Abstract No. 249 - Assessing the link between MRI imaging and short term outcome in uterine fibroid embolisation (UFE)

Abstract

Purpose A poor correlation between reduction in fibroid size and uterine volume following UFE, and patient symptoms has been previously described using US imaging. The information provided by MRI imaging is significantly greater than US. The aim of this study is to identify whether there are features identifiable on either pre or post UFE MRI that are associated with patient outcome. Materials and Methods All patients at our institution have MRI pre and post UFE. Patient are also asked to complete a Quality of Life questionnaire at their booking clinic appointment. Patients are also assessed six months following UFE with MRI and repeat clinic asessment. At the clinic they are again requested to complete a Quality of life questionnaire. All patients who underwent UFE and had both pre and post MRI and had completed pre and post embolisation Quality of life questionnaires were included in the study. Various factors including pre-embolisation fibroid size, presence of adenomyomatosis, ovarian artery parasitization, post embolisation necrosis and post-embolisation changes in fibroid and uterine size were correlated with outcome factors. Results 172 patients were included in the study. Increasing size of the dominant fibroid and presence of adenomyomatosis were not found to be associated with a poorer outcome. The uterine volume reduced by 23% overall (SD 52%) and the dominant fibroid reduced in volume by 42% overall. The degree of necrosis in the dominant fibroid also showed significant increase (2.9). The Symptom severity score showed a marked improvement of -28 as did HRQL (26). However, despite overall improvement in all, no significant correlation with any of the imaging variables was demonstrated with the symptomatic scores. Conclusion The identification of ovarian parasitisation and adenomyosis pre-intervention were not associated with a poorer short-term post-embolisation outcome. Degree of fibroid necrosis, reduction in fibroid volume, and reduction in overall uterine size do not correlate with patient's symptomatic improvement post UFE. MRI may be of more use in assessing long term prognosis, and further investigation is needed.