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Susceptibility weighted MRI after uterine artery embolization for leiomyoma

Yasuyuki Yamahana1, Tetsuya Katsumori2, Hiroshi Miura1

  • 1Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.

Magnetic Resonance Imaging
|January 18, 2019
PubMed
Abstract

Insights

Susceptibility-weighted imaging (SWI) shows a hypointense rim on uterine leiomyomas after uterine artery embolization (UAE). This SWI finding correlates with tumor infarction, aiding in evaluating embolic effects post-procedure.

Area of Science:

  • Radiology
  • Medical Imaging
  • Gynecologic Oncology

Background:

  • Uterine artery embolization (UAE) is a common treatment for symptomatic leiomyomas.
  • Assessing treatment effectiveness, particularly tumor infarction, is crucial for patient outcomes.
  • Susceptibility-weighted imaging (SWI) offers unique contrast properties for visualizing hemorrhage and iron deposition.

Purpose of the Study:

  • To determine if SWI findings correlate with tumor infarction after UAE for leiomyoma.
  • To evaluate the diagnostic performance of a specific SWI finding (hypointense peripheral rim) in predicting infarction.

Main Methods:

  • Retrospective analysis of 27 patients undergoing UAE with pre- and post-procedural SWI and contrast-enhanced MRI (CE-MRI).
  • Independent review of 261 leiomyomas (≥1 cm) by two blinded readers.
  • Correlation analysis between the presence of a hypointense peripheral rim on SWI and infarction rates (≥90% vs. <90%) on CE-MRI.

Main Results:

  • A hypointense peripheral rim was observed on post-procedural SWI in a significant proportion of leiomyomas.
  • The presence of this rim showed a correlation with ≥90% tumor infarction (Spearman's coefficient = 0.474 and 0.438, p<0.001).
  • Sensitivity and specificity for detecting infarction ranged from 65.8% to 77.2% and 82.6% to 100%, respectively, depending on the reader.

Conclusions:

  • A hypointense peripheral rim on SWI is a detectable finding in leiomyomas shortly after UAE.
  • This SWI finding is associated with significant tumor infarction, as confirmed by CE-MRI.
  • SWI can be a valuable tool for assessing the acute embolic effects of UAE on leiomyomas.
Keywords:
FibroidLeiomyomaMagnetic resonance imagingSuceptibility weighted imagingUterine artery embolizationUterus

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