Ultrasound Findings After Uterine Artery Embolisation: Pictorial Essay and Clinical Validation

Uterine artery embolisation (UAE) is an evidence-based treatment for symptomatic fibroids and adenomyosis. Ultrasound is commonly utilised for assessment post UAE given its wide availability and low cost; however, contemporary studies describing the typical ultrasound findings post UAE are limited, with a preference for discussion of Magnetic Resonance Imaging (MRI) findings over recent years. However, MRI is not funded in many jurisdictions, leaving patients to bear the costs. As such, there remains an important role for ultrasound follow-up in this cohort. This article presents the common and expected ultrasound appearances after UAE. At 6 months post-treatment, fibroids are expected to have decreased in volume by 40%-70%, have no central vascularity, and appear heterogeneous but generally more hypoechoic than pre-treatment. Based on first principles, adenomyosis features, including myometrial-endometrial junctional thickening and myometrial thickening, may diminish after UAE, along with infarction of an adenomyoma if present. Retrospective review of 107 primary uterine artery embolisation cases in patients with symptomatic uterine fibroids (n = 95) and/or adenomyosis (n = 17) demonstrated a significant correlation between persistent vascularity in a fibroid or adenomyoma and seeking further treatment due to ongoing symptoms (p < 0.01). Significant correlation was also demonstrated with post-treatment volume change of a dominant fibroid or adenoma. There was no significant correlation with the hypoechoic appearance of the dominant fibroid. While the mainstay of follow-up evaluation after UAE for symptomatic fibroids and adenomyosis is clinical assessment of symptoms by the treating Interventional Radiologist, ultrasound imaging features provide an important adjunct in clinical decision-making.