Incidence of Nonviable Leiomyomas on Contrast Material–Enhanced Pelvic MR Imaging in Patients Referred for Uterine Artery Embolization Paul Nikolaidis,

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Incidence of Nonviable Leiomyomas on Contrast Material–Enhanced Pelvic MR Imaging in Patients Referred for Uterine Artery Embolization Paul Nikolaidis, MD, Aheed J. Siddiqi, MD, James C. Carr, MD, Robert L. Vogelzang, MD, Frank H. Miller, MD, Howard B. Chrisman, MD, Albert A. Nemcek, MD, Reed A. Omary, MD, MS Journal of Vascular and Interventional Radiology Volume 16, Issue 11, Pages 1465-1471 (November 2005) DOI: 10.1097/01.RVI.0000175333.41751.71 Copyright © 2005 Society of Interventional Radiology Terms and Conditions

Figure 1 Axial (a) and sagittal (b) T1-weighted fat saturated Gd-enhanced MR images demonstrate numerous viable enhancing leiomyomas. A single nondominant, nonviable leiomyoma is seen in the left aspect of the uterine fundus superiorly. As all other leiomyomas enhance avidly, this patient would benefit from UAE. Postembolization image 3 months after embolization: axial (c) and sagittal (d) T1-weighted fat-saturated Gd-enhanced MR images demonstrate a decrease in uterine size, along with decrease in the size of the uterine leiomyomas which now do not enhance, indicating a successful UAE procedure. Journal of Vascular and Interventional Radiology 2005 16, 1465-1471DOI: (10.1097/01.RVI.0000175333.41751.71) Copyright © 2005 Society of Interventional Radiology Terms and Conditions

Figure 2 Illustration of dominant nonviable leiomyomas. (a) Axial T2-weighted MR imaging of the uterus in a symptomatic 42-year-old woman shows two large intramural leiomyomas with low signal intensity. (b) Axial T1-weighted fat-saturated Gd-enhanced MR images demonstrate a complete lack of enhancement of these leiomyomas. This patient would not have benefited from UAE. Journal of Vascular and Interventional Radiology 2005 16, 1465-1471DOI: (10.1097/01.RVI.0000175333.41751.71) Copyright © 2005 Society of Interventional Radiology Terms and Conditions

Figure 3 Sagittal T2-weighted MR imaging (a) demonstrates a diffusely widened junctional zone (2.9 cm) without any discrete leiomyomas, diagnostic of adenomyosis. Corresponding axial T1-weighted fat-saturated GD-enhanced MR images (b) demonstrate no evidence of uterine leiomyomas and homogeneous enhancement of the area of adenomyosis. Journal of Vascular and Interventional Radiology 2005 16, 1465-1471DOI: (10.1097/01.RVI.0000175333.41751.71) Copyright © 2005 Society of Interventional Radiology Terms and Conditions

Figure 4 (a) Sagittal T2-weighted MR images of the uterus in the same patient as Figure 3 show a rounded hypointense submucosal leiomyoma projecting into the hyperintense endometrial cavity (arrow). A second small intramural leiomyoma is present. (b) The corresponding sagittal T1-weighted fat-saturated Gd-enhanced MR image demonstrates avid enhancement of the submucosal leiomyoma (e). Note complete lack of enhancement of the myometrial leiomyoma just anterior and inferior to it, indicating it is not viable (n). This patient was referred for hysteroscopy for resection of the submucosal leiomyoma. Journal of Vascular and Interventional Radiology 2005 16, 1465-1471DOI: (10.1097/01.RVI.0000175333.41751.71) Copyright © 2005 Society of Interventional Radiology Terms and Conditions