7 %-57,0 %; P ¼ 0,01). L’intervalle moyen avant la derniere visite de suivi etait de
* Address for correspondence: Kong T. Tan, MD, Division of Interventional Radiology, University Health Network, University of Toronto, 585 University Avenue, PMB 1-293, Toronto, Ontario M5G 2N2, Canada.
E-mail address: [email protected] (K. T. Tan).
0846-5371/$ - see front matter Ó 2015 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2014.08.005
Gonadal artery embolization for fibroids / Canadian Association of Radiologists Journal 66 (2015) 164e170
165
cette etape, les sympt^omes (menorragie, dysmenorrhee et gonflement) avaient ete entierement resolus chez 82,4 % (n ¼ 14) des 11 mois. A patientes. Lors du dernier examen de suivi, 11,8 % (n ¼ 2), des patientes ont par ailleurs signale un etat de menopause. Conclusions : Selon nos observations, l’embolisation des arteres ovariennes s’est averee un traitement d’appoint efficace et securitaire a l’embolisation des arteres uterines en presence d’une ou de plusieurs arteres ovariennes hypertrophiques exigeant une intervention. Toutefois, l’infarcissement incomplet du fibromyome chez 23 % des patientes demeure preoccupant en raison de l’eventuel echec du traitement a long terme. De plus, l’effet a long terme de l’embolisation sur la fonction ovarienne est incertain. Ó 2015 Canadian Association of Radiologists. All rights reserved. Key Words: Uterine fibroid; Embolization; Gonadal artery; Magnetic resonance imaging
Uterine artery embolization (UAE) is an acceptable alternative to surgery in the treatment of symptomatic uterine leiomyomata [1]. Current evidence indicates that patients are more satisfied post-UAE compared to postsurgery (hysterectomy or myomectomy). However, UAE has an increased likelihood of requiring a surgical intervention within 2-5 years of the initial procedure [1]. One of the well-documented reasons for UAE failure is collateral supply to perfused fibroids via hypertrophic ovarian arteries [2e4]. In cases where 1 ovarian artery or both ovarian arteries are contributing to the fibroid’s vascular supply, ovarian artery embolization (OAE) may be a minimally invasive alternative to surgical reintervention [3]. OAE is not formally accepted as a treatment option for symptomatic fibroids. The radiation exposure from additional imaging to identify hypertrophic arteries is a hypothesized risk of OAE [2,5]. It has also been postulated that OAE may lead to ovarian failure and premature menopause by impeding blood flow to the ovaries [5,6]. However, Hu et al. [7] have recently demonstrated that this may not necessarily occur. There are limited studies describing outcomes of OAE with corresponding magnetic resonance (MR) findings. The first 2 publications were case reports of selective ovarian artery catheterization and successful embolization [6,8], followed by a report of 6 patients from the United States [9], and then a European study evaluating safety and effectiveness in a sample of 13 patients [10]. Here, we report our clinical experience and corresponding MR findings of 17 patients who received OAE and UAE.
The average age of the patients presenting for treatment of symptomatic fibroids patients in this study group was 45.1 years old (range 29-52 years old). Presenting symptoms included menorrhagia in 94.1% (n ¼ 16), dysmenorrhea/pain in 58.8% (n ¼ 10), bulk and/or pressure symptoms including urinary frequency in 76.5% (n ¼ 13). 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]. All MR images were obtained with a 1.5-T system (Excite; GE Medical Systems, Milwaukee, WI). After an initial localization scan was obtained, the following sequences were performed: axial T1-weighted fast spoiled gradient-echo imaging; sagittal T2-weighted fast spin-echo imaging; sagittal dynamic contrast-enhanced T1-weighted fast spoiled gradient-echo imaging at 0, 30, 60, 90 seconds after the administration of a gadolinium chelate; and axial delayed T1-weighted fast spoiled gradient-echo imaging. In our institution, as part of our standard pretreatment clinical evaluation, all patients were asked if they would agree to ovarian artery embolization should an ovarian artery or arteries supplied the fibroids. They were each consulted about the risk of premature menopause from this procedure, in addition to infertility risk in the group of patients who wished to maintain fertility.
Methods Embolization Technique Patients and Baseline Data Collection Institutional review board approval was granted for this retrospective review of 17 patients who underwent OAE in a 6-year period (2006-2012). There were a total of 456 UAE cases in the same period. The clinical and imaging records of the women treated with OAE were reviewed. Outpatient consultation notes were used to assess presenting symptoms which were categorized as menorrhagia, dysmenorrhea/pain, and bulk and/or pressure symptoms including urinary frequency. In addition, patient age, previous history of uterine fibroid interventions, menopausal state, and desire to preserve fertility were recorded.
Informed consent was obtained from all patients. Sterile technique, local anaesthesia, and moderate intravenous sedation were used. Fellowship-trained interventional radiologists with 5-25 years’ experience performed embolization procedures. Urinary bladder Foley catheter was placed routinely. Right common femoral artery access was obtained under sterile technique followed by insertion of a 5-F vascular sheath. Individual uterine artery was selected with Robert’s uterine catheter (COOK Medical, Bloomington, IN). Polyvinyl alcohol (PVA) particles in 250-500 mm (COOK Medical) mixed with contrast was injected into the artery until flow stasis. Postembolization arteriogram was performed to
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J. Campbell et al. / Canadian Association of Radiologists Journal 66 (2015) 164e170
Postprocedure MR images from this visit were accessed to calculate percent dominant fibroid infarction in addition to uterine and dominant fibroid volume changes. Patients also attended additional follow-up visits at 6 months, 1 year, and 2 years postprocedure depending on physician recommendation. Final visit clinical notes describing patient symptom resolution and menopausal state (defined as absent of menstrual cycle) were recorded. Figure 1. Flow diagram summarizing procedure history of reviewed patients. OAE ¼ ovarian artery embolization; UAE ¼ uterine artery embolization.
visualize results. Further embolization was performed if there was rapid flow in the uterine artery. Hemostasis was achieved with manual compression. Patients were medicated for pain control and observed for a minimum of 4 hours postprocedure before discharged home with pain medications. For ovarian artery embolization, a suitable selective catheter was used to cannulate the origin of the ovarian artery. A microcatheter (Progreat, Terumo, Tokyo, Japan) was then advanced further into the ovarian artery. Often the artery was very tortuous and hence the microcatheter would only progress to mid or proximal segment. To minimize the risk of spasm and perforation, we did not attempt to pass the catheter beyond the tortuous segment of the artery. PVA particles were injected (250-500 mm) to complete flow stasis in the ovarian artery. Postprocedure Data Collection Patients were assessed clinically at approximately 3 months postprocedure and imaging with enhanced pelvic MR imaging (MRI) was obtained prior to the clinic visit.
Patient no.
Dominant fibroid characteristics on MR
Uterus (mL)
Dominant fibroid (mL)
1 2 3
Left fundus intramural fibroid Lower anterior intramural fibroid Right lower uterine body intramural fibroid Left abdomen pedunculated fibroid Anterior fundus, 30%. This likely accounted for the initial treatment failures. The remaining 7 patients never received previous embolization therapy. Table 2 summarizes the MR outcome measures. The average MR follow-up time was 3 months for this patient group (range 3-6 months). MRI showed complete infarction in 11 cases, 90%-100% infarction in 2 cases, 30%-50% in 1 case, and 0%-10% infarction in 2 cases. The average uterine volume at the MR follow-up time point was 512 mL, corresponding to a mean uterine volume reduction of 32.3% (95% CI: 22.5%-42.2%). The average dominant fibroid volume was 191 mL after 3 months,
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J. Campbell et al. / Canadian Association of Radiologists Journal 66 (2015) 164e170
Table 2 MR imaging outcome measures Patient
Post-MR infarction %
Uterus % reduction
Dominant fibroid % reduction
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
100 100 100 100 100 90e100 100 100 100 30e50 100 90e100 100 90e100 100 0e10 0e10
39.52 48.05 61.88 13.88 6.41 14.29 52.09 50.00 3.27 16.36 49.18 42.02 20.86 36.97 62.35 1.74 34.25
42.60 58.33 69.04 22.65 28.21 32.56 93.61 23.84 44.44 38.60 26.64 77.30 15.74 54.55 63.65 30.47 75.00
MR ¼ magnetic resonance.
corresponding to a mean dominant fibroid volume reduction of 42.4% (95% CI: 27.7%-57.0%). The measured reduction in uterine and dominant fibroid volume were significant (P < .001 and P ¼ .01, respectively). The average final follow-up time was 11 months (range 3-24 months) and patients had a clinical visit and an US at this time. The average uterine volume on US at the final time point was 357 mL, corresponding to a mean uterine volume reduction of 42.4% (95% CI: 30.0%-54.7%). The average dominant fibroid volume was 87 mL at the final time point, corresponding to a volume reduction of 62.4% (95% CI: 50.9%-73.8%). The measured reduction in uterine and dominant fibroid volume were both significant at this final follow-up (P < .001 and P ¼ .001, respectively). Complete symptom resolution was achieved in the majority of cases (82.4%; n ¼ 14); mean clinic follow-up time was 11 months (range 3-24 months). The 3 cases who reported continuation of symptoms were those with
