Hemodynamics of ovarian veins: MR angiography in women with uterine leiomyomata

Purpose

The passive reflux into ovarian veins (OVs) is well known as a common finding in normal asymptomatic women. The purpose of this study was to investigate the hemodynamics of OVs in women with myomatous uterus.

Materials and methods

Thirty-two women with symptomatic uterine leiomyomata underwent time-of-flight MR (TOF-MR) angiography, including venography and arteriography, and contrast-enhanced MRI. The frequency of reflux into OVs on TOF-MR angiography was retrospectively assessed with uterine volume, and compared to that of normal women in previous publication. The statistical evaluation was performed using Fisher's exact test.

Results

The mean uterine volume was 932 ± 612 ml (range, 301–2627 ml). The reflux into left OVs was observed in 4 of 32 women (13%) and that into right OVs was noted in 0 of 32 women (0%). These rates were significantly lower than those of normal asyptomatic women in the previous publication (p < 0.05). The reflux into OVs was observed in 0 of 19 women (0%) with 600 ml or larger myomatous uterus, whereas it was noted in 4 of the remaining 13 women (31%) with less than 600 ml myomatous uterus, with significant difference between the two groups (p = 0.02).

Conclusions

We found that reflux into OVs was infrequent in the vast majority of women with myomatous uterus, especially those with larger uterus due to leiomyomata on the basis of TOF-MR angiography. These findings suggested myomatous uterus could affect the flow direction of OVs, and passive reflux into OVs might be prevented due to the influence of antegrade flow of OVs.     

子宫腺肌病的超声诊断

子宫腺肌病是妇科常见病,为子宫内膜异位于子宫肌壁内的良性病变,多发于35～50岁经产妇。为提高对子宫腺肌病的诊断率,现将我院经手术病理证实的98例子宫腺肌病声像图表现及误诊原因分析如下。     

Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata

PURPOSE: To assess the safety and effectiveness of tris-acryl gelatin microspheres (Embospheres) in the treatment of leiomyomata by uterine artery embolization. MATERIALS AND METHODS: This was a Phase I study of 30 patients with symptomatic leiomyomata. Each patient underwent ultrasound imaging and completed questionnaires regarding symptoms and health status at baseline and 3 and 6 months after treatment. Bilateral embolization was performed with use of tris-acryl gelatin microspheres. Summary statistics were used to characterize the demographic and procedure data. Paired t-tests were used to assess change in the severity of menstrual bleeding and health-related quality of life. RESULTS: Bilateral embolization was technically successful in all patients. Three months after treatment, menstrual bleeding was markedly improved as assessed by menorrhagia questionnaire (P <.0001) and menstrual calendar (P <.0001). Pelvic pain and discomfort was improved in 92% of cases. Physical component summary scores of the SF-12 also increased from baseline at 3 months (P =.02) and at 6 months (P =.01). Minor complications occurred in nine patients; there were no major complications. CONCLUSION: Although limited, this initial experience suggests that tris-acryl gelatin microspheres are an effective and safe embolic agent for the treatment of uterine leiomyomata.     

Treatment of intrauterine and large pedunculated subserosal leiomyomata with sequential uterine artery embolization and myomectomy

Successful clinical outcomes were obtained after a combined therapy of uterine artery embolization (UAE) and subsequent myomectomy for gigantic subserosal leiomyoma exceeding 1,000 cm3 in volume on a short stalk and multiple intrauterine leiomyomata in young patients who desired fertility and uterine preservation. UAE effectively treated symptomatic multiple intramural and submucosal leiomyomata for menorrhagia symptoms, which also facilitated uncomplicated subsequent myomectomy with devascularized gigantic leiomyoma for the treatment of bulk symptoms.     

Uterine artery embolization for the treatment of uterine leiomyomata midterm results.

INTRODUCTION: The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids. MATERIALS AND METHODS: Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. RESULTS: Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. CONCLUSION: Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.     

Magnetic resonance imaging outcome after uterine artery embolization for leiomyomata with use of tris-acryl gelatin microspheres

PURPOSE: To determine the imaging outcome after uterine artery embolization (UAE) with use of tris-acryl gelatin microspheres (Embospheres). MATERIALS AND METHODS: A retrospective analysis of magnetic resonance (MR) images was performed comparing studies completed 3-4 months after UAE to those performed before UAE. Twenty-three patients with 61 leiomyomata (as many as three fibroids per patient) were examined. Orthogonal T2, axial T1-weighted fat-saturated, sagittal T2 fast spin-echo, and dynamic T1-weighted sagittal images after Gadolinium injection were analyzed. Two abdominal imaging specialists examined the volume and uterine and leiomyoma perfusion. The Wilcoxon signed-rank test was used for inferences in leiomyoma size difference, infarction, and volume of fibroid tissue perfused. RESULTS: Median volume of all leiomyomata (n = 61) decreased by 52% (P <.001). For dominant fibroids alone (n = 23), a median 52% volume decrease (P <.001) was also noted, whereas the median uterine volume decreased 32%. Median perfused volume of all fibroids decreased from 31 mL to 0 mL, signifying a 100% decrease (P <.001). For dominant fibroids, a 100% median perfused volume decrease from 116 mL to 0 mL was noted (P <.001). Fifty-two of 61 fibroids (85%) and 20 of 23 dominant fibroids (87%) were completely devascularized and two fibroids disappeared. There was no myometrial ischemia identified. CONCLUSIONS: Tris-acryl gelatin microspheres (Embospheres) are an effective embolic agent for UAE, causing infarction and significant decrease in leiomyoma volume.     

Computed tomography of a rapidly growing hepatic hemangioma

A rapidly growing hepatic hemangioma was observed in a 40-year-old woman during the follow-up period of 1.5 years. Contrast enhanced CT and angiography performed 3.5 years prior to and at the time of operation were compatible with hemangioma, but the diameter of the mass changed from 4.6 to 7.2 cm during this period. The pathogenetic reason for this rapid growth was unclear at the time of resection.     

Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay

PURPOSE: To determine if uterine artery embolization (UAE) for leiomyomata causes a change in ovarian function as measured by serial basal follicle stimulating hormone (FSH) assay. MATERIALS AND METHODS: Sixty-three patients undergoing UAE for symptomatic leiomyomata had blood samples obtained on day 3 of a menstrual cycle before UAE and on day 3 during menstrual cycles 3 and 6 months after treatment. Analysis of variance was used to detect differences in FSH levels among age groups at each interval. Repeated measures analysis of variance was used to determine if individual mean change occurred for the group as a whole and for each age group. Onset of new menopausal symptoms was compared between groups with use of the chi(2) test. RESULTS: There was no significant change in basal FSH levels for the group as a whole (P =.16), but there was a statistically significant difference when age groups were compared (P =.03). Individual change of >2 SD from baseline mean FSH level occurred at 6 months in seven patients, all 45-50 years of age. Four of these patients (15% of patients over age 44) had FSH levels increase to more than 20 IU/L. chi(2) analysis did not reveal any difference among the groups studied in the onset of menopausal symptoms. CONCLUSIONS: Most patients had no change in ovarian function as measured by basal FSH after UAE. For patients aged 45 or older, there is approximately a 15% chance of an increase in basal FSH into the perimenopausal range.     

Transient uterine myometrial contraction associated with moles

PURPOSE: To examine the incidence of transient distortion of uterine central tissue and myometrial hypointense areas observed on MR images in women with clinically suspicious moles. MATERIALS AND METHODS: The study population consisted of six women aged 15-47 years with clinically suspicious moles (hydatidiform mole in four, invasive mole in one, and microscopic mole in one). The control study population was 105 reproductive-age women (18-52 years) without uterine malignancy, gestational trophoblastic disease, or pregnancy. MR images were analyzed to check for discrepancies of the uterine central tissue configuration. If a discrepancy was observed, the myometrial hypointense area, its diameter, and changes in its shape and location were analyzed. RESULTS: Differences in uterine central tissue configuration and hypointense areas were observed in all six patients. In the control study, only seven cases showed uterine endometrial distortion, and five exhibited hypointense areas. These areas disappeared, changed in shape, or other hypointense areas appeared on subsequent MR images. Significant differences (P < 0.01) in the incidence of uterine central tissue distortion and hypointense areas, and in their maximum diameter between the study and the control groups were observed. CONCLUSION: Uterine myometrial hypointense areas with central tissue distortion, most likely due to transient myometrial contraction, are frequently seen in women with clinically suspicious moles.     

Plasma proinsulin, C-peptide and sex hormone concentrations in regularly menstruating premenopausal females with ovulatory and anovulatory menstrual cycles

AIM: Highly active females are at risk of athletic menstrual irregularities including anovulatory menstrual cycles, oligomenorrhea and even amenorrhea. On the other hand, the functional relationship between endocrine pancreas and ovaries is supported by numerous studies indicating that disturbed female sex hormone secretion coexists with insulin resistance and glucose intolerance. However, the relationship between circulating beta islet and ovarian hormones in regularly menstruating active women with ovulatory and anovulatory menstrual cycle has not been studied. METHODS: A total of 32 regularly menstruating women participated in the study. Prospective subjects monitored their BBT for 3 months before the study. The determination of plasma progesterone levels between days 5-8 and again between days 19-22 of the menstrual cycles made possible the classification of subjects as ovulating or non-ovulating. Plasma 17-beta-estradiol, testosterone, insulin, proinsulin, C-peptide and glucose concentrations were assayed on the same menstrual cycle days as progesterone. RESULTS: There were no differences in circulating insulin, C-peptide and glucose between non-ovulating and ovulating women. In contrast, in non-ovulating subjects plasma proinsulin concentrations between days 19-22 were slightly, but significantly higher than between days 5-8 of the menstrual cycle (P<0.05). Exclusively in non-ovulating women significant and positive correlation was noted between circulating proinsulin and 17-beta-estradiol in data collected from both days 5-8 and 19-22 of the menstrual cycle (P<0.008). CONCLUSIONS: Our results indicate that in the face of low circulating progesterone and subsequent anovulation circulating 17-beta-estradiol slightly, but significantly, affect either pancreatic beta-cell biosynthetic activity or proinsulin hepatic and/or renal clearance.     

Familial cerebral cavernous haemangioma diagnosed in an infant with a rapidly growing cerebral lesion

Cavernous haemangiomas of the central nervous system are vascular malformations best imaged by MRI. They may present at any age, but to our knowledge only 39 cases in the first year of life have previously been reported. A familial form has been described and some of the underlying genetic mutations have recently been discovered. We present the clinical features and serial MRI findings of an 8-week-old boy who presented with subacute intracranial haemorrhage followed by rapid growth of a surgically proven cavernous haemangioma, mimicking a tumour. He also developed new lesions. A strong family history of neurological disease was elucidated. A familial form of cavernous haemangioma was confirmed by identification of a KRIT 1 gene mutation and cavernous haemangiomas in the patient and other family members. We stress the importance of considering cavernous haemangiomas in the context of intracerebral haemorrhage and in the differential diagnosis of rapidly growing lesions in this age group. The family history is also important in screening for familial disease.     

Patient radiation dose associated with uterine artery embolization

PURPOSE: To evaluate the estimated absorbed radiation doses to the ovaries and skin entrance during uterine artery embolization (UAE) for leiomyomas. MATERIALS AND METHODS: Radiation dose was measured in 20 patients who underwent UAE for leiomyomas. Measurements were obtained by placing lithium fluoride dosimeters both into the posterior fornix of the vagina and on the skin at the beam entrance site. Patient doses were obtained with thermoluminescent dosimeters. RESULTS: The mean fluoroscopic time was 21.89 minutes, and the mean number of angiographic exposures was 44. The mean estimated absorbed ovarian dose was 22.34 cGy, and the mean absorbed skin dose was 162.32 cGy. These values compare to published values for the assessed absorbed ovarian dose during hysterosalpingography (0.04-0.55 cGy), fallopian tube recanalization (0.2-2.75 cGy), computed tomography of the trunk (0.1-1.9 cGy), and pelvic irradiation for Hodgkin disease (263-3,500 cGy). CONCLUSION: The estimated absorbed ovarian dose during UAE is greater than that during common fluoroscopic procedures. On the basis of the known risks of pelvic irradiation for Hodgkin disease, the dose associated with UAE is unlikely to result in acute or long-term radiation injury to the patient or to a measurable increase in the genetic risk to the patient's future children.     

Impaired vascular function in exercising anovulatory premenopausal women is associated with low bone mineral density

In estrogen‐deficient post‐menopausal women, osteoporosis shares a common link with cardiovascular disease risk, including endothelial dysfunction. The current study sought to examine associations between bone mineral density (BMD) and endothelial function in estrogen‐deficient premenopausal women with exercise‐associated menstrual disturbances. Recreationally trained women (24.3 ± 0.8 years; overall mean ± SEM) who were estrogen deficient (amenorrheic or eumenorrheic anovulatory cycles; E2Def; n = 13) or estrogen replete (eumenorrheic ovulatory cycles; E2Rep; n = 14) were studied. Total body and lumbar BMD (L1‐L4) were determined using dual‐energy X‐ray absorptiometry. Serum markers of oxidative stress (oxidized low‐density lipoprotein; OxLDL), energy deficiency (triiodothyronine), and bone turnover (osteocalcin, c‐telopeptide X, P1NP) were assessed. Estrogen exposure was determined by assessing daily urinary estrone‐3‐glucuronide (E1G) across a monitoring period. Calf blood flow (CBF), an index of endothelial function, was measured using strain‐gauge plethysmography. CBF, total body and L1‐L4 BMD, triiodothyronine and E1G were lower (P < 0.05), and c‐telopeptide crosslinks higher (P < 0.05) in E2Def. Osteocalcin and OxLDL did not differ (P > 0.05) between groups. L1‐L4 BMD, osteocalcin, and E1G were the strongest predictors of CBF (R²=0.615, P < 0.001). CBF was the strongest predictor of L1‐L4 BMD (R²=0.478, P < 0.001). L1‐L4 (r = 0.558, P = 0.008) and CBF (r = 0.534, P = 0.004) were independently correlated with E1G. In young recreationally trained premenopausal women with anovulatory menstrual disturbances, low CBF predicts decreased lumbar BMD, suggesting impaired peripheral endothelial function may predict early unfavorable changes in bone metabolism. This finding may be of relevance in the early detection of cardiovascular and bone health decrements in otherwise healthy estrogen‐deficient premenopausal women.