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Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes

Authors
 Man Deuk Kim  ;  Yong Min Kim  ;  Hyun Cheol Kim  ;  Jung Hyun Cho  ;  Hyung Gon Kang  ;  Chan Lee  ;  Hee Jin Kim  ;  Jong Tae Lee 
Citation
 JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol.22(4) : 497-502, 2011 
Journal Title
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
ISSN
 1051-0443 
Issue Date
2011
MeSH
Adult ; Endometriosis/complications ; Endometriosis/diagnosis ; Endometriosis/therapy* ; Female ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Necrosis ; Particle Size ; Polyvinyl Alcohol/therapeutic use* ; Prospective Studies ; Recurrence ; Republic of Korea ; Time Factors ; Treatment Outcome ; Uterine Artery Embolization/adverse effects ; Uterine Artery Embolization/methods* ; Uterine Diseases/complications ; Uterine Diseases/diagnosis ; Uterine Diseases/therapy*
Abstract
PURPOSE: To evaluate the safety and effectiveness of a new embolization technique named the 1-2-3 protocol to achieve complete necrosis of adenomyosis after uterine artery embolization (UAE) and to determine predictive factors on magnetic resonance (MR) imaging.

MATERIALS AND METHODS: A total of 40 patients with adenomyosis without leiomyomas diagnosed on MR imaging were prospectively enrolled. They were subdivided into three categories based on MR signal intensity (SI) of the adenomyosis on T2-weighted imaging: dark, low, and heterogeneous SI or SI equal to that of the myometrium. Nonspherical polyvinyl alcohol particles were used in all cases, beginning with 150-250-μm particles and progressively increasing to 250-355-μm and then 355-500-μm particles to the endpoint. Patients were assessed for extent of devascularization on MR imaging and for durability of symptom control.

RESULTS: Of the 40 patients who underwent UAE for adenomyosis with the 1-2-3 protocol, 33 (82.5%) exhibited complete necrosis of adenomyosis. All six patients with dark SI of adenomyosis exhibited complete necrosis (100%). Of the 28 patients with low SI of adenomyosis, 25 (89.3%) showed complete necrosis. Among the six patients with heterogenous SI or SI equal to that of myometrium, only two (33.3%) showed complete necrosis (P < .01). Of 16 patients with complete necrosis followed up to 18 months, none reported recurrent menorrhagia. Of the five patients without necrosis, only one had no symptoms at 18 months.

CONCLUSIONS: UAE with the 1-2-3 protocol is safe and highly effective to achieve complete necrosis of adenomyosis. Dark SI of adenomyosis is the most favorable predictive factor for UAE on MR imaging, followed by low SI. Heterogenous SI or SI equal to that of the myometrium is an unfavorable predictive factor.
Full Text
http://www.sciencedirect.com/science/article/pii/S1051044311004350
DOI
10.1016/j.jvir.2011.01.426
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/92900
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