(Ultrasound Review) Two research articles recently have appeared regarding uterine artery embolization for the treatment of fibroids. Researchers at University of California, Los Angeles investigated the role of uterine artery Doppler flow, and the results were published in the Journal of Ultrasound in Medicine. The purpose of this study was "to determine whether Doppler flow measurements are useful in predicting variables associated with uterine fibroid embolization, including shrinkage of the uterus and myomas, adenomyosis, and uterine fibroid embolization failure," the authors wrote.
Two hundred and twenty-seven women with menorrhagia or postmenopausal bleeding due to fibroids had Doppler performed prior to uterine artery embolization. Six months after treatment all women had uterine and fibroid volumes calculated and 188 had Doppler examination to assess peak systolic velocity (PSV). They measured the uterine artery PSV at the level of the cervix and uterine body on each side, and correlated this with uterine and fibroid shrinkage, adenomyosis, and treatment failure. Laparoscopy, hysteroscopy, and deep myometrial biopsy were performed on all patients.
"Embolization was performed by a radiologist using either 300-500m m or 500-700m m polyvinyl alcohol particles," they said.
Results showed a positive correlation between pretreatment PSV and fibroid size. Patients with adenomyosis were shown to have a significantly lower PSV (33.2 cm/s) compared with those without adenomyosis (39.3 cm/s). Progression of symptoms, insufficient shrinkage, and hysterectomy all were indicators of embolization failure.
There was a total of 109 (48%) failures in total. The preembolization PSV values were significantly higher than the postembolization PSV values. Forty-two patients were shown to have adneomyosis, which is associated with embolization failure. According to the authors, when the PSV exceeded 64 cm/s this was a good indication that fibroid embolization was likely to be unsuccessful.
They concluded ‘higher PSV values were associated not only with the number of vials of polyvinyl alcohol particles used in the embolization but also with the particle load used to embolize one litre of uterine tissue. Preembolization Doppler flow studies may give patients an indication of their chance of failure.’
In related research, doctors at CHU Bretonneau, France prospectively studied the ultrasound assessment of uterine artery embolization for the treatment of fibroids. Using interval ultrasound examinations, they investigated a smaller group of 58 women over two years, in order to evaluate the impact of uterine artery embolization on fibroid size and vascularization. Surgeons considered intervention necessary in women with sufficiently severe symptoms who were not benefiting from medical treatment. Symptoms experienced included abnormal bleeding, pelvic pressure and pain, and anemia.
"Free-flow embolization was performed using 150-250m m polyvinyl alcohol particles and absorbable gelatin sponge," the French group wrote in Ultrasound in Obstetrics & Gynecology. Both transabdominal and transvaginal ultrasound examinations were performed and uterine and fibroid volume was calculated. When four or more fibroids were present the largest four were measured. At subsequent visits (3, 6, 12 and 24 months), the percentage reduction in size was calculated. Power Doppler was used to assess the intrafibroid and perifibroid tumour vascularity and spectral Doppler was used to determine the resistive index.
Results demonstrated that "most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years." Treatment failed to correct the patient’s fibroid-related symptoms in two cases (3%). They concluded "uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography."
Treatment failure was much lower for this second study and this could relate to the difference in particle size used for embolization and the long-term effects on uterine vascularization or the high rate of adenomyosis in the first study.
"Role of uterine artery Doppler flow in fibroid embolization"M McLucas et al
University of California, Los Angeles
J Ultrasound Med 2002 (February); 21:113-120
"Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids"
F Tranquart et al
Service de Medicine Nucleaire et Ultrasons, CHU Bretonneau, Tours, France
Ultrasound Obstet Gynecol 2002 (January); 19:81-87
By Ultrasound Review
March 18, 2002
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