Value of magnetic resonance imaging in predicting efficacy of GnRH analogue treatment for uterine leiomyoma

BACKGROUND: Estimating pharmacological efficacy is important when selecting conservative treatment of uterine leiomyoma. Hence, the ability of magnetic resonance (MR) imaging to predict gonadotrophin-releasing hormone (GnRH) analogue efficacy was investigated. METHODS: A total of 85 lesions was studied in 40 patients who were clinically diagnosed as having uterine leiomyoma and treated with GnRH analogue for 24 weeks. To evaluate changes in lesion size, T2-weighted and gadopentetate-dimeglumine (Gd-DTPA)-enhanced, T1-weighted MR images were obtained within 2 weeks before, and immediately after termination of, GnRH analogue treatment. RESULTS: An average 46.3% size reduction was observed in 45 lesions (52.9%); these were seen as low signal intensity on T2-weighted images and enhanced by Gd-DTPA. Also, an average 44.7% size reduction was observed in lesions enhanced by Gd-DTPA, irrespective of signal intensity findings on T2-weighted images. The average size reduction of unenhanced lesions was only 17.8%, and significantly different from enhanced lesions (P < 0.001). The prediction of efficacy was difficult in those lesions not enhanced. CONCLUSIONS: It is considered that evaluation of MR signal intensities, and the presence or absence of Gd-DTPA enhancement, would predict treatment efficacy before GnRH analogue administration.