Clinical Study
Three-Dimensional Quantitative Assessment of Uterine Fibroid Response after Uterine Artery Embolization Using Contrast-Enhanced MR Imaging

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Abstract

Purpose

To evaluate the clinical feasibility and diagnostic accuracy of three-dimensional (3D) quantitative magnetic resonance (MR) imaging for the assessment of total lesion volume (TLV) and enhancing lesion volume (ELV) before and after uterine artery embolization (UAE).

Materials and Methods

This retrospective study included 25 patients with uterine fibroids who underwent UAE and received contrast-enhanced MR imaging before and after the procedure. TLV was calculated using a semiautomated 3D segmentation of the dominant lesion on contrast-enhanced MR imaging, and ELV was defined as voxels within TLV where the enhancement exceeded the value of a region of interest placed in hypoenhancing soft tissue (left psoas muscle). ELV was expressed in relative (% of TLV) and absolute (in cm3) metrics. Results were compared with manual measurements and correlated with symptomatic outcome using a linear regression model.

Results

Although 3D quantitative measurements of TLV demonstrated a strong correlation with the manual technique (R2 = 0.93), measurements of ELV after UAE showed significant disagreement between techniques (R2 = 0.72; residual standard error, 15.8). Six patients (24%) remained symptomatic and were classified as nonresponders. When stratified according to response, no difference in % ELV between responders and nonresponders was observed. When assessed using cm3 ELV, responders showed a significantly lower mean ELV compared with nonresponders (4.1 cm3 [range, 0.3–19.8 cm3] vs 77 cm3 [range, 11.91–296 cm3]; P < .01).

Conclusions

The use of segmentation-based 3D quantification of lesion enhancement is feasible and diagnostically accurate and could be considered as an MR imaging response marker for clinical outcome after UAE.

Section snippets

Study Cohort and Clinical Evaluation

This retrospective single-institution study was conducted in compliance with the Health Insurance Portability and Accountability Act, approved by the institutional review board, and designed in agreement with the Standards for Reporting of Diagnostic Accuracy (16). A retrospective review was performed of 91 consecutive patients with symptomatic uterine fibroids who underwent their first UAE procedure between December 2010 and December 2012. Patients without follow-up MR imaging (n = 52),

Baseline Patient Characteristics

The Table summarizes baseline characteristics of the selected patients. All 25 patients underwent technically successful bilateral UAE. No complications during or after the procedure were recorded. No patient underwent reintervention, and none showed worsened clinical symptoms after the procedure. Analysis of clinical outcome revealed that menorrhagia and bulk-related symptoms improved in 15 patients (60%) at first follow-up compared with baseline assessment. Disease-related symptoms improved

Discussion

The main finding of this pilot study is that 3D quantitative evaluation of uterine fibroid response to embolization using contrast-enhanced MR imaging is clinically feasible and diagnostically accurate. Although demonstrating a good intermethod correlation for the quantification of the total lesion volumes, the enhancement-based component of the semiautomated 3D technique showed significant disagreement with the subjective assessment method and concurrently provided a better correlation with

Acknowledgment

This study was funded by National Institutes of Health Grant (NIH/NCI R01 CA160771, P30 CA0069730) as well as Philips Research North America, Briarcliff Manor, New York, French Society of Radiology, and Rolf W. Günther Foundation for Radiological Science. The authors acknowledge the contributions of Stacey A. Scheib, MD, and Mark Zakaria, MD.

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    • From the SIR 2014 Annual Meeting.

    The authors have been interviewed for the recently published online podcast for JVIR.

    M.L. is an employee of Philips Research North America. M.L.L. is a paid consultant for AprioMed and has received a research grant from Merit Medical. J.-F.G. is a paid consultant for BTG, Bazer, Guerbet, Nordion, Philips Research North America, and Jennerex and has received research grants from the National Institutes of Health, Department of Defense, Philips Research North America, Threshold, Bayer HealthCare, and BTG. None of the other authors have identified a conflict of interest.

    Appendix A and Figure E1 are available online at www.jvir.org.

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