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Monday, July 6, 2015

MRI May Predict Midterm Symptom Recurrence after Uterine Artery Embolization for Adenomyosis

Uterine artery embolization (UAE) for adenomyosis has been shown to result in short term symptom relief but may recur after longer follow-up periods. The purpose of this study was to evaluate the relationship between the post-UAE percentage of necrosis and symptom recurrence at midterm follow-up.

This retrospective study analyzed the percentage of necrosis of uterine adenomyosis on contrast-enhanced MR imaging in 50 women who underwent the procedure for symptomatic adenomyosis. Three dimensional reconstruction software was used to measure the volumes of adenomyosis on the baseline scan and the necrotic volume at the 3 month follow up scan, as defined by non-enhancement on T1-weighted post contrast images. Adenomyosis-related symptoms were assessed using an oral questionnaire at baseline and up to 48 months post-procedure.

During the follow up period, symptom recurrence occurred in 24% (12 of 50) of women. Women with < 34.3% necrosis after UAE had a sevenfold higher risk of symptom recurrence compared with patients with > 34.3% necrosis. Initial uterine volume and the type of adenomyosis (focal or diffuse) did not show significant relationships with recurrence. The study was limited by a small number of patients at a single institution. The distribution of the percentage of necrosis found in the patients was heavily skewed in that 38 out of 50 women had > 34% necrosis.

Comment:
The findings suggest that midterm symptom prognosis after UAE for adenomyosis can be predicted by MR imaging at 3 months post-procedure based on percentage of necrosis. This may have implications for early patient management, aggressive imaging, and appropriate counseling. However, the number of limitations in the study warrant further investigation with larger patient populations and additional MRI analysis of necrotic volumes at later intermediate follow up periods.


Click here to see the full abstract


A 40-year-old woman who underwent UAE for symptomatic adenomyosis. (a) Sagittal T2-weighted MR image obtained before UAE shows focal junctional zone thickening of the uterus. (b) Sagittal T2-weighted MR image obtained 3 months after UAE shows decreased size of adenomyosis and the uterus. The volume of adenomyosis was calculated semiautomatically to be 142.580 cm3. (c) Sagittal contrast-enhanced T1-weighted MR image obtained 3 months after UAE shows partial necrotic area without enhancement. The volume of necrosis was calculated semiautomatically to be 65.477 cm3. The percentage of necrosis was 45.9%


Citation: Bae, S. H. et al. Uterine Artery Embolization for Adenomyosis: Percentage of Necrosis Predicts Midterm Clinical Recurrence. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2015.04.026


Author: Laura Traube, MD, MPH, Fellow in Interventional Radiology, UCLA Medical Center

1 comment:

  1. I have suffered from adenomyosis with severe cramps during and after my period. It was very painful and heavy bleeding and severe lower back pain my pain was unbearable to a point of being not able to move and a stabbing like pain on the left of my ovaries. Pain goes away when a clot comes out. But it took a while for the clot to come out. After several meetings with my gynaecologist which she suggested "Hysterectomy" but I refused I know what Hysterectomy is and how heart aching it can be then she stated that Allopathic treatment will help in pain management but it will not cure the disease. I started treatment with a drug named "endoheal 2 mg". This gave me pain relief but reduced my periods almost to no periods with numerous side effects - spotting and fluctuation in my dates. I was not mentally satisfied to bear the side effects so I came across ''Ayurvedic doctor" who started my treatment with herbs. Though I continued above drug 'endoheal 2 mg'" parallel for nine months for easy pain management. From then I continued taking the treatment. It reduced the size of my lesion but did not reduce it further after few months. And there was no relief in pain during menstruation but my Dr. Advised me to continue it during 3 months without any gap. I had noticed a quick ageing of my skin in the last 2 years. I am a smoker but for some reason I feel my quick ageing has to do with something else because I have been smoking for a long time and it's only recently that I noticed a fast decline of my skin elasticity. After then pain radiates very badly in my left leg, lower left back and left side of my vagina. The pain normally start anytime during 3, 5,6 days, but at time I had to take a painkiller for this also as it irritates whole day. Then pain disappears after fews day. My digestion was slow but Dr. Ronnie's supplements has improved it impossible situations is becoming possible miracles gradually.

    I was lucky to read in the internet about a lady who was cured from Adenomyosis through Herbal Medication. I contacted Ronnie through an email address I got from a testimony shared on the internet. Without further delay I made an order, I switched over to it. I had great breakthrough, that in the first month, I was already testifying of the effective of the Herbal medication. After 3months course of taken the medicine, all symptoms were gone. It has been 1 year and four months since I became free from adenomyosis. Anyone who is not in my position would not understand what I went through, the heart break, the pain and how frustrated I was for 6 odd years. Believe me, it was hell. I am so happy; I never believed I will be this happy again in life. My story is quite lengthy, it might help you too. You may contact Dr. Ronnie to know more via his email on. ronniemd70@gmail.com

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