1.
Uterine fibroid embolization
Over the past decade UFE has been a popular and effective treatment for symptomatic fibroids,
alternative to hysterectomy and myomectomy.
Embolization is a minimally invasive means of blocking the arteries that supply blood to the fibroids.
UFE is an angiographic procedure that is usually performed by using a unilateral femoral artery approach.
The procedure is usually done in the hospital with an overnight stay post-procedure.
UFE is performed by interventional radiologist in local anesthesia.
The procedure involves inserting a catheter through the small incision in groin using x-ray guidance,
maneuvering it through the uterine artery,
and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids.
The procedure takes approximately 60 to 90 minutes.
Both uterine arteries are embolized to ensure the entire blood supply to the fibroids is blocked. Blockage of the blood supply causes shrinkage and necrosis of the fibroids.
Nearly 90 percent of women with fibroids experience relief of their symptoms after UFE.
The expected average reduction in the volume of the fibroids is 40-50% in three months,
which amounts to about a 20 percent reduction in their diameter.
Serious complications are rare after UAE,
occurring in less than 4% of patients.
These include arterial injury,
infection or injury to the uterus,
or ovary,
venous thromboembolism and allergic reaction to the x-ray contrast material.
Overall,
there are fewer serious complication after UFE then after surgical alternative.
2.
Fibroids
2.1.
Classification
Fibroids (leiomyomas) are the most common uterine neoplasms,
occurring in 20%-30% of women in their reproductive years.
They are composed of smooth muscle and fibrous connective tissue.
Fibroids are surrounded by a pseudocapsule and well circumscribed.
Fibroids may arise in different parts of the uterus.
Leiomyomas are usually classified according to their location as submucosal (Fig.
1,
2),
intramural (Fig.
3,
4) or subserosal (Fig.
5,
6).
Submucosal leiomyomas are located under the mucosal lining of uterus.
Intramural leiomyomas lie entirely within the muscular wall of the uterus.
Subserosal leiomyomas lie beneath the uterine serosa and can become very large,
and distort the contour of the outer surface of the uterus.
Some intramural or subserosal leiomyomas grow on a stalk attached to the uterus,
they are referred to as pedunculated.
Fibroids may be single or multiple.
2.2.
Symptoms
Classification of fibroids has clinical significance because the symptoms and treatment vary among subtypes of fibroids.
In general,
20-30% of patients with fibroids are symptomatic.
The clinical presentation depends on the location,
size and number of fibroids.
Most common type is intramural leiomyomas,
which are usually asymptomatic.
Occasionally they can cause menorrhagia and infertility.
Subserosal fibroids are usually asymptomatic,
pedunculated subserosal fibroids may undergo torsion,
leading to infarction and pain.
Submucosal leiomyomas are responsible for most symptoms,
although they are the least common,
representing only 5% of all uterine fibroids.
Even small submucosal fibroids may lead to abnormal uterine bleeding and infertility.
3.
Role of MRI
MRI is the most accurate diagnostic imaging modality allowing precise determination of the size,
location and number of leiomyomas.
MRI may help in deciding whether a myomectomy,
hysterectomy or UFE is the most appropriate form of treatment.
MRI can demonstrate the vascularity of fibroids and allow determination of whether UFE is a reasonable treatment option.
The success of UFE can be assessed on MRI by demonstrating the degree of shrinkage and loss of enhancement of the fibroids.