03:36 PM Abstract No. 135 Utility of routine pelvic MRI in the clinical management of patients following uterine fibroid embolization

Abstract

To assess the utility of routine pelvic MRI in the clinical management of patients following uterine fibroid embolization (UFE). Using PACS and electronic medical records, consecutive patients undergoing UFE for symptomatic fibroids from 2015 to 2017 and followed in interventional radiology (IR) clinic at 3 months post-UFE were identified. Routine 3-month post-UFE MRI was obtained in a subset of the cohort based on individual IR preference. MRI findings, clinical course, and clinical management changes (defined as gynecology referral for further intervention) were compiled. The proportion of patients with clinical management change in the MRI and non-MRI groups and compliance for follow-up in the two groups were compared using chi-square test. Of 175 patients undergoing UFE, 14 were lost to follow-up and excluded. Of 161 included patients, 60 underwent routine MRI, and 101 did not. In the MRI group, 7 patients had new or persistent symptoms. Follow-up MRI findings resulted in gynecological referral in 4 patients, of whom 3 (5%) required intervention. In the non-MRI group, 16 patients with new or persistent symptoms prompted 14 gynecology referrals and 3 (2.9%) further interventions. No difference existed in the proportion of patients in the two groups requiring further intervention (5% vs. 2.9% (p=0.528)). However, of the symptomatic patients referred, a significantly smaller proportion actually required intervention in the non-MRI group (n=3, 21.4%) vs. the MRI group (n=3, 75%; p=0.045). Routine MRI in asymptomatic patients never prompted management change (n=0). However, loss to follow-up was significantly reduced in patients scheduled for routine post-UFE MRI on the same day as their follow-up visit (n=1, 1.6%) vs. those scheduled for routine follow-up alone (n=13, 11.3%) (p=0.024). In patients with persistent or new symptoms following UFE, post-procedural MRI reduces unnecessary gynecological referrals by identifying patients who do not require further intervention. Although the routine use of post-UFE MRI in asymptomatic patients does not significantly change management, it is associated with significantly increased patient compliance with clinical follow-up.