Can an apparent diffusion coefficient of uterine fibroid before uterine artery embolization predict potential fibroid response?
, 2, 2, 2
Abstract
Objectives: ACOG guidance confirms the use of uterine artery embolisation (UAE) as an alternative to hysterectomy or myomectomy. The main objective of this article is to evaluate the ability of preoperative magnetic resonance ımaging (MRI) to study the relationship between uterine fibroid reduction and diffusion coefficient (ADC) value after UAE. This is a relevant topic with the growing interest in using ADC as a noninvasive imaging biomarker for monitoring tissue changes and predicting uterine fibroid response to UAE over the past years. Material and methods: In this prospective controlled non-randomized trial; uterine fibroid volume, fibroid diameter, uterine volume, fibroid ADC and normal myometrium ADC were recorded before and after UAE. Wilcoxon test was used in the analysis of the dependent quantitative data. Pearson correlation coefficients were calculated between post-UAE uterine volume, fibroid volume, and average fibroid diameter reduction and the patient’s age, parity, gravidity, fibroid ADC and myometrial ADC before UAE. Results: The mean fibroid volume reduction was 36.0% (range between 17.3–77.7%). Mean fibroid diameter, fibroid volume, uterine volume, and myometrium ADC values after UAE were significantly lower than before the procedure (p = 0.002, < 0.001, 0.001, 0.006 respectively), but the decrease in fibroid ADC is not significant. As a result decrease in fibroid volume was greater as pre-UAE fibroid ADC values increased, and that finding may contribute to the selection of the patients for the procedure. Conclusions: The ADC value before UAE was positively correlated with fibroid volume reduction.
Keywords: embolizationgynecologymyomauterine artery
References
- Bulman JC, Ascher SM, Spies JB. Current concepts in uterine fibroid embolization. Radiographics. 2012; 32(6): 1735–1750.
- American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008; 112(2 Pt 1): 387–400.
- Tomislav S, Josip M, Liana CS, et al. Uterine artery embolization as nonsurgical treatment of uterine myomas. ISRN Obstet Gynecol. 2011; 2011: 489281.
- Deshmukh SP, Gonsalves CF, Guglielmo FF, et al. Role of MR imaging of uterine leiomyomas before and after embolization. Radiographics. 2012; 32(6): E251–E281.
- Jha RC, Ascher SM, Imaoka I, et al. Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arterial embolization. Radiology. 2000; 217(1): 228–235.
- de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016; 215(6): 745.e1–745.e12.
- Spies JB. Current evidence on uterine embolization for fibroids. Semin Intervent Radiol. 2013; 30(4): 340–346.
- Volkers NA, Hehenkamp WJK, Birnie E, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007; 196(6): 519.e1–519.11.
- van der Kooij SM, Hehenkamp WJK, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2010; 203(2): 105.e1–105.13.
- Pron G, Bennett J, Common A, et al. Ontario Uterine Fibroid Embolization Collaboration Group. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril. 2003; 79(1): 120–127.
- Spies JB, Bruno J, Czeyda-Pommersheim F, et al. Uterine artery embolization for leiomyomata. Obstet Gynecol. 2001; 98(1): 29–34.
- Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG. 2002; 109(11): 1262–1272.
- Gupta JK, Sinha A, Lumsden MA, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014.
- Fonseca MCM, Castro R, Machado M, et al. Uterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison. Clin Ther. 2017; 39(7): 1438–1455.e2.
- Liapi E, Kamel IR, Bluemke DA, et al. Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging. J Comput Assist Tomogr. 2005; 29(1): 83–86.
- Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007; 188(6): 1622–1635.
- Meyer HJ, Garnov N, Surov A. Comparison of Two Mathematical Models of Cellularity Calculation. Transl Oncol. 2018; 11(2): 307–310.
- Williams PL, Coote JM, Watkinson AF. Pre-uterine artery embolization MRI: beyond fibroids. Cardiovasc Intervent Radiol. 2011; 34(6): 1143–1150.
- Silberzweig JE, Powell DK, Matsumoto AH, et al. Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques. Radiology. 2016; 280(3): 675–692.
- Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995; 346(8976): 671–672.
- Spies JB, Myers ER, Worthington-Kirsch R, et al. FIBROID Registry Investigators. The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol. 2005; 106(6): 1309–1318.
- Marret H, Cottier JP, Alonso AM, et al. Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG. 2005; 112(4): 461–465.
- Isonishi S, Coleman RL, Hirama M, et al. Analysis of prognostic factors for patients with leiomyoma treated with uterine arterial embolization. Am J Obstet Gynecol. 2008; 198(3): 270.e1–270.e6.
- Lee MS, Kim MD, Jung DC, et al. Apparent Diffusion Coefficient of Uterine Leiomyoma as a Predictor of the Potential Response to Uterine Artery Embolization. J Vasc Interv Radiol. 2013; 24(9): 1361–1365.
- Hecht EM, Do RKG, Kang SK, et al. Diffusion-weighted imaging for prediction of volumetric response of leiomyomas following uterine artery embolization: a preliminary study. J Magn Reson Imaging. 2011; 33(3): 641–646.
- Sutter O, Soyer P, Shotar E, et al. Diffusion-weighted MR imaging of uterine leiomyomas following uterine artery embolization. Eur Radiol. 2016; 26(10): 3558–3570.
- Cao MQ, Suo ST, Zhang XB, et al. Entropy of T2-weighted imaging combined with apparent diffusion coefficient in prediction of uterine leiomyoma volume response after uterine artery embolization. Acad Radiol. 2014; 21(4): 437–444.
- Smeets AJ, Nijenhuis RJ, van Rooij WJ, et al. Uterine artery embolization in patients with a large fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol. 2010; 33(5): 943–948.
- Dutton S, Hirst A, McPherson K, et al. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG. 2007; 114(11): 1340–1351.
- Dao D, Kang SJ, Midia M. The utility of apparent diffusion coefficients for predicting treatment response to uterine arterial embolization for uterine leiomyomas: a systematic review and meta-analysis. Diagn Interv Radiol. 2019; 25(2): 157–165.
