Shearwave elastographic evaluation of uterine leiomyomas after uterine artery embolization: preliminary results
Shearwave elastographic evaluation of uterine leiomyomas after uterine artery embolization: preliminary results
Background/aim: We aimed to investigate the role of Shearwave Elastography (SWE) in the evaluation of response to uterine arteryembolization (UAE) in patients with uterine leiomyomas.Materials and methods: SWE images of the dominant uterin leiomyomas were obtained before and 1.5 months after performing UAEin 33 women suffering from symptoms due to leiomyomas (menometrorrhagia, bulk related symptoms, pelvic pain). Leiomyomas werealso evaluated by 2 observers for location and longest diameter in axial plane. Interobserver agreement in the quantitative SWE analysiswas calculated using intraclass correlation coefficients.Results: Thirty-three women (mean age, 39.7 years; range, 31–48 years) were examined with SWE 1.5 months after UAE. After treatment,3 patients (9.1%) had fever, 1 patient had nausea and 29 patients (87.9%) had no complications. The post UAE stiffness measurementsof leiomyomas (mean SWE ± SD = 13.34 ± 3.9kPa) were significantly lower than the pre UAE measurements (mean SWE ± SD = 17.16± 4.8kPa) (P < 0.001). There was excellent agreement between the 2 blinded observers in SWE measurements.Conclusion: SWE values of leiomyomas after UAE significantly decreased. SWE, with its high reproducibility, could become a usefultool in the follow up of uterin leiomyomas after UAE.
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- 1. Verkauf BS. Changing trends in treatment of leiomyomata uteri.
Current Opinion in Obstetrics & Gynecology 1993; 5 (3): 301-310.
- 2. Pokras R, Hufnagel VG. Hysterectomy in the United States.
American Journal of Public Health 1988; 78: 852
- 3. Chryssikopoulos A, Loghis C. Indications and results of total
hysterectomy. International Surgery 1986; 71: 188
- 4. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, et al.
Laparoscopic versus abdominal myomectomy: a prospective,
randomized trial to evaluate benefits in early outcome.
American Journal of Obstetrics & Gynecology 1996; 174: 654-
658. doi: 10.1016/S0002-9378(96)70445-3
- 5. Ravina JH, Bouret JM, Fried D, Benifla JL, Daraï E et al.
Value of preoperative embolization of uterine fibroma: report
of a multicenter series of 31 cases. Contraception, Fertilité,
Sexualité 1995; 23: 45-49.
- 6. Worthington-Kirsch RL, Popky GL, Hutchins FL. Uterine
arterial embolization for the management of leiomyomas:
quality-of-life assessment and clinical response. Radiology
1998; 208: 625-629. doi: 10.1148/radiology.208.3.9722838
- 7. Goodwin SG, McLucas B, Lee M, Chen G, Perella R et al.
Uterine artery embolization for the treatment of uterine
leiomyomata: midterm results. Journal of Vascular and
Interventional Radiology 1999; 10: 1159-1165. doi: 10.1016/
S1051-0443(99)70213-7
- 8. Spies JB, Scialli AR, Jha RC, Imaoka I, Ascher SM et al. Initial
results from uterine fibroid embolization for symptomatic
leiomyomata. Journal of Vascular and Interventional Radiology
1999; 10: 1149-1157. doi: 10.1016/S1051-0443(99)70212-5
- 9. Hutchins Jr FL, Worthington-Kirsch RL, Berkowitz RP.
Selective uterine artery embolization as primary treatment
for symptomatic leiomyomata uteri. Journal of the American
Association of GynecologicLaparoscopists 1999; 6: 279-284.
doi: 10.1016/S1074-3804(99)80061-9
- 10. Walker WJ, Green A, Sutton C. Bilateral uterine artery
embolisation for myomata—results, complications and
failures. Minimally Invasive Therapy and Allied Technologies
1999; 8: 449-454. doi: 10.3109/13645709909152923
- 11. Pelage JP, Le Dref O, Soyer P, Kardache M, Dahan H et al.
Fibroid-related menorrhagia: treatment with superselective
embolization of the uterine arteries and mid-term
follow-up. Radiology 2000; 215: 428-431. doi: 10.1148/
radiology.215.2.r00ma11428
- 12. Brunereau L, Herbreteau D, Gallas S, Cottier JP, Lebrun JL et
al. Uterine artery embolization in the primary treatment of
leiomyomas. American Journal of Roentgenology 2000; 175:
1267-1272. doi: 10.2214/ajr.175.5.1751267
- 13. Andersen PE, Lund N, Justesen P, Munk T, Elle B et al. Uterine
artery embolization of symptomatic uterine fibroids. Acta
Radiologica 2001; 42: 234-238.
- 14. Bradley EA, Reidy JF, Forman RG, Jarosz J, Braude PR.
Transcatheter uterine artery embolization to treat large uterine
fibroids. British Journal of Obstetrics and Gynaecology 1998;
105: 235-240. doi: 10.1111/j.1471-0528.1998.tb10060.x
- 15. de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der
Kooij S et al. Uterine artery embolization vs hysterectomy
in the treatment of symptomatic uterine fibroids: 10-year
outcomes from the randomized EMMY trial. American
Journal of Obstetrics And Gynecology 2016; 215 (6): 745-e10.
doi: 10.1016/j.ajog.2016.06.051
- 16. deSouza NM, Williams AD. Uterine arterial embolization for
leiomyomas: perfusion and volume changes at MR imaging
and relation to clinical outcome. Radiology 2002; 222 (2), 367-
374. doi: 10.1148/radiol.2222010584
- 17. Jha RC, Ascher SM, Imaoka I, Spies, JB. Symptomatic
fibroleiomyomata: MR imaging of the uterus before and after
uterine arterial embolization. Radiology 2000; 217 (1): 228-
235. doi: 10.1148/radiology.217.1.r00se49228
- 18. Walker WJ, Pelage JP. Uterine artery embolisation for
symptomatic fibroids: clinical results in 400 women with
imaging follow up. British Journal of Obstetrics and
Gynaecology: An International Journal of Obstetrics &
Gynaecology 2002; 109 (11): 1262-1272. doi: 10.1046/j.1471-
0528.2002.01449.x
- 19. Tranquart F, Brunereau L, Cottier JP, Marret H, Gallas S et
al. Prospective sonographic assessment of uterine artery
embolization for the treatment of fibroids. Ultrasound
in Obstetrics and Gynecology 2002; 19 (1): 81-87. doi:
10.1046/j.0960-7692.2001.00535.x
- 20. McLucas B, Adler L, Perrella R. Uterine fibroid embolization:
nonsurgical treatment for symptomatic fibroids. Journal of
the American College of Surgeons 2001; 192 (1): 95-105. doi:
10.1016/S1072-7515(00)00738-9
- 21. Cosgrove DO, Berg WA, Doré CJ, Skyba DM, Henry JP et al.
BE1 Study Group. Shear wave elastography for breast masses
is highly reproducible. European radiology 2012; 22 (5): 1023-
1032.
- 22. Goodwin SC, Vedantham S, McLucas B, Forno AE, Perrella
R. Preliminary experience with uterine artery embolization
for uterine fibroids. Journal of Vascular and Interventional
Radiology 1997; 8: 517-526. doi: 10.1016/S1051-
0443(97)70603-1
- 23. Pelage JP, Soyer P, Le Dref O, Dahan H, Coumbaras J et al.
Uterine arteries: bilateral catheterization with a single femoral
approach and a single 5-F catheter: technical note. Radiology
1999; 210: 573-575. doi: 10.1148/radiology.210.2.r99fe01573
- 24. Silberzweig JE, Powell DK, Matsumoto AH, Spies JB.
Management of Uterine Fibroids: A Focus on Uterine-sparing
Interventional Techniques. Radiology 2016; 280: 675. doi:
10.1148/radiol.2016141693
- 25. Kirby JM, Burrows D, Haider E, Maizlin Z, Midia M et al.
Utility of MRI before and after uterine fibroid embolization:
why to do it and what to look for. Cardiovasc Intervent Radiol
2011; 34: 705-716.
- 26. Burn PR, McCall JM, Chinn RJ, Vashisht A, Smith JR et al.
Uterine fibroleiomyoma: MR imaging appearances before and
after embolization of uterine arteries. Radiology 2000; 214:
729-734. doi: 10.1148/radiology.214.3.r00fe07729
- 27. Chang JM, Moon WK, Cho N, Yi A, Koo HR et al. Clinical
application of shear wave elastography (SWE) in the diagnosis
of benign and malignant breast diseases. Breast Cancer Res
Treat 2011; 129:89-97.
- 28. Ragazzoni F, Deandrea M, Mormile A, Ramunni MJ, Garino
F et al. High diagnostic accuracy and interobserver reliability
of real-time elastography in the evaluation of thyroid nodules.
Ultrasound Med Biol 2012; 38: 1154-1162. doi: 10.1016/j.
ultrasmedbio.2012.02.025
- 29. Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY et al. Shear
wave elastography of thyroid nodules in routine clinical
practice: preliminary observations and utility for detecting
malignancy. European radiology 2012; 22 (11): 2397-2406.
- 30. Berg WA, Cosgrove DO, Doré CJ, Schafer FKW, Svensson WE
et al. Shear-wave elastography improves the specificity of breast
US: the BE1 multinational study of 939 masses. Radiology
2012, 262 (2): 435-449. doi: 10.1148/radiol.11110640
- 31. McLucas B, Goodwin SC, Kaminsky D. The embolised fibroid
uterus. Minimally Invasive Therapy & Allied Technologies, 7
(3): 267-271. doi: 10.3109/13645709809152862
- 32. Cornelis F, Ferrand J, Chapelain YL, Ciraru vigneron N, Ravina
JH et al. Morphological features of embolised myomata.
Minimally Invasive Therapy & Allied Technologies 1999, 8 (6):
437-439. doi: 10.3109/13645709909152921
- 33. Gordic S, Ayache JB, Kennedy P, Besa C, Wagner M et al.
Value of tumor stiffness measured with MR elastography
for assessment of response of hepatocellular carcinoma to
locoregional therapy. Abdominal Radiology 2017, 42 (6): 1685-
1694.
- 34. Li J, Jamin Y, Boult JK, Cummings C, Waterton JC et al. Tumour
biomechanical response to the vascular disrupting agent
ZD6126 in vivo assessed by magnetic resonance elastography.
Br J Cancer 2014, 110 (7): 1727-1732. doi: 10.1038/bjc.2014.76