Imaging Fibroids Pre and Post Uterine Artery Embolisation
Fibroids are common in women of reproductive age and non-surgical management with uterine artery embolisation for symptomatic patients is increasingly performed. In this chapter, the role of diagnostic radiology, in particular MRI, in the diagnosis, mappi
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Contents
Abstract
1
Introduction..........................................................................
43
2 2.1 2.2 2.3
Pre-embolisation Imaging................................................... Fibroid Appearances.............................................................. Fibroid Mapping .................................................................... Making the Diagnosis............................................................
44 44 44 46
3 Post-embolisation Imaging.................................................. 3.1 Typical Post-embolisation Appearances ............................... 3.2 Imaging of Complications.....................................................
49 50 50
Conclusion ............................................................................
53
References......................................................................................
53
4
Fibroids are common in women of reproductive age and non-surgical management with uterine artery embolisation for symptomatic patients is increasingly performed. In this chapter, the role of diagnostic radiology, in particular MRI, in the diagnosis, mapping and assessment of fibroid disease prior to embolisation is discussed. While ultrasound is readily available, MRI has been shown to be more accurate at characterising fibroids and defining their number and location. In particular fibroid vascularity prior to embolisation is well demonstrated with Gadolinium-enhanced MRI. Contraindications to embolisation such as pedunculated fibroids on a narrow stalk or non-vascular, degenerated fibroids are also readily identified with MRI. Following embolisation, early change in fibroid vascularity can be demonstrated which has a prognostic implication to long-term response. Post-embolisation appearances such as intrafibroid gas, infection and fibroid passage are also discussed and demonstrated. Given that uterine artery embolisation is increasingly being performed, diagnostic radiologists therefore need to be familiar with pretreatment diagnosis and assessment and typical postembolisation appearances.
1
A. E. T. Jacques (&) Department of Radiology, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK e-mail: [email protected]
Introduction
Fibroids are common in women of reproductive age, increasing in prevalence up to the fifth and sixth decades. They may often be asymptomatic but for patients who suffer distressing or unmanageable symptoms of pain, menorrhagia, dysmenorrhoea or irregular menstrual bleeding, treatment options including uterine artery embolisation (UAE) may be considered. UAE is an accepted alternative to surgical or medical management and is routinely performed in many institutions. Diagnostic radiologists are therefore being increasingly involved in the pre- and post-treatment
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and Gynaecology, Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2012_752, Springer Berlin Heidelberg 2012 Published Online: 31 August 2012
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