Uterine Artery Embolization for Pure Adenomyosis: Predictive Factors Affecting Outcomes

Area of Science:

• Interventional Radiology
• Gynecologic Imaging
• Women's Health

Background:

• Uterine artery embolization (UAE) is a common treatment for symptomatic adenomyosis.
• Predicting treatment response, specifically necrosis of adenomyotic tissue, is crucial for optimizing patient outcomes.
• Understanding factors influencing necrosis can refine patient selection and pre-procedural counseling.

Purpose of the Study:

• To identify pre-procedural imaging characteristics associated with incomplete post-UAE necrosis in patients with pure adenomyosis.
• To evaluate the impact of necrosis on symptom severity and quality of life.

Main Methods:

• Retrospective analysis of 147 patients undergoing UAE for adenomyosis (Jan 2011-May 2025).
• Pre-procedural MRI assessed T2 signal intensity, morphology (Type I/II), and location (focal/diffuse).
• Post-procedure MRI (3 months) evaluated necrosis; Symptom Severity Scores (SSS) and HRQOL were assessed pre- and post-procedure.

Main Results:

• Complete necrosis occurred in 78.9% (116/147) of patients.
• Multivariate analysis identified Type II adenomyosis (OR 10.492) and heterogeneous T2 signal (OR 4.003) as predictors of incomplete necrosis.
• Incomplete necrosis rates were 13.6% for Type I and 63.6% for Type II adenomyosis.
• Patients with complete necrosis showed significantly greater improvements in SSS and HRQOL.

Conclusions:

• Type II adenomyosis morphology and heterogeneous T2 signal intensity are significantly associated with increased risk of incomplete necrosis post-UAE.
• These imaging findings can aid in pre-procedural counseling and patient management for adenomyosis.
• Optimizing necrosis prediction may enhance the effectiveness of UAE for adenomyosis.