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Case 1: 43 year old woman with history of pelvic pain, anemia and dysfunctional uterine bleeding.
a & b. Coronal and sagittal MRI scans demonstrate diffuse adenomyosis (small arrow) and submucosal fibroid (large arrow)
c. Catheter angiogram reveals enlarged, tortuous uterine artery	d. Delayed image shows contrast blush of enlarged hypervascular uterus
e. Completion angiogram after coil embolization demonstrates complete occlusion of the uterine artery
Case 2: 33 year old woman with uncontrolled bleeding after myomectomy.
a. Catheter angiogram demonstrates active arterial bleeding from the left uterine artery that was subsequently embolized successfully	b. Right internal iliac angiography also demonstrates active hemorrhage from the right ovarian artery which was successfully managed with catheter therapy
c & d. Two weeks after embolization, patient underwent MR imaging for persistent pelvic pain. Sagittal and axial MR images show pelvic hematomas

Above images are all original MR scans performed at Parkside MR Center.

Fibroid tumors occur in up to 77% of all women and are especially common in black women. They are frequently symptomatic due to dysfunctional uterine bleeding and mass effect upon the pelvic organs and are associated with infertility. Symptomatic leiomyomas represent the most common indication for hysterectomy in the United States.

Symptoms related to fibroids are largely dependent upon their origin. Serosal fibroids can grow unrestricted and demonstrate mass effect upon adjacent pelvic structures. Although fibroids are most commonly located in an intramural location, the minority that are subserosal in location are most responsible for severe menorrhagia.

Several options currently exist for treatment of debilitating fibroids including medication with GnRH analogs, myomectomy and uterine artery embolization. MR can accurately assess the size and number of fibroids prior to therapy and can distinguish between a pedunculated leiomyoma and an adnexal lesion. MRI is also helpful in evaluating other conditions which may cause pelvic pain such as adenomyosis, endometriosis and pelvic venous congestion syndrome. Surveillance MR imaging is also valuable in assessing treatment outcomes.

MR imaging is used in evaluating patients who may be suitable candidates for uterine artery embolization. Uterine artery embolization can be performed for all fibroid types but is most successful for submucosal lesions. Patients with a pedunculated leiomyoma may be contraindicated for uterine artery embolization depending upon the size ratio of the stalk to tumor. MR imaging can provide value information in this regard. MR angiography may also be employed to assess whether there is a significant blood supply from the ovarian artery to the fibroid. When such a blood supply exists, the success of uterine artery embolization decreases. MR imaging may be employed in evaluation of post treatment complications. These include hematoma, endometritis, and tubo-ovarian abscess.

For more information on uterine artery embolization and other case studies, call us at 847-696-7900.

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