Asunto(s)
Leiomiomatosis/terapia , Embolización de la Arteria Uterina/efectos adversos , Neoplasias Uterinas/terapia , Vasoconstricción , Vasoespasmo Intracraneal/etiología , Angiografía Cerebral/métodos , Femenino , Humanos , Leiomiomatosis/irrigación sanguínea , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Síndrome , Neoplasias Uterinas/irrigación sanguínea , Vasoespasmo Intracraneal/diagnóstico , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
PURPOSE: To compare the status of uterine and ovarian arteries after uterine artery embolization (UAE) in patients with incomplete and complete fibroid infarction via unenhanced 3D time-of-flight magnetic resonance (MR) angiography. MATERIALS AND METHODS: Thirty-five consecutive women (mean age 43 years; range 26-52 years) with symptomatic uterine fibroids underwent UAE and MR imaging before and within 2 months after UAE. The patients were divided into incomplete and complete fibroid infarction groups on the basis of the postprocedural gadolinium-enhanced MR imaging findings. Two independent observers reviewed unenhanced MR angiography before and after UAE to determine bilateral uterine and ovarian arterial flow scores. The total arterial flow scores were calculated by summing the scores of the 4 arteries. All scores were compared with the Mann-Whitney test. RESULTS: Fourteen and 21 patients were assigned to the incomplete and complete fibroid infarction groups, respectively. The total arterial flow score in the incomplete fibroid infarction group was significantly greater than that in the complete fibroid infarction group (P=0.019 and P=0.038 for observers 1 and 2, respectively). In 3 patients, additional therapy was recommended for insufficient fibroid infarction. In 1 of the 3 patients, bilateral ovarian arteries were invisible before UAE but seemed enlarged after UAE. CONCLUSION: The total arterial flow from bilateral uterine and ovarian arteries in patients with incomplete fibroid infarction is less well reduced than in those with complete fibroid infarction. Postprocedural MR angiography provides useful information to estimate the cause of insufficient fibroid infarction in individual cases.
Asunto(s)
Leiomioma/terapia , Angiografía por Resonancia Magnética/métodos , Ovario/irrigación sanguínea , Embolización de la Arteria Uterina , Neoplasias Uterinas/terapia , Útero/irrigación sanguínea , Adulto , Velocidad del Flujo Sanguíneo , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Leiomioma/patología , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , Neoplasias Uterinas/patologíaRESUMEN
PURPOSE: To clarify the benefits of unenhanced magnetic resonance (MR) angiography in planning uterine artery embolization (UAE). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. Fifty-five consecutive women (mean age, 42 years; age range, 26-52 years) who underwent UAE for symptomatic uterine fibroids were placed chronologically into groups 1, 2, or 3, which were composed of 20, 22, and 13 patients, respectively. Digital subtraction angiography was performed in groups 1 and 2 but not in group 3. In the 35 patients in groups 2 and 3, unenhanced MR angiography was performed before UAE, and two independent radiologists assessed the results. The parameters indicating performance of UAE were compared among the three groups with the Tukey test. RESULTS: Forty-five patients underwent routine UAE (19, 16, and 10 patients in groups 1, 2, and 3, respectively). Sixty-eight (97%) of 70 uterine artery origins were demonstrated clearly at MR angiography. Among five ovarian arteries detected at MR angiography, collateral supply was confirmed in four (80%). The assessment of MR angiographic results and discontinuation of digital subtraction angiography led to a reduction in the mean performance time (from 96.2 minutes to 51.9 minutes [P = .004]), fluoroscopy time (from 28.5 minutes to 17.8 minutes [P = .036]), dose-area product (from 109.8 Gy.cm(2) to 25.4 Gy.cm(2) [P < .001]), and contrast medium volume (from 103.8 mL to 40.8 mL [P < .001]). CONCLUSION: Unenhanced MR angiography provides useful information regarding uterine and ovarian arteries before UAE.