Measurement of uterine leiomyomata volume pre and post uterine artery embolization aided by MRI

Abstract

Uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short- and mid-term outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay, and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures. It is of paramount importance to obtain thorough information of the presence and nature of uterine myomas to precisely counsel women as to the risks and benefits of UFE. Sonography as the first line of management is readily available, can accurately confirm the presence of uterine fibroids and concomitant uterine enlargement. However, the pre-procedural evaluation of the size, number, and location of uterine fibroids can be made with much greater accuracy using pelvic Magnetic resonance imaging (MRI) as compared with sonography. MRI is the best imaging modality to diagnose, map, and characterize fibroids. It can also diagnose benign and malignant concurrent pelvic pathology, which may also be responsible for the symptoms. Some of these pathologies may preclude UFE, or change the embolization protocol, such as the presence of adenomyosis.