Normalized Relative Contrast Improves the Power of Pre-Therapy Contrast-Enhanced MRI to Predict the Prognosis of Uterine Leiomyoma Treated With Uterine Artery Embolization

Kejia Cai, Karen Xie, Winnie Mar, Alison Palumbo, Frederick C. Damen, Yi Sui, Yang Lu, Xiaohong J. Zhou, Grace M. Knuttinen

Abstract


Background: Uterine artery embolization (UAE) has emerged as an effective treatment option for women with symptomatic uterine leiomyomas, the most common benign tumor of the female reproductive system. Assessing factors that aid in predicting treatment outcomes is critical for patient selection, procedure planning and post-procedural follow-up. Previous studies have demonstrated variable correlations between MRI predictors and response to UAE. In this study, we investigated if the relative tumor to intratumor myometrium contrast may improve the predictive power of pre-therapy contrast-enhanced MRI.

Methods: A retrospective study of a total of 42 uterine leiomyomas treated with UAE was performed. Treated tumors were categorized as either fully or not fully responsive based on if they became completely necrotic 3 - 6 months post-UAE.

Results: There was no significant difference (P = 0.34) in the pre-UAE contrast to noise ratio (CNR) between fully responsive (64.6 38.6) and not fully responsive (74.2 24.8) tumors. On the other hand, the pre-UAE relative contrast of not fully responsive tumors was significantly higher than the fully responsive tumors (1.6 0.4 vs. 1.0 0.4, P < 0.05). Pre-UAE tumor relative contrast was found to correctly predict 7/9 not fully responsive and 30/33 fully responsive tumors at a threshold of 1.3. Larger area under the receiver operating characteristic (ROC) curve based on relative contrast than that based on CNR also indicated that relative contrast improved the predictive power of pre-therapy contrast-enhanced MRI.

Conclusion: Upon further validation with large studies, pre-UAE relative contrast may prove to be a useful tool to predict UAE treatment outcome of leiomyomas and improve the clinical management of uterine leiomyoma.




J Clin Gynecol Obstet. 2015;4(1):164-169
doi: http://dx.doi.org/10.14740/jcgo279w

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Keywords


Uterine artery embolization; Uterine leiomyomas; Contrast-enhanced MRI; Treatment response

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