Abstract
ObjectiveTo evaluate uterine arteries (UA) of potential living donors for uterus transplantation (UTx) by comparison of CT angiography (CTA), digital subtraction angiography (DSA), and MR angiography (MRA) with care taken to minimize radiation doses.MethodsProspective donors for a clinical UTx trial were included. CTA, DSA, and MRA measurements in three predefined segments of the UAs were evaluated. Radiation doses were estimated and 1-year graft survival was recorded.ResultsTwelve potential donors (age 37–62 years) were investigated. There was no difference in visualized average UA lumen diameter when comparing CTA (mean 2.0 mm, SD 0.4), DSA (mean 2.1 mm, SD 0.6), and MRA (mean 2.0 mm, SD 0.3). MRA was not able to fully evaluate 10 (43%) out of 23 UA that proved to be patent on DSA. One UA was not identified by any of the modalities, and three MRA-absent UAs were identified by both CTA and DSA. The estimated mean effective dose was lower for DSA (5.1 mSv, SD 2.8) than CTA (7.1 mSv, SD 2.0), but not significantly (p value = 0.06). Three potential donors were excluded due to UA pathology and one due to adenomyosis. Eight donors underwent hysterectomy, with 1-year graft survival in six women.ConclusionMRI including MRA should be the initial modality to examine potential UTx donors to acquire valuable details of uterine anatomy, and if UAs are fully visualized, there is no need for further angiographic methods with radiation. If UAs are not visualized by MRA, CTA may be performed and in selective cases with addition of the invasive modality DSA.Key Points• For uterine transplantation, pelvic MRI with MRA provides information of the uterine structure and of the diameters of uterine arteries in living donors.• Failure of MRA to demonstrate uterine arteries could be followed by CTA which will visualize the uterine arteries in a majority of cases. If MRA and additional CTA provide inconclusive results, the uterine arteries should be further evaluated by DSA.• Information of CTA can be used in the angio-system for DSA settings to minimize the radiation and contrast media doses.
Highlights
Uterus transplantation (UTx) is the first available treatment, still at a clinical experimental stage, for absolute uterine factor infertility (AUFI), a condition caused either by a uterine absence or presence of a nonfunctional uterus
Failure of MR angiography (MRA) to demonstrate uterine arteries could be followed by CT angiography (CTA) which will visualize the uterine arteries in a majority of cases
All 12 women underwent imaging by CTA, digital subtraction angiography (DSA), and MRI/ MRA (Fig. 1a–c)
Summary
Uterus transplantation (UTx) is the first available treatment, still at a clinical experimental stage, for absolute uterine factor infertility (AUFI), a condition caused either by a uterine absence or presence of a nonfunctional uterus. The proof of concept of UTx as a treatment for AUFI came with the first live birth after UTx in 2014 [2], as part of nine living donor (LD) UTx procedures within the world’s first UTx trial [3]. It is proposed that one of several possible reasons for early graft failure, with thrombosis of uterine vessels, is related to poor uterine artery (UA) quality and secondary hypo-perfusion of the uterus after transplantation [8, 9]. The proportion of early graft failures in our initial UTx study from 2013 was 2/9, and in that trial, only MRI was used for evaluating the uterus and its vasculature prior to donor inclusion [3]. The measured blood flow in these two cases was lower than in most other
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