Fibroid Volume Reduction Research Articles

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

Background. Symptomatic uterine fibroids have a significant impact on women’s health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels ( p =0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus.

Outcome of patients with uterine fibroids after 3-month ulipristal acetate therapy

ObjectivesTo determine the proportion and the characteristics of patients who did or did not respond after 3 months of ulipristal acetate (UPA) therapy. Study designIn this retrospective cohort study conducted in the University Hospital of Bordeaux (France) and University Medical Center Ljubljana (Slovenia), symptomatic non-menopausal patients with fibroids that qualified for surgery were pretreated by 3 months of oral UPA 5 mg/day. Clinical success was defined by normalization of the bleeding score, and/or regression of pelvic pain, and/or abdominal distension. Imaging success was defined by reduction in fibroid volume ≥ 25%. ResultsThe clinical and imaging success rates were 54/66 (82%) and 39/66 (59%) respectively. The absence of previous pregnancy (p = 0.004) and the size of the dominant fibroid ≥ 80 mm (p = 0.004) were independent factors associated with clinical failure. Age <35 years (p = 0.02) was the only independent factor associated with imaging failure. ConclusionYoung women developing fibroids and/or women with large fibroids may be resistant to ulipristal acetate therapy.

Preoperative medical therapy before surgery for uterine fibroids.

Preoperative medical therapy before surgery for uterine fibroids.

48 - A Systematic Review of Uterine Fibroid Volume Reduction after Uterine-Sparing Non-Resective Treatment

48 - A Systematic Review of Uterine Fibroid Volume Reduction after Uterine-Sparing Non-Resective Treatment

MRI Enhancement as a Predicator of Uterine Fibroid Volume Reduction after Embolism

Aim of the Study: To evaluate the response of necrotic fibroids to UAE and to identify whether pre-UAE enhancement or other factors are predictors of fibroid shrinkage. Materials and methods: This is a retrospective review of all women who underwent UAE for symptomatic fibroids from January 2013 till July 2017, who experienced a follow-up MRI 5-6 months after UAE were included. There were 54 fibroids (37 non-enhancing and 17 enhancing) among 24 women with a mean age of 56 (range 40-59) years. All fibroids were assessed for size, position, enhancement on subtraction images, and Apparent Diffusion Constant (ADC). Results: Enhancing fibroids had an average decrease in diameter by 23 ± 6%, not significantly different compared to that non-enhancing fibroids which decreased by 19 ± 3% (p=0.491). Multiple linear regression with percent change in fibroid diameter as the dependent variable and patient age, fibroid position, and pre-UAE fibroid diameter, enhancement, and ADC as independent variables, showed that ADC (p<0.005) and pre-UAE diameter (p<0.005) were the only significant independent variables. Conclusion: Pre-UAE size and ADC, but not contrast enhancement, predicted fibroid diameter reduction. Enhancing and non-enhancing fibroids had similar size reduction after UAE. Non-enhancement should not be considered a contraindication to UAE.

P14.01: Evaluation of intramural fibroid vascularisation after uterine artery embolisation by 3D power Doppler ultrasound

The popularity of minimally invasive techniques for the treatment of symptomatic uterine fibroids as an alternative to surgical procedures is increasing. The most widely used procedure of this type is uterine artery embolisation (UAE). During UAE embolic material is administered into bilateral uterine arteries to reduce the tumour's blood supply. This results in necrosis, fibroid volume reduction and relief of symptoms. In some cases tumour regrowth and recurrence of clinical symptoms after UAE are observed, due to fibroid revascularisation. In this study uterine fibroid vascularisation changes after UAE were analysed during a 3 months follow-up period. 64 premenopausal patients with symptomatic intramural fibroids qualified for UAE in the 3rd Chair and Department of Gynecology, Medical University of Lublin, were included in the study. Dominant fibroid vascularisation was evaluated before UAE, 24 hours and 3 months after UAE using the VOCAL technique by calculating the vascular-flow index (VFI). Data were analysed using the repeated measures ANOVA with the post hoc Fisher's test. P values below 0,05 were considered significant. Mean fibroid VFI before UAE was estimated at 0,85 (±0,11 SE), 24 hours after UAE at 0,03 (±0,01 SE), and after 3 months at 0,08 (±0,02 SE). Analysis of variance showed a significant (p <0.0001) effect of time after UAE on the vascularisation of uterine fibroids. A post hoc analysis showed that the fibroid VFI's assessed after 24 hours and 3 months after UAE were significantly lower than before UAE (p <0,0001). Fibroid VFI assessed 24 hours after UAE was not significantly different from VFI 3 months after UAE (p = 0.62). Statistically significant fibroid vascular-flow index reduction was observed at 24 hours after UAE. Three months after UAE this effect was maintained, with an insignificant increase of VFI between 24 hours and 3 months post UAE.

Volumetric magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids through abdominal scars: the impact of a scar patch on therapeutic efficacy and adverse effects

BackgroundTo retrospectively compare the treatment success, therapeutic efficacy, and adverse effects of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment for uterine fibroid patients with and without abdominal scars.MethodsSeventy-six women who underwent treatment were divided into group 1 (patients with abdominal scars, which were covered with scar patches that prevents ultrasound energy from reaching the scar tissue immediately behind the patch) and group 2 (patients without abdominal scars). Non-perfused volume (NPV) ratios immediately after treatment, and fibroid volume reduction ratios and symptom severity scores (SSS) at the 6-months follow-up were assessed. All adverse effects were recorded.ResultsThe mean NPV ratios in groups 1 and 2 were 87.0 ± 14.1% and 91.5 ± 13.3%. At the 6-months follow-up, the fibroid volume reduction ratios in groups 1 and 2 were 0.45 ± 0.27 and 0.43 ± 0.21, and the corresponding improvement in mean transformed SSS were 0.7 ± 0.39 and 0.79 ± 0.28, respectively. No serious adverse effects were reported. The minor adverse effects encountered in this study are likely related to the temperature increase in the near-field of the ultrasound beam path, which inevitably leads to skin burns, or far-field heat absorption by distant bony structures (i.e., sciatic nerve symptoms), and are typically manifested inter-procedurally and resolved shortly thereafter.ConclusionsThe findings in this study suggest that the scar patch could be used safely and efficiently in MRgHIFU treatment for the patients with uterine fibroids and abdominal scars in the ultrasound beam path.

Ineffectiveness of Magnetic Resonance Imaging Enhancement to Predict Fibroid Volume Reduction After Uterine Artery Embolization

Fibroid nonenhancement is considered a relative contraindication to uterine artery embolization (UAE) for symptomatic fibroids. This retrospective study assessed the impact of UAE on nonenhancing fibroids to determine imaging predictors of fibroid shrinkage. All women who underwent UAE for symptomatic fibroids between May 2009 and July 2014 and had follow-up magnetic resonance imaging 6 months after UAE were included. There were 59 fibroids (5 nonenhancing, 54 enhancing) among 18 women aged 40 to 53 (mean 46) years. All fibroids were assessed for size, position, and enhancement on subtraction and apparent diffusion constant (ADC) images. Enhancing fibroids had an average decrease in diameter of 19% ± 3%, not significantly different than nonenhancing fibroids, which decreased 23% ± 6% (P = 0.49). Multiple linear regression with percent change in fibroid diameter as the dependent variable and patient age, fibroid position, and pre-UAE fibroid diameter, enhancement, and ADC as independent variables showed that ADC (P = 0.04) and pre-UAE diameter (P = 0.03) were the only significant independent variables. In conclusion, pre-UAE size and ADC, but not contrast enhancement, predicted fibroid diameter reduction. Enhancing and nonenhancing fibroids had a similar size reduction after UAE. Nonenhancement should not be considered a contraindication to UAE.

Magnetic Resonance Signal Intensity Ratio Measurement Before Uterine Artery Embolization: Ability to Predict Fibroid Size Reduction.

To evaluate whether the magnetic resonance imaging (MRI) signal intensity (SI) ratio between the dominant fibroid and the periphery striated muscle can predict fibroid volume reduction >50% after uterine fibroid embolization (UFE). From October 2013 until May 2016, 52 patients were included in this prospective study. The SI ratio before UFE was calculated using circular region of interests placed on the dominant fibroid and the iliac muscle. The SI fibroid-to-iliac muscle ratio was calculated as SI of the dominant fibroid/SI of the iliac muscle on T1-, T2-, and T1 post-contrast-weighted sequences. The dominant fibroid volume was measured and analyzed before and after UFE. In all, 46 patients who completed the three-month follow-up MRI were available for analysis. The correlation between SI fibroid-to-muscle ratio at the T2-weighted sequence and imaging volume reduction outcome was statistically significant (p<0.002). All other parameters showed no statistically significant reduction in fibroid volume: (p<0.68) for SI ratio at T1-weighted, (p<0.13) for SI ratio at T1 post-contrast, and (p<0.58) for fibroid volume. Spearman's rank showed positive correlation (r=0.439, p<0.003) between the fibroid-to-muscle SI ratio on T2-weighted sequence. The area under curve (AUC) for SI fibroid-to-muscle ratio on T2-weighted sequence was 0.776. For the other parameters, the AUC values were 0.512, 0.671, and 0.578, respectively. SI dominant fibroid-to-muscle ratio at T2-weighted sequence before UFE was significantly related to dominant fibroid volume reduction after UFE and may be used for better patient selection.

Place of ulipristal acetate in the management of uterine fibroids: Preoperative treatment or sequential treatment?

Symptomatic uterine fibroids affect 25% of women of childbearing potential and are responsible for various symptoms, mainly menometrorrhagia, pelvic pain and infertility. No currently available medical treatment is able to eradicate fibroids. Two treatments are indicated preoperatively to reduce bleeding and decrease the size of fibroids: GnRH agonists and ulipristal acetate. Ulipristal acetate, a selective progesterone receptor modulator, exerts an antagonist effect on fibroid tissue, inducing apoptosis. It rapidly induces amenorrhoea (after an average of seven days of treatment) and reduces fibroid volume. It causes few adverse effects and, in particular, is associated with a low rate of hot flashes compared to GnRH agonists. Due to its partial antagonist effect on endometrial tissue, endometrial thickening with no glandulocystic atypia is commonly observed during treatment and is reversible after stopping treatment. These specific histological changes are called Progesterone receptor modulator-Associated Endometrial Changes (PAEC). Since February 2012, ulipristal acetate has been approved in Europe for preoperative treatment of symptomatic fibroids for two three-month cycles. The use of ulipristal acetate facilitates surgery or allows modification of the surgical approach (due to a reduction of fibroid volume) and restores normal preoperative hemoglobin. In some cases, the reduction of menometrorrhagia induced by treatment can allow surgery to be postponed. Since May 2015, ulipristal acetate is also indicated as repeated sequential treatment for moderate-to-severe symptoms due to uterine fibroids.

Uterine fibroid shrinkage after short-term use of selective progesterone receptor modulator or gonadotropin-releasing hormone agonist.

ObjectiveThe aim of this study was to evaluate the effect of short-term use of selective progesterone receptor modulator (SPRM) or gonadotropin-releasing hormone (GnRH) agonist on uterine fibroid shrinkage among Korean women.MethodsThis retrospective study involved 101 women with symptomatic uterine fibroids who received ulipristal acetate (SPRM, n=51) and leuprolide acetate (GnRH agonist, n=50) for 3 months between November 2013 and February 2015. The fibroid volume was measured both before and after treatment using ultrasonography, computed tomography, and magnetic resonance imaging. The outcomes were compared between the SPRM and GnRH agonist groups.ResultsThe median rate of fibroid volume reduction after SPRM treatment was 12.4% (IQR −14.5% to 40.5%) which was significantly lower than the reduction rate observed after GnRH agonist treatment (median 34.9%, IQR 14.7% to 48.6%, P=0.004). 19 of 51 (37.3%) patients with SPRM treatment did not show any response of volume shrinkage, while 7 of 50 (14.0%) women with GnRH agonist showed no response (P=0.007).ConclusionShort-term SPRM treatment yields lower volume reduction than GnRH agonist treatment in Korean women with symptomatic fibroids. Further large-scale randomized trials are needed to confirm our findings.

Monitoring Leiomyoma Response to Uterine Artery Embolization Using Diffusion and Perfusion Indices from Diffusion-Weighted Imaging.

Purpose To investigate the potential of diffusion and perfusion indices (ADC and perfusion fraction f) from DWI at 3.0 T in monitoring treatment response to uterine artery embolization (UAE) at 6-month follow-up. Methods Twelve female patients with uterine fibroids who underwent 3.0-T pelvic DWI before and 6 months after UAE were included. ADC and perfusion fraction f were calculated from DWI. The Wilcoxon signed-rank test and Spearman rank correlation test were used for statistics. Results Seventeen fibroids were studied. The median ADCs showed a significant increase from 1.20 × 10−3 mm2/s (range, 0.86–1.66 × 10−3 mm2/s) at baseline to 1.56 × 10−3 mm2/s (range, 1.00–1.86 × 10−3 mm2/s) at 6-month follow-up (P = 0.0003). Conversely, the median perfusion fraction f was significantly decreased after UAE (P = 0.0001), with a median pre-UAE value of 14.2% (range, 6.7%–17.6%) and a median post-UAE value of 9.2% (range, 3.2%–14.6%). Significant correlations were found between fibroid volume reduction rate and percentage changes in ADC and perfusion fraction f at 6-month follow-up relative to baseline, with ρ values of −0.50 (P = 0.04) and 0.55 (P = 0.02), respectively. Conclusion ADC and perfusion fraction f obtained from DWI at 3.0 T may help to evaluate treatment response to UAE.

MRI enhancement predicting fibroid volume reduction to uterine artery embolization

MRI enhancement predicting fibroid volume reduction to uterine artery embolization

Embolización de arterias uterinas para manejo de miomato sis: experiencia con 200 pacientes

Objetivos: Evaluar la eficacia y seguridad de la embolización de arterias uterinas en la reducción del volumen uterino, tamaño de miomas, signos y síntomas relacionados a la enfermedad y la satisfacción del paciente. Diseño: Estudio clínico, retrospectivo y longitudinal. Locación: Instituto de Radiología Intervencionista Brazzini. Participantes: Doscientos pacientes sometidos a EAU bilateral. Intervención: Embolización de arterias uterinas realizado con partículas de polyvinyl alcohol de 355 a 500 μm y micro esferas embolizantes de 500 a 900 micras. El seguimiento fue de tres, seis, doce y hasta setenta y dos meses, que incluyeron ecografías uterinas pre y post embolización, reporte de mejoría sintomatológica por pacientes (EAV 0 a 10), satisfacción postratamiento, complicaciones y datos epidemiológicos relevantes. Resultados: De los 200 pacientes estudiados, los síntomas que impulsaron la consulta fueron, en primer lugar y con 42%, los trastornos menstruales, y en segundo lugar con 17%, la anemia. El tipo de mioma más frecuente fue, con 54%, el mioma intramural. La reducción media en el tamaño uterino y del mioma dominante fue 43,4% y 59%, respectivamente. De las pacientes, 56,5% tenía indicación de histerectomía al llegar a la consulta (N° 113), y de estos, luego del tratamiento, dos pacientes fueron sometidas a este procedimiento (1,02%). Las mujeres refirieron mejoría de sus síntomas en la escala análoga visual (0 a 10) de 6,7 puntos (Pre: 9 puntos, Post: 2,3 puntos). La mayoría (95%) refirió estar satisfecha con el procedimiento realizado. Conclusiones: La EAU redujo el tamaño de los miomas, el tamaño total de útero y como resultado del tratamiento se evidenció una disminución significativa de los síntomas. Las pacientes intervenidas refirieron estar satisfechas con el procedimiento, tenían una mejor calidad de vida y estaban contentas de haber evitado someterse a un procedimiento quirúrgico mayor.

A retrospective study of magnetic resonance-guided focused ultrasound ablation for uterine myoma in Taiwan

ObjectiveTo report our experiences with 40 patients who were treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS) for uterine fibroids and their 6-month follow-up status. Materials and MethodsA total of 40 patients with uterine fibroids underwent MRgFUS from January 2009 to November 2011. The Uterine Fibroid Symptoms and Quality of Life Questionnaire was used to determine the patients' Symptom Severity Scores (SSS) prior to and 6 months after treatment. The nonperfused volume (NPV) values and NPV ratio were obtained immediately at the end of the treatment and at 6 months follow-up. ResultsNo procedure-related complications were noted throughout the 6-month follow-up period among the 40 patients who underwent MRgFUS for uterine fibroids. The mean reduction in SSS in our patients after 6 months was 43.7%, and the mean reduction of fibroid volume was 31.7%. In addition, the mean reduction of NPV and mean NPV ratio was 52.7% and 33.3%, respectively. ConclusionThe results obtained from this study demonstrated that MRgFUS can be safely and effectively used to ablate uterine fibroids to produce a significant decrease in mean fibroid volume and improve SSS for up to 6 months after treatment.

Efficacies of uterine artery embolization for symptomatic uterine fibroids using gelatin sponge: a single-center experience and literature review.

AimThe aim of this study was to retrospectively analyze the efficacies of uterine artery embolization (UAE) using gelatin sponge for symptomatic uterine fibroids.MethodsA series of 60 consecutive premenopausal women underwent UAE using gelatin sponge particles or porous gelatin particles. Patients were routinely followed up at 1, 3, 6, and 12 months after the procedure and asked to report any procedure-related complications. At each follow-up, an original clinical questionnaire was completed by the patients to evaluate changes in fibroid-related symptoms. Pelvic magnetic resonance imaging was performed before and at 3 and 12 months after the procedure, and the changes in volume of the dominant fibroid were calculated.ResultsBilateral UAE was successfully performed in all the patients. Median age was 45 years (range 34–53 years), and median follow-up period was 25.2 months (range 1–116 months). At the 3- and 12-month follow-up, the dominant fibroid volumes were found to be significantly decreased by 33.4% (95% confidence interval [CI]: 24.9–41.1) and 48.4% (95% CI: 40.7–56.1) compared to baseline volumes, respectively. Excluding patients not having menorrhagia or bulk-related symptoms, at 12 months 49 of 50 (98%) women showed improvement in menorrhagia, and 45 of 47 (95.7%) women showed improvement in bulk-related symptoms. During the follow-up period, ten patients (16.7%) required further interventions including two patients who had undergone hysterectomy. No sequelae were experienced by any of the patients.ConclusionUAE using gelatin sponge was associated with a high clinical success rate and good fibroid volume reduction compared to UAE using other embolic agents.

Repeated intermittent use of ulipristal acetate associated with rapid growth and multilocular cystic hydropic degeneration of a uterine fibroid: A case report

Introduction: Uterine fibroids or leiomyomas are common benign tumors often associated with menorrhagia, pressure symptoms and dysmenorrhea. selective progesterone receptor modulators (sPrMs) such as ulipristal acetate (UPA) have been proven a safe and effective treatment resulting in significant volume reduction of uterine fibroids and amenorrhea. safety concerns of long-term use of UPA have mainly focused on endometrial changes, which have been proven to be benign and self-resolving. case report: A 44-year-old woman presented with symptomatic subserosal fibroid of 7.5 cm in diameter and was prescribed UPA for three months. After a positive initial treatment response, a repeated three-month course of UPA was started. At the end of the second course the patient became symptomatic presenting with cyclic abdominal pain. Ultrasound imaging revealed a large multilocular cystic pelvic mass sized 10x11 cm suspicious of a malignant tumor and abdominal hysterectomy was performed.

Current management of myomas: the place of medical therapy with the advent of selective progesterone receptor modulators.

To review the current management of myomas with the advent of selective progesterone receptor modulators. Selective progesterone receptor modulators have proved effective and recent publications on the use of ulipristal acetate (UPA) have analyzed the performance of long-term intermittent utilization of 10 mg UPA given in repeated courses of 3 months. This long-term intermittent therapy maximizes the efficacy of UPA. Indeed, control of bleeding is achieved sooner after each course. With each subsequent course, a statistically greater number of patients show a fibroid volume reduction of more than 50%. The choice of therapy is influenced by different factors, such as the severity of symptoms, tumor characteristics, age, and wish to preserve the uterus (and fertility). Use of UPA will undoubtedly modify the surgical approach.

Long-term medical management of uterine fibroids with ulipristal acetate

To investigate the efficacy and safety of repeated 12-week courses of 5 or 10 mg daily ulipristal acetate for intermittent treatment of symptomatic uterine fibroids. Double-blind, randomized administration of four 12-week courses of ulipristal acetate. Gynecology centers. Four hundred fifty-one subjects with symptomatic uterine fibroid(s) and heavy menstrual bleeding. Four repeated 12-week treatment courses of daily 5 or 10 mg ulipristal acetate. Endometrial safety and general safety, laboratory parameters, amenorrhea, controlled bleeding, fibroid volume, quality of life (QoL), and pain. Efficacy results, such as bleeding control and fibroid volume reduction, were in line with previously published data. Pain and QoL showed marked improvements from screening, even during the off-treatment intervals. The safety profile of ulipristal acetate was confirmed, and repeated treatment courses did not increase the occurrence of adverse reactions. There were no significant changes in laboratory parameters during the study. The percentage of subjects with endometrial thickness ≥ 16 mm was 7.4% (all subjects) after the first treatment course and returned to below screening levels (4.9%) in subsequent treatment courses. As in previous studies, ulipristal acetate did not increase the occurrence of endometrial features of concern. The frequency of nonphysiological changes did not increase with repeated treatment. They were observed in 17.8% and 13.3% of biopsies after treatment courses 2 and 4, respectively, and were reversible after treatment cessation. The results of this study demonstrate the efficacy and further support the safety profile of repeated intermittent treatment of symptomatic fibroids with ulipristal acetate. NCT01629563.

Correlation of Reductions in Perfused Fibroid Volume With Subsequent Reductions in Total Fibroid Volume After Transcervical Radiofrequency Ablation.

Study Objective To determine if the extent of fibroid ablation, as reflected in a decrease in perfused fibroid volume three months after treatment, correlates with a reduction in total fibroid volume at 12 months. Design Prospective, longitudinal, multicenter, single-arm trial. Setting Academic and community hospitals in the United Kingdom, The Netherlands and Mexico. Patients 27 women with heavy menstrual bleeding secondary to fibroids. Intervention Radiofrequency ablation guided by built-in intrauterine sonography (the Sonata™ System). Measurements and Main Results The 27 patients had a total of 42 fibroids that were ablated. Contrast-enhanced MRI was used to determine the perfused and total fibroid volumes at baseline, at 3 months post-treatment and again at 12 months post-treatment. All MRI measurements were performed at a single core laboratory (MedQIA, Los Angeles, USA). Using a least squares method for linear regression, the change in total fibroid volume at 12 months as a function of the change in perfused fibroid volume at 3 months was found to have a correlation coefficient (R2) of 0.7518. The linear equation describing this relationship was y = 0.9919x + 0.0052. Conclusion There is a positive correlation between the reduction in perfused fibroid volume noted on contrast-enhanced MRI at 3 months after transcervical radiofrequency ablation and the reduction in total fibroid volume at 12 months. Thus, as larger portions of a fibroid are ablated, there will tend to be a greater reduction in total fibroid volume at 1 year.