MRI enhancement predicting fibroid volume reduction to uterine artery embolization

Objectives: Fibroid non-enhancement is considered a relative contraindication to uterine artery embolization (UAE) for symptomatic fibroids. The purpose was to assess the impact of UAE on non-enhancing fibroids and to determine imaging predictors of fibroid shrinkage. Materials and methods: Retrospective review of all women who underwent UAE for symptomatic fibroids (5/09-7/14) and had follow-up MRI 6 months after UAE were included. There were 59 fibroids (5, non-enhancing; 54, enhancing) among 18 women with a mean age of 46 (range 40-53) years. All fibroids were assessed for size, position, enhancement on subtraction images, and Apparent Diffusion Constant (ADC). Results: Enhancing fibroids had an average decrease in diameter by 19± 3%, not significantly different that non-enhancing fibroids which decreased by 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. Conclusion: Pre-UAE size and ADC, but not contrast enhancement, predicted fibroid diameter reduction. Enhancing and non-enhancing fibroids had similar size reduction after UAE. Non-enhancement should not be considered a contraindication to UAE. Correspondence to: Amy Deipolyi, MD, PhD, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA, E-mail: [email protected]