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27.08.2018 | Clinical Investigation | Ausgabe 2/2019

CardioVascular and Interventional Radiology 2/2019

Evaluation of Uterine Contractility by Magnetic Resonance Imaging in Women Undergoing Embolization of Uterine Fibroids

Zeitschrift:
CardioVascular and Interventional Radiology > Ausgabe 2/2019
Autoren:
Vinicius Adami Vayego Fornazari, Denis Szejnfeld, Jacob Szejnfeld, Claúdio Emilio Bonduki, Stela Adami Vayego, Suzan Menasce Goldman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00270-018-2053-6) contains supplementary material, which is available to authorized users.

Abstract

Purpose

To assess uterine contractility using ultrafast magnetic resonance imaging (cine MRI) before and after uterine fibroid embolization (UFE).

Materials and Methods

This is a prospective study of uterine contractility in 26 patients (age 30–41 years) undergoing UFE for symptomatic uterine fibroids. Cine MRI was performed before and 6 months after UFE. Two radiologists evaluated uterine contractility and classified it as absent, ordered, or disordered. Patients were then grouped into three distinct patterns of progression: unchanged contractility (group A), modified contractility (B), and loss of contractility (C). These findings were then confronted with factors that might have interfered with uterine contractility pattern (uterine volume, location of dominant fibroid, fibroid/myometrium index, and fibroid necrosis pattern).

Results

Of the 26 patients, 8 (30.7%) had no contractility before the procedure, while 18 (69.2%) exhibited some form of contractility (11 [61%] ordered, 7 [39%] disordered). All 8 patients who had no contractility at baseline exhibited contractility after UFE (5 ordered, 3 disordered). Of the 11 who had ordered contractility at baseline, 9 remained ordered and 2 lost contractility after UFE. Of the 7 with disordered contractility at baseline, 1 remained disordered, 5 progressed to ordered contractility, and 1 lost contractility. Overall, 10 patients (38%) had no change in contractility after UFE (group A), 13 (50%) had a positive change (group B), and 3 (11%) lost contractility (group C). The potential interference factors assessed had no statistically significant effect in any group.

Conclusion

In women of reproductive age with symptomatic fibroids, uterine contractility improved significantly after UFE.

Level of Evidence

Level 3—non-randomized controlled cohort/follow-up study.

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Zusatzmaterial
Supplementary material—Video 1. Sagittal cine magnetic resonance (MR) images (ultrafast sequence), absence of uterine pathology showing ordered uterine peristalsis with cervico-fundal direction. (MOV 2501 kb)
270_2018_2053_MOESM1_ESM.mov
Supplementary material—Video 2. Sagittal cine magnetic resonance (MR) images (ultrafast sequence), presence diffuse submucosal myoma, of before uterine fibroid embolization (UFE) showing ordered uterine peristalsis. (MOV 1094 kb)
270_2018_2053_MOESM2_ESM.mov
Supplementary material—Video 3. Sagittal cine magnetic resonance (MR) (ultrafast sequence) images, obtained 6 months after uterine fibroid embolization (UFE), showing maintained ordered uterine peristalsis (group A—unchanged contractility pattern). (MOV 1481 kb)
270_2018_2053_MOESM3_ESM.mov
Supplementary material—Video 4. Before uterine fibroid embolization (UFE). Sagittal magnetic resonance imaging (MRI) (ultrafast sequence) showing a submucosal fibroid and absence of uterine contractility. (MOV 1941 kb)
270_2018_2053_MOESM4_ESM.mov
Supplementary material—Video 5. Sagittal cine MR images (ultrafast sequence), obtained 6 months after uterine fibroid embolization (UFE), showing new-onset ordered uterine peristalsis (group B—positive change in contractility). (MOV 1208 kb)
270_2018_2053_MOESM5_ESM.mov
Supplementary material—Video 6. Sagittal cine MR images (ultrafast sequence), obtained before uterine fibroid embolization (UFE), showing ordered uterine peristalsis. (MOV 2116 kb)
270_2018_2053_MOESM6_ESM.mov
Supplementary material—Video 7. Sagittal cine MR images (ultrafast sequence), obtained 6 months after uterine fibroid embolization (UFE), showing absence of uterine contractility (group C—loss of contractility). (MOV 1669 kb)
270_2018_2053_MOESM7_ESM.mov
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