Prognostic value of pre-embolisation MRI features of uterine fibroids in uterine artery embolisation.

AIM: To evaluate the prognostic value of pretreatment pelvic magnetic resonance imaging (MRI) features in uterine artery embolisation (UAE) for symptomatic fibroids.

MATERIALS AND METHODS: MRI characteristics of 109 fibroids (≥3 cm) in 70 patients were analysed retrospectively. Imaging was performed 1.8±1.3 (SD) months before and 6.6±1.8 months after UAE. On pretreatment images, signal intensity (SI) of fibroids was compared with that of the myometrium and skeletal muscle on T1- and T2-weighted sequences; the contrast enhancement pattern and localisation of fibroids were also analysed. Fibroid volume reduction (VR) was assessed by control imaging. The numerical analogue quality-of-life score was obtained before and after UAE. Statistical analysis was performed using the Mann-Whitney U-test, Kruskal-Wallis test, and Wilcoxon signed-rank test.

RESULTS: The mean fibroid volume decreased by 51.1±30.8% during the 6.6±1.8 months (p<0.001). Mean quality-of-life score improved by 48.2±27.6 points (p<0.001). The mean VR of submucosal fibroids (82.1±18.5%) was greater than that of intramural (49.4±30.7%) and subserosal (43±28.3%) fibroids (p<0.001 for both). Fibroids that were isointense/hyperintense to myometrium on T2-weighted images showed a better response than hypointense fibroids (63.7±25.8% versus 48.6±31.3%, respectively; p=0.041). On contrast-enhanced images, isointense/hyperintense fibroids showed a better VR than hypointense fibroids (61.3±27.4% versus 47.6±31.6%, respectively; p=0.035). Baseline fibroid volume of <50 cm3 was also associated with favourable imaging outcome (p=0.021). T2 SI compared to skeletal muscle and T1 SI compared to myometrium or skeletal muscle did not show association with VR.

CONCLUSIONS: Localisation, T2 SI, contrast enhancement, and <50 cm3 fibroid volume were associated with better VR; these may help with treatment decisions.