Uterine Artery Embolization in 101 Cases of Uterine Fibroids: Do Size, Location, and Number of Fibroids Affect Therapeutic Success and Complications?

The purpose of this study was to evaluate whether the size, location, or number of fibroids affects therapeutic efficacy or complications of uterine artery embolization (UAE). Patients with symptomatic uterine fibroids (n = 101) were treated by selective bilateral UAE using 500- to 710-μm polyvinyl alcohol (PVA) particles. Baseline measures of clinical symptoms, sonography, and MRI taken before the procedure were compared to those taken 1, 3, 6, and 12 months later. Complications and outcomes were analyzed for associations with fibroid size, location, and number. Reductions in mean fibroid volume were similar in patients with single (66.6 ± 21.5%) and multiple (67.4 ± 25.0%) fibroids (p-value = 0.83). Menstrual improvement occurred in patients with single (93.3%) and multiple (72.2%) fibroids (p = 0.18). Changes in submucosal and other fibroids were not significantly different between the two groups (p’s > 0.56). Linear regression analysis between primary fibroid volume as independent variable and percentage reduction of fibroid volume after 1 year yielded an R² of 0.083 and the model coefficient was not statistically significant (p = 0.072). Multivariate regression models revealed no statistically or clinically significant coefficients or odds ratios for three independent variables (primary fibroid size, total number, and fibroid location) and all outcome variables (percent reduction of uterus and fibroid volumes in 1 year, improvement of clinical symptoms [menstrual, bulk related, and urinary] in 1 year, and complications after UAE). In conclusion, neither the success rate nor the probability of complications was affected by the primary fibroid size, location, or total number of fibroids.     

Does Size Really Matter? Analysis of the Effect of Large Fibroids and Uterine Volumes on Complication Rates of Uterine Artery Embolisation

The purpose of this study was to determine whether there is a correlation between large uterine fibroid diameter, uterine volume, number of vials of embolic agent used and risk of complications from uterine artery embolisation (UAE). This was a prospective study involving 121 patients undergoing UAE embolisation for symptomatic uterine fibroids at a single institution. Patients were grouped according to diameter of largest fibroid and uterine volume. Results were also stratified according to the number of vials of embolic agent used and rate of complications. No statistical difference in complication rate was demonstrated between the two groups according to diameter of the largest fibroid (large fibroids were classified as ≥10 cm; Fisher’s exact test P = 1.00), and no statistical difference in complication rate was demonstrated according to uterine volume (large uterine volume was defined as ≥750 cm³; Fisher’s exact test P = 0.70). 84 of the 121 patients had documentation of the number of vials used during the procedure. Patients were divided into two groups, with ≥4 used defined as a large number of embolic agent. There was no statistical difference between these two groups and no associated increased risk of developing complications. This study showed no increased incidence of complications in women with large-diameter fibroids or uterine volumes as defined. In addition, there was no evidence of increased complications according to quantity of embolic material used. Therefore, UAE should be offered to women with large fibroids and uterine volumes.     

Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial

Purpose

This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy.

Methods

Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n?=?81) or UAE (n?=?82). Endpoints at 1?year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention.

Results

UAE patients had shorter hospitalization (2 vs. 6?days, p?significant and equal improvements in QoL scores had occurred in both groups (myomectomy n?=?59; UAE n?=?61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2?years, among UAE patients (n?=?57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n?=?37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US.

Conclusions

UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.     

Role of Coil Embolization during Prostatic Artery Embolization: Incidence,Indications, and Safety Profile☆

Purpose

To determine if coil embolization is a safe adjunctive measure to prevent nontarget embolization during prostatic artery embolization (PAE).

Embolic Brain Infarcts: A Rare Fatal Complication of Preoperative Embolization of a Massive Solitary Fibrous Tumor of the Pleura

Solitary fibrous tumor of the pleura (SFTP) is a rare intrathoracic neoplasm, often giant in size and highly vascular, which can make surgical resection very challenging. Preoperative percutaneous embolization before surgical removal can significantly reduce the risk of uncontrollable intraoperative hemorrhage. However, a rare potential life threatening complication could result from embolization of SFTP and must be taken into consideration. This report describes a 69-year-old female with a large right thoracic SFTP, who underwent preoperative angiography and embolization and developed diffuse embolic brain infarcts immediately after the administration of polyvinyl alcohol particles.     

Comparative Analysis of Cone-Beam CT Angiogram and Conventional CT Angiogram for Prostatic Artery Identification Prior to Embolization

Pre-prostatic artery embolization (PAE) cone-beam computed tomography (CT) angiograms (n = 31; mean age: 62.4 ± 9.75 years) and conventional CT angiograms (n = 32; mean age: 62.5 ± 7.2 years) were retrospectively compared. Mean signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), radiation exposure, and prostatic artery (PA) identification scores (0–4) for cone-beam CT angiogram and conventional CT angiogram were 33.19 (± 14.31) and 18.13 (± 5.38) (P < .01); 27.42 (± 13.39) and 14.78 (± 4.92) (P < .01); 14.57 mSv (±2.5) and 19.25 mSv (±3.7) (P < .01); 3.36 (± 0.89) and 3.16 (± 0.95) (P = .08), respectively. Pre-PAE cone-beam CT angiogram allows for PA identification with improved SNR and CNR and less radiation dose compared to conventional CT angiogram.     

Multimodal Visibility of a Modified Polyzene-F–coated Spherical Embolic Agent for Liver Embolization: Feasibility Study in a Porcine Model

PurposeTo evaluate multimodal visibility of modified currently available microspheres on radiography, magnetic resonance (MR) imaging, and computed tomography (CT) in a porcine liver model.Materials and MethodsLivers of four pigs were embolized with two sizes (100 μm ± 25 and 700 μm ± 50) of modified Embozene Microspheres embedded with different densities of barium sulfate and iodine as radiopaque materials (intensity groups A–C, with increasing intensity from A to C for 100 μm and intensities A and C for 700 μm) and iron oxide as magnetic substance for MR imaging visibility. Pigs embolized with currently available Embozene Microspheres served as control groups. Pre- and postinterventional MR imaging (T1- and T2-weighted) and CT were performed. Qualitative and quantitative (ie, determination of signal-to-noise ratio [SNR]) particle visibility was evaluated on radiography, MR imaging, and CT.ResultsModified particles of both sizes were visible on radiography, MR imaging, and CT. Particles in the control group were not visible. For modified particles of both sizes, SNRs measured on MR imaging decreased significantly after embolization (eg, cluster analysis of group A, 100 μm ± 50 particles, T1-weighted, ?74.6% ± 3.4; P = .03). For modified particles of both sizes, SNR measured on CT increased significantly after embolization (eg, cluster analysis of group A, 700 μm ± 25 particles, +54.3% ± 13.5; P = .03).ConclusionsModification of currently available Embozene Microspheres was successful, with multimodal visibility on radiography, MR imaging, and CT in porcine liver. In the future, this might improve procedure accuracy and allow monitoring, control, and improvement of embolotherapy during and after the procedure.     

Prostatic Artery Embolization in the Treatment of Localized Prostate Cancer: A Bicentric Prospective Proof-of-Concept Study of 12 Patients

Purpose

To provide initial data on tumoricidal efficacy of embolization on prostate cancer via histopathologic examination of prostatectomy specimens after embolization.

Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients

Dislocation of the knee is a relatively rare injury with modern arthroscopic techniques, operative reconstruction has become the standard of care. The primary aim of this study was to prospectively follow a large, consecutive series of patients with knee dislocation to document associated injuries, surgical treatment, knee function, and knee osteoarthritis (OA) at a minimum of 2 years follow-up. Hundred and twenty-two consecutive patients with a traumatic knee dislocation (Schenck II–IV) were treated at the Oslo University Hospital, Ulleval, between May 1996 and December 2004. Follow-up evaluation of 85 patients consisted of evaluation of knee joint laxity using the KT1000, the Lachman test, the pivot shift test, the reversed pivot shift, the posterior drawer test, the dial test, and the varus–valgus tests compared to the uninjured knee. Knee function was evaluated using the Lysholm score, the Tegner activity level score, the IKDC2000 score, and four single leg hop tests. Radiographic evaluation was performed using the Kellgren & Lawrence classification grade 0–4. Knee function at a minimum of 2 years after surgery disclosed a Lysholm score of a median of 83, a Tegner activity score of 5, and above 83% on all single leg hop tests compared to the uninjured side. Knee function was lower in the patients with a knee dislocation caused by high-energy trauma compared to low energy trauma. Eighty-seven percent had Kellgren & Lawrence grade 2 or higher for the injured knee compared to 35% for the uninjured knee.     

Embolization Coils Migrating and Being Passed per Rectum After Embolization of a Splenic Artery Pseudoaneurysm, “The Migrating Coil”: A Case Report

Acute or chronic blood loss from pseudoaneurysms of the splanchnic artery in chronic pancreatitis poses diagnostic and management challenges. Arteriographic examination offers both diagnostic and therapeutic options, with success rates of 76%–100% for both modalities. In cases of failure of embolization, repeat embolization is also an option. Surgical intervention is advocated for rebleeding and failure of embolization. Evidence-based guidelines regarding the optimal treatment modality for this condition are lacking. There has been a reported case of dislodgement of coil into the stomach through a gastropseudocystic fistula. We report the case of a migrating steel-wire coil through the gastrointestinal tract and splenic artery pseudoaneurysm. We highlight the potential complications of pseudoaneurysm and other available therapeutic management options.     

Outcomes of Endovascular Treatment and Open Repair for Renal Artery Aneurysms: A Single-Center Retrospective Comparative Analysis

Purpose

To compare outcomes of endovascular repair and open repair in treatment of renal artery aneurysms (RAAs).

Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

Purpose Carbimazole ameliorates hyperthyroidism but reduces radioiodine uptake and adversely affects the outcome of simultaneous radioiodine therapy. We explored whether withdrawal of carbimazole for 3 days can restore the outcome of radioiodine treatment without concurrent exacerbation of hyperthyroidism. By generating three groups with comparable radioiodine uptake, we also investigated whether the effect of carbimazole depends on the radioiodine uptake.Methods Stratified by a radioiodine uptake >30%, 227 consecutive adult patients were prospectively assigned to radioiodine therapy (target dose 200 Gy) without, on or 3 days off carbimazole. Patients were clinically (Crooks-Wayne score) and biochemically (T₃, fT₄, TSH) followed up after 3, 6 and 12 months. Primary endpoint was outcome 12 months after radioiodine therapy.Results A total of 207 patients completed follow-up (toxic nodular goitre, n=117; Graves’ disease, n=90). The overall success rate was 71.5%. Patients without and 3 days off carbimazole had similar biochemical (81.4% and 83.3%, respectively; p=0.82) and clinical outcomes [median (range) Crooks-Wayne score 0 (0–16) and 1 (0–10), respectively; p=0.73], which were both higher than in patients on carbimazole [42.6%, p<0.001; Crooks-Wayne score 3 (0–30), p<0.03]. Time to achieve cure was delayed on carbimazole. No changes in thyroid hormone levels occurred after 3 days’ discontinuation of carbimazole. Logistic regression revealed that all observed cure rates were independent of entity, sex, age, thyroid volume, radioiodine uptake, radioiodine half-life, fT₄, T₃ and TSH.Conclusion Patients under carbimazole treatment can be referred for radioiodine therapy after withdrawal of carbimazole for only 3 days. Three days of carbimazole withdrawal is long enough to restore the success of radioiodine therapy and short enough to avoid the risk of exacerbation of hyperthyroidism.     

Influence of age and sex on signal intensities of the posterior lobe of the pituitary gland on T1-weighted images from 3 T MRI

Purpose

To elucidate the influence of age and sex on the signal intensity (SI) of the posterior lobe of the pituitary gland (PPG) on T1-weighted images (T1WI) from 3 T MRI.

Materials and methods

Sagittal T1WI acquired from three-dimensional fast spoiled gradient recalled acquisition in the steady state in 1,634 subjects without conditions affecting antidiuretic hormone were evaluated retrospectively. The presence or absence of a bright signal in the PPG was assessed qualitatively. The SI ratio of the PPG to the pons (SIR) was obtained from quantitative measurements. We statistically analyzed these data, creating 14 subject groups categorized according to age and sex, and applied a Poisson generalized linear model to the SIR data.

Results

The characteristic bright signal was absent in 47 subjects (2.8 %), with no significant difference in incidence among the groups. The SIR was inversely related to age in both males (r > 0.7) and females (r > 0.9), and was significantly higher in females in the third to the eighth decades (p < 0.05). Analysis of the whole SIR dataset using a generalized linear model showed that the estimated SIR decreased by 1.7 % per decade and is higher in females.

Conclusion

Age and sex influence the SI of the PPG on T1WI. These findings may aid the recognition of PPG signal abnormalities on T1WI.     

Uterine fibroids: Influence of “T2-Rim sign” on immediate therapeutic responses to magnetic resonance imaging-guided high-intensity focused ultrasound ablation

ObjectivesTo investigate the influence of a high-signal-intensity peripheral rim on T2-weighted MR images (i.e., T2-rim sign) on the immediate therapeutic responses of MR-guided high intensity focused ultrasound (MR-HIFU) ablation of uterine fibroids.MethodsThis retrospective study was approved by the institutional review board, and patient informed consent was obtained for MR-HIFU ablation. In total, 196 fibroids (diameter 6.2 ± 2.6 cm) in 123 women (age 43.4 ± 5.0 years) who underwent MR-HIFU ablation from January 2013 to April 2016 were included. The effects of a T2-rim sign on the immediate therapeutic responses (non-perfused volume [NPV] ratio, ablation efficiency [NPV/treatment cell volume], ablation quality [grade 1-5, poor to excellent]) were investigated with univariable and multivariable analyses using generalized estimating equation (GEE) analysis. In multivariable analysis, T2 signal intensity ratio of fibroids-to-skeletal muscle, relative peak enhancement of fibroids, and subcutaneous fat thickness were also considered.ResultsThe presence of a T2-rim sign significantly lowered the NPV ratio (54.0 ± 28.0% vs. 83.7 ± 17.7%), ablation efficiency (0.6 ± 0.5 vs. 1.3 ± 0.6), ablation quality (3.1 ± 1.2 vs. 4.2 ± 0.8), (P < 0.0001). GEE analysis showed that the presence of a T2-rim sign was independently significant for ablation efficiency and ablation quality (P < 0.05).ConclusionUterine fibroids with a T2-rim sign showed significantly poorer immediate therapeutic responses to MR-HIFU ablation.