Baylor University Medical Center Proceedings July 2017 - 259

Ineffectiveness of magnetic resonance imaging
enhancement to predict fibroid volume reduction after
uterine artery embolization
Ginny Bao, BA, Lizbeth Hu, BA, Hearns W. Charles, MD, and Amy R. Deipolyi, MD, PhD

Fibroid nonenhancement is considered a relative contraindication to uterine artery embolization (UAE) for symptomatic fibroids. This retrospective
study assessed the impact of UAE on nonenhancing fibroids to determine
imaging predictors of fibroid shrinkage. All women who underwent UAE for
symptomatic fibroids between May 2009 and July 2014 and had followup magnetic resonance imaging 6 months after UAE were included. There
were 59 fibroids (5 nonenhancing, 54 enhancing) among 18 women aged
40 to 53 (mean 46) years. All fibroids were assessed for size, position,
and enhancement on subtraction and apparent diffusion constant (ADC)
images. Enhancing fibroids had an average decrease in diameter of
19% ± 3%, not significantly different than nonenhancing fibroids, which
decreased 23% ± 6% (P = 0.49). Multiple linear regression with percent
change in fibroid diameter as the dependent variable and patient age,
fibroid position, and pre-UAE fibroid diameter, enhancement, and ADC as
independent variables showed that ADC (P = 0.04) and pre-UAE diameter
(P = 0.03) were the only significant independent variables. In conclusion,
pre-UAE size and ADC, but not contrast enhancement, predicted fibroid
diameter reduction. Enhancing and nonenhancing fibroids had a similar
size reduction after UAE. Nonenhancement should not be considered a
contraindication to UAE.

terine artery embolization (UAE) is a minimally invasive
treatment with the potential to decrease ﬁbroid size
and reduce symptoms (1-3). Volume reduction after
embolization is associated with decreased ﬁbroid-related
symptoms, such as pain and dysmenorrhea (4, 5). Complete necrosis after UAE also predicts better long-term outcomes, with
less pain and ﬁbroid recurrence (4). Through the use of magnetic
resonance imaging (MRI), ﬁbroids are readily identiﬁed and
monitored after UAE. Fibroids are typically hypointense on
T2 and enhance following the intravenous administration of
gadolinium due to ample blood supply (6). Multiple papers have
recommended that women with nonenhancing ﬁbroids should
be excluded from UAE due to anticipated minimal response in
terms of size reduction (6-10), though there is a lack of studies
directly comparing outcomes of enhancing vs nonenhancing
ﬁbroids. One retrospective study with 94 patients described the
incidence of nonenhancing ﬁbroids and recommended against
their embolization, but did not report if the nonenhancing
ﬁbroids actually had poorer response (7). For patients with un-

Proc (Bayl Univ Med Cent) 2017;30(3):259-261

resectable hepatocellular carcinoma, chemoembolization is still
performed for hypovascular tumors, as there is evidence that
a portion of these tumors do respond to embolization (11). It
is possible that nonenhancing ﬁbroids respond similarly. The
purpose of this study was to determine the response of necrotic
ﬁbroids to UAE and to identify whether pre-UAE enhancement
or other factors are predictors of ﬁbroid shrinkage.
METHODS
This retrospective study involved all women who underwent
UAE for symptomatic ﬁbroids between May 2009 and July
2014 with follow-up MRI 6 months after the procedure, identiﬁed through a search of the departmental picture archiving and
communication system. The mean follow-up period was 7.4
months. A total of 59 ﬁbroids (5 nonenhancing, 54 enhancing)
were analyzed in 18 patients ranging from 40 to 53 years of age
with a mean age of 46 years. Fibroids analyzed ranged in size
from 1.6 to 18.2 cm, with a mean diameter of 5.4 cm. Eightyﬁve other patients underwent UAE during this period, but did
not have follow-up imaging and were therefore excluded.
UAE was performed as previously described (12). Brieﬂy,
procedures were performed with monitored anesthesia care. Access was obtained via the right common femoral artery, using a
5Fr introducer sheath (Cordis, Miami Lakes, FL); the anterior
division of the internal iliac artery on each side was selected with
a 5Fr guiding Cobra catheter (AngioDynamics, Latham, NY). A
2.8Fr ProGreat microcatheter (Terumo Interventional Systems,
Somerset, NJ) was then directed into each uterine artery. Embolization was performed with 500 to 700 micron Embospheres
(BioSphere Medical, Rockland, MA) until antegrade ﬂow stasis.
A completion perirenal aortogram was performed to exclude
ovarian artery supply to the uterus. Patients were admitted for
at least one night of observation.
From New York University School of Medicine, New York, New York (Bao, Hu);
South Florida Vascular Associates, Coconut Creek, Florida (Charles); and
Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New
York, New York (Deipolyi).
Ginny Bao and Lizbeth Hu contributed equally to this work.
Corresponding author: Amy R. Deipolyi, MD, PhD, Interventional Radiology
Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York,
NY 10065 (e-mail: deipolya@mskcc.org).
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