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Evaluation of Uterine Contractility by Magnetic Resonance Imaging in Women Undergoing Embolization of Uterine Fibroids

  • Clinical Investigation
  • Arterial Interventions
  • Published:
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Abstract

Purpose

To assess uterine contractility using ultrafast magnetic resonance imaging (cine MRI) before and after uterine fibroid embolization (UFE).

Materials and Methods

This is a prospective study of uterine contractility in 26 patients (age 30–41 years) undergoing UFE for symptomatic uterine fibroids. Cine MRI was performed before and 6 months after UFE. Two radiologists evaluated uterine contractility and classified it as absent, ordered, or disordered. Patients were then grouped into three distinct patterns of progression: unchanged contractility (group A), modified contractility (B), and loss of contractility (C). These findings were then confronted with factors that might have interfered with uterine contractility pattern (uterine volume, location of dominant fibroid, fibroid/myometrium index, and fibroid necrosis pattern).

Results

Of the 26 patients, 8 (30.7%) had no contractility before the procedure, while 18 (69.2%) exhibited some form of contractility (11 [61%] ordered, 7 [39%] disordered). All 8 patients who had no contractility at baseline exhibited contractility after UFE (5 ordered, 3 disordered). Of the 11 who had ordered contractility at baseline, 9 remained ordered and 2 lost contractility after UFE. Of the 7 with disordered contractility at baseline, 1 remained disordered, 5 progressed to ordered contractility, and 1 lost contractility. Overall, 10 patients (38%) had no change in contractility after UFE (group A), 13 (50%) had a positive change (group B), and 3 (11%) lost contractility (group C). The potential interference factors assessed had no statistically significant effect in any group.

Conclusion

In women of reproductive age with symptomatic fibroids, uterine contractility improved significantly after UFE.

Level of Evidence

Level 3—non-randomized controlled cohort/follow-up study.

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Author information

Authors and Affiliations

  1. Interventional Radiology and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Vinicius Adami Vayego Fornazari & Denis Szejnfeld

  2. Department of Diagnostic Imaging (DDI), Escola Paulista Medicina (EPM), UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Jacob Szejnfeld & Suzan Menasce Goldman

  3. Outpatient Clinics of Arterial Embolization of Uterine Myoma and Cardiovascular Diseases and Thromboembolism, Gynecological Endocrinology Course, Department of Gynecology, EPM, UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Claúdio Emilio Bonduki

  4. Department of Statistics, Universidade Federal do Paraná (UFPR), Rua General Carneiro, 370, Centro, Curitiba, PR, 81531-990, Brazil

    Stela Adami Vayego

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  1. Vinicius Adami Vayego Fornazari
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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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For this type of study consent for publication is not required. This study was registered in the National Information System on Research Ethics Involving Human Beings (Sistema Nacional de Informação Sobre Ética em Pesquisa envolvendo Seres Humanos, SISNEP) and approved by the Research Ethics Committee/Plataforma Brasil (CAAE: 22039914.5.0000.5505).

Electronic supplementary material

Below is the link to the electronic supplementary material.

270_2018_2053_MOESM1_ESM.mov

Supplementary material—Video 1. Sagittal cine magnetic resonance (MR) images (ultrafast sequence), absence of uterine pathology showing ordered uterine peristalsis with cervico-fundal direction. (MOV 2501 kb)

270_2018_2053_MOESM2_ESM.mov

Supplementary material—Video 2. Sagittal cine magnetic resonance (MR) images (ultrafast sequence), presence diffuse submucosal myoma, of before uterine fibroid embolization (UFE) showing ordered uterine peristalsis. (MOV 1094 kb)

270_2018_2053_MOESM3_ESM.mov

Supplementary material—Video 3. Sagittal cine magnetic resonance (MR) (ultrafast sequence) images, obtained 6 months after uterine fibroid embolization (UFE), showing maintained ordered uterine peristalsis (group A—unchanged contractility pattern). (MOV 1481 kb)

270_2018_2053_MOESM4_ESM.mov

Supplementary material—Video 4. Before uterine fibroid embolization (UFE). Sagittal magnetic resonance imaging (MRI) (ultrafast sequence) showing a submucosal fibroid and absence of uterine contractility. (MOV 1941 kb)

270_2018_2053_MOESM5_ESM.mov

Supplementary material—Video 5. Sagittal cine MR images (ultrafast sequence), obtained 6 months after uterine fibroid embolization (UFE), showing new-onset ordered uterine peristalsis (group B—positive change in contractility). (MOV 1208 kb)

270_2018_2053_MOESM6_ESM.mov

Supplementary material—Video 6. Sagittal cine MR images (ultrafast sequence), obtained before uterine fibroid embolization (UFE), showing ordered uterine peristalsis. (MOV 2116 kb)

270_2018_2053_MOESM7_ESM.mov

Supplementary material—Video 7. Sagittal cine MR images (ultrafast sequence), obtained 6 months after uterine fibroid embolization (UFE), showing absence of uterine contractility (group C—loss of contractility). (MOV 1669 kb)

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Fornazari, V.A.V., Szejnfeld, D., Szejnfeld, J. et al. Evaluation of Uterine Contractility by Magnetic Resonance Imaging in Women Undergoing Embolization of Uterine Fibroids. Cardiovasc Intervent Radiol 42, 186–194 (2019). https://doi.org/10.1007/s00270-018-2053-6

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