E2037. MRI Following Uterine Artery Embolization for Leiomyomas or Adenomyosis: Treatment Response and Complications
  1. Matthew Hung; Hospital of the University of Pennsylvania
  2. Richard Shlansky-Goldberg; Hospital of the University of Pennsylvania
  3. Evan Siegelman; Hospital of the University of Pennsylvania
Leiomyomas and adenomyosis are two of the most common gynecological conditions responsible for significant morbidity in women of reproductive age, leading to symptoms such as menorrhagia, dysmenorrhea, dyspareunia, pelvic pain and pressure. Uterine artery embolization (UAE) is an effective minimally invasive treatment option for symptomatic uterine fibroids and adenomyosis; compared to alternatives such as myomectomy or hysterectomy, UAE offers several advantages such as shorter hospitalization and potential preservation of fertility. Magnetic resonance imaging (MRI) is not only integral for preprocedural planning, but is also the imaging modality of choice in assessing treatment response and monitoring for complications following UAE.

Educational Goals / Teaching Points
A goal of this exhibit is to familiarize the learner with the expected short term and long term response on MRI after UAE for leiomyomas or adenomyosis. An additional goal is to enable the learner to detect a variety of potential complications that can be seen after UAE through illustrative examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The MRI appearance of successfully embolized uterine fibroids in the short term and long term will be reviewed. Examples will include major features such as nonenhancement and reduction in size with centripetal migration, as well as ancillary features such as hemorrhagic necrosis, calcification, and intralesional gas. A variety of complications seen on MRI will be reviewed, including fibroid expulsion, endometritis, pyomyoma, parasitization of a previously pedunculated subserosal fibroid, and uterine necrosis. A case of endometrial stromal sarcoma that was detected on post-UAE MRI will also be discussed, highlighting the need to consider malignancy in the differential when a viable mass is seen following embolization. Expected MRI findings after UAE for adenomyosis will also be reviewed, with examples including devascularization of the junctional zone and expulsion of necrotic adenomyotic tissue.

UAE is an effective treatment option for uterine fibroids and adenomyosis. However, both the diagnostic and treating interventional radiologists should be familiar with MRI findings after embolization to confirm treatment response and detect potential complications.