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Imaging Manifestations of Complications Associated with Uterine Artery Embolization¹

¹ From the Department of Radiology, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007. Presented as an education exhibit at the 2004 RSNA Scientific Assembly. Received May 18, 2005; revision requested May 31 and received June 30; accepted July 12. J.B.S. is a research support consultant for Boston Scientific and Biosphere Medical; all remaining authors have no financial relationships to disclose.

View larger version (156K): [in a new window]   Figure 1a.  Spontaneous fibroid passage. (a, b) Sagittal single-shot fast spin-echo (SE) T2-weighted (repetition time msec/echo time msec = 4.4/64) (a) and gadolinium-enhanced fat-suppressed three-dimensional (3D) T1-weighted volumetric interpolated breath-hold examination (VIBE) (4.5/1.9, 15° flip angle) (b) MR images obtained 2 months after UAE show an infarcted fibroid (*) in the endometrial canal. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 1 year after UAE, the fibroid is no longer seen. The patient, who reported that the fibroid had been expelled spontaneously without complication, did not require treatment.

 

View larger version (164K): [in a new window]   Figure 1b.  Spontaneous fibroid passage. (a, b) Sagittal single-shot fast spin-echo (SE) T2-weighted (repetition time msec/echo time msec = 4.4/64) (a) and gadolinium-enhanced fat-suppressed three-dimensional (3D) T1-weighted volumetric interpolated breath-hold examination (VIBE) (4.5/1.9, 15° flip angle) (b) MR images obtained 2 months after UAE show an infarcted fibroid (*) in the endometrial canal. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 1 year after UAE, the fibroid is no longer seen. The patient, who reported that the fibroid had been expelled spontaneously without complication, did not require treatment.

 

View larger version (176K): [in a new window]   Figure 1c.  Spontaneous fibroid passage. (a, b) Sagittal single-shot fast spin-echo (SE) T2-weighted (repetition time msec/echo time msec = 4.4/64) (a) and gadolinium-enhanced fat-suppressed three-dimensional (3D) T1-weighted volumetric interpolated breath-hold examination (VIBE) (4.5/1.9, 15° flip angle) (b) MR images obtained 2 months after UAE show an infarcted fibroid (*) in the endometrial canal. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 1 year after UAE, the fibroid is no longer seen. The patient, who reported that the fibroid had been expelled spontaneously without complication, did not require treatment.

 

View larger version (173K): [in a new window]   Figure 1d.  Spontaneous fibroid passage. (a, b) Sagittal single-shot fast spin-echo (SE) T2-weighted (repetition time msec/echo time msec = 4.4/64) (a) and gadolinium-enhanced fat-suppressed three-dimensional (3D) T1-weighted volumetric interpolated breath-hold examination (VIBE) (4.5/1.9, 15° flip angle) (b) MR images obtained 2 months after UAE show an infarcted fibroid (*) in the endometrial canal. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 1 year after UAE, the fibroid is no longer seen. The patient, who reported that the fibroid had been expelled spontaneously without complication, did not require treatment.

 

View larger version (130K): [in a new window]   Figure 2a.  Fibroid passage requiring hysteroscopic intervention in a patient who complained of severe pain 3 months after undergoing UAE. Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D gradient-echo T1-weighted (193/4.76, 70° flip angle) (b) MR images show an infarcted fibroid (*) distending the endometrial canal and extending to the level of the internal os. Hysteroscopic resection of the fibroid was successfully performed and provided symptomatic relief.

 

View larger version (134K): [in a new window]   Figure 2b.  Fibroid passage requiring hysteroscopic intervention in a patient who complained of severe pain 3 months after undergoing UAE. Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D gradient-echo T1-weighted (193/4.76, 70° flip angle) (b) MR images show an infarcted fibroid (*) distending the endometrial canal and extending to the level of the internal os. Hysteroscopic resection of the fibroid was successfully performed and provided symptomatic relief.

 

View larger version (154K): [in a new window]   Figure 3a.  Fibroid passage requiring hysteroscopic resection. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images obtained prior to UAE show a dominant fibroid in the center of the uterus that is mostly sub-mucosal. Note the heterogeneous enhancement of the fibroid in b. (c) On a sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 27 days after UAE, the dominant fibroid is heterogeneous and enhances less than the adjacent myometrium. The fibroid has prolapsed through the open cervix into the vaginal fornix, with its stalk attached to the posterior uterine wall (arrow). (d) Follow-up sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 2 days after hysteroscopic removal of the prolapsing fibroid shows residual tissue at the site of attachment (arrow). Note that both the endocervical and endovaginal canals have returned to their native configurations.

 

View larger version (162K): [in a new window]   Figure 3b.  Fibroid passage requiring hysteroscopic resection. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images obtained prior to UAE show a dominant fibroid in the center of the uterus that is mostly sub-mucosal. Note the heterogeneous enhancement of the fibroid in b. (c) On a sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 27 days after UAE, the dominant fibroid is heterogeneous and enhances less than the adjacent myometrium. The fibroid has prolapsed through the open cervix into the vaginal fornix, with its stalk attached to the posterior uterine wall (arrow). (d) Follow-up sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 2 days after hysteroscopic removal of the prolapsing fibroid shows residual tissue at the site of attachment (arrow). Note that both the endocervical and endovaginal canals have returned to their native configurations.

 

View larger version (152K): [in a new window]   Figure 3c.  Fibroid passage requiring hysteroscopic resection. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images obtained prior to UAE show a dominant fibroid in the center of the uterus that is mostly sub-mucosal. Note the heterogeneous enhancement of the fibroid in b. (c) On a sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 27 days after UAE, the dominant fibroid is heterogeneous and enhances less than the adjacent myometrium. The fibroid has prolapsed through the open cervix into the vaginal fornix, with its stalk attached to the posterior uterine wall (arrow). (d) Follow-up sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 2 days after hysteroscopic removal of the prolapsing fibroid shows residual tissue at the site of attachment (arrow). Note that both the endocervical and endovaginal canals have returned to their native configurations.

 

View larger version (165K): [in a new window]   Figure 3d.  Fibroid passage requiring hysteroscopic resection. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images obtained prior to UAE show a dominant fibroid in the center of the uterus that is mostly sub-mucosal. Note the heterogeneous enhancement of the fibroid in b. (c) On a sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 27 days after UAE, the dominant fibroid is heterogeneous and enhances less than the adjacent myometrium. The fibroid has prolapsed through the open cervix into the vaginal fornix, with its stalk attached to the posterior uterine wall (arrow). (d) Follow-up sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) obtained 2 days after hysteroscopic removal of the prolapsing fibroid shows residual tissue at the site of attachment (arrow). Note that both the endocervical and endovaginal canals have returned to their native configurations.

 

View larger version (168K): [in a new window]   Figure 4a.  Endometritis in a patient who presented with complaints of pain, vaginal discharge, and fever 2 months after undergoing UAE. Sagittal (a) and axial (b) fast SE T2-weighted MR images (4.4/64), sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (c), and axial fat-suppressed gradient-echo T1-weighted MR image (193/4.76, 70° flip angle) (d) demonstrate an infarcted intramural fibroid whose inferior aspect is contiguous with the endometrial canal and that is beginning to pass into the endometrial canal. Note the punctate foci of signal void representing air, findings that can be associated with necrosis and superinfection. (Reprinted, with permission, from reference 18.)

 

View larger version (127K): [in a new window]   Figure 4b.  Endometritis in a patient who presented with complaints of pain, vaginal discharge, and fever 2 months after undergoing UAE. Sagittal (a) and axial (b) fast SE T2-weighted MR images (4.4/64), sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (c), and axial fat-suppressed gradient-echo T1-weighted MR image (193/4.76, 70° flip angle) (d) demonstrate an infarcted intramural fibroid whose inferior aspect is contiguous with the endometrial canal and that is beginning to pass into the endometrial canal. Note the punctate foci of signal void representing air, findings that can be associated with necrosis and superinfection. (Reprinted, with permission, from reference 18.)

 

View larger version (172K): [in a new window]   Figure 4c.  Endometritis in a patient who presented with complaints of pain, vaginal discharge, and fever 2 months after undergoing UAE. Sagittal (a) and axial (b) fast SE T2-weighted MR images (4.4/64), sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (c), and axial fat-suppressed gradient-echo T1-weighted MR image (193/4.76, 70° flip angle) (d) demonstrate an infarcted intramural fibroid whose inferior aspect is contiguous with the endometrial canal and that is beginning to pass into the endometrial canal. Note the punctate foci of signal void representing air, findings that can be associated with necrosis and superinfection. (Reprinted, with permission, from reference 18.)

 

View larger version (150K): [in a new window]   Figure 4d.  Endometritis in a patient who presented with complaints of pain, vaginal discharge, and fever 2 months after undergoing UAE. Sagittal (a) and axial (b) fast SE T2-weighted MR images (4.4/64), sagittal gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (c), and axial fat-suppressed gradient-echo T1-weighted MR image (193/4.76, 70° flip angle) (d) demonstrate an infarcted intramural fibroid whose inferior aspect is contiguous with the endometrial canal and that is beginning to pass into the endometrial canal. Note the punctate foci of signal void representing air, findings that can be associated with necrosis and superinfection. (Reprinted, with permission, from reference 18.)

 

View larger version (121K): [in a new window]   Figure 5a.  PID. (a) On a US image, the left fallopian tube is dilated with echogenic debris (arrows), a finding that is consistent with pyosalpinx. The left ovary (LO) is relatively spared. (b) US image shows incomplete septa projecting into a fluid-filled tubular structure (arrow), findings that help distinguish hydrosalpinx and pyosalpinx from other adnexal conditions.

 

View larger version (124K): [in a new window]   Figure 5b.  PID. (a) On a US image, the left fallopian tube is dilated with echogenic debris (arrows), a finding that is consistent with pyosalpinx. The left ovary (LO) is relatively spared. (b) US image shows incomplete septa projecting into a fluid-filled tubular structure (arrow), findings that help distinguish hydrosalpinx and pyosalpinx from other adnexal conditions.

 

View larger version (187K): [in a new window]   Figure 6.  Pyomyoma in a patient with sepsis who had undergone UAE 10 days earlier. CT scan of the pelvis obtained with use of oral and rectal contrast material shows an increased volume of gas within both an infarcted fibroid and the surrounding myometrium compared with prior CT scans (not shown). Pyomyoma was found at hysterectomy.

 

View larger version (138K): [in a new window]   Figure 7a.  Deep venous thrombosis. US images of the right (a) and left (b) common femoral veins obtained without (left side) and with (right side) compression 16 days after UAE show bilateral thrombi (V). Noncompressible, hypoechoic, nonocclusive thrombus is seen in the lumina of both veins (arrows).

 

View larger version (133K): [in a new window]   Figure 7b.  Deep venous thrombosis. US images of the right (a) and left (b) common femoral veins obtained without (left side) and with (right side) compression 16 days after UAE show bilateral thrombi (V). Noncompressible, hypoechoic, nonocclusive thrombus is seen in the lumina of both veins (arrows).

 

View larger version (98K): [in a new window]   Figure 8a.  Pulmonary embolism. (a, b) Contrast-enhanced CT scans of the thorax obtained 4 days after UAE (b obtained at a higher level than a) show a discrete filling defect (arrow) in a pulmonary artery branch to the right lower lobe. (c) Three-dimensional multiplanar reformatted image from contrast-enhanced CT data shows the filling defect expanding a pulmonary artery that supplies the right lower lobe (arrow), a finding that is diagnostic for a pulmonary embolus.

 

View larger version (105K): [in a new window]   Figure 8b.  Pulmonary embolism. (a, b) Contrast-enhanced CT scans of the thorax obtained 4 days after UAE (b obtained at a higher level than a) show a discrete filling defect (arrow) in a pulmonary artery branch to the right lower lobe. (c) Three-dimensional multiplanar reformatted image from contrast-enhanced CT data shows the filling defect expanding a pulmonary artery that supplies the right lower lobe (arrow), a finding that is diagnostic for a pulmonary embolus.

 

View larger version (87K): [in a new window]   Figure 8c.  Pulmonary embolism. (a, b) Contrast-enhanced CT scans of the thorax obtained 4 days after UAE (b obtained at a higher level than a) show a discrete filling defect (arrow) in a pulmonary artery branch to the right lower lobe. (c) Three-dimensional multiplanar reformatted image from contrast-enhanced CT data shows the filling defect expanding a pulmonary artery that supplies the right lower lobe (arrow), a finding that is diagnostic for a pulmonary embolus.

 

View larger version (136K): [in a new window]   Figure 9a.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (161K): [in a new window]   Figure 9b.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (159K): [in a new window]   Figure 9c.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (139K): [in a new window]   Figure 9d.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (167K): [in a new window]   Figure 9e.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (174K): [in a new window]   Figure 9f.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (154K): [in a new window]   Figure 9g.  Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.

 

View larger version (159K): [in a new window]   Figure 10.  Ovarian dysfunction. Gadolinium-enhanced 3D maximum-intensity-projection T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) clearly depicts dilated bilateral ovarian arterial collateral vessels (arrows). The presence of ovarian arterial collateral vessels to the uterus in patients with uterine fibroids may increase the risk for both premature menopause by means of inadvertent ovarian embolization-infarction and fibroid regrowth after UAE. (Reprinted, with permission, from reference 18.)

 

View larger version (167K): [in a new window]   Figure 11a.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (179K): [in a new window]   Figure 11b.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (169K): [in a new window]   Figure 11c.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (169K): [in a new window]   Figure 11d.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (126K): [in a new window]   Figure 11e.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (145K): [in a new window]   Figure 11f.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (161K): [in a new window]   Figure 11g.  Fibroid regrowth. (a, b) Sagittal single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (b) MR images obtained prior to UAE show a dominant intramural fibroid within the anterior uterine body. (c, d) On sagittal single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced gradient-echo T1-weighted (160/4.1, 80° flip angle) (d) MR images obtained 5 months after UAE, the dominant fibroid has decreased in size and vascularity. A nidus of enhancement in the fibroid continued to grow at 1-, 2-, and 3-year intervals after UAE. (e–g) Axial (e) and sagittal (f ) single-shot fast SE T2-weighted MR images (4.4/64) and a sagittal gadolinium-enhanced 3D T1-weighted VIBE MR image (4.5/1.9, 15° flip angle) (g) obtained 4 years after UAE show regrowth of the dominant fibroid without areas of infarction.

 

View larger version (148K): [in a new window]   Figure 12a.  Uterine necrosis. (a) Sagittal fast SE T2-weighted MR image (5700/81) obtained prior to UAE shows low-signal-intensity fibroids (F) embedded within the myometrium. (b) On an axial gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (180/1.5, 90° flip angle) obtained prior to UAE, both the index fibroid (F) and the adjacent myometrium (M) demonstrate enhancement. (c) On a sagittal fast SE T2-weighted MR image (6000/85) obtained 4 days after UAE, the myometrium has diffusely higher signal intensity than the index fibroid (F). (d) Delayed sagittal gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (195/1.6, 90° flip angle) shows no enhancement of the fibroids, endometrium, or myometrium, a finding that is consistent with uterine necrosis (N). Note the peripheral area of enhancement (arrow), a finding that is thought to represent a serosal rim of viable myometrium. (Reprinted, with permission, from reference 43.)

 

View larger version (153K): [in a new window]   Figure 12b.  Uterine necrosis. (a) Sagittal fast SE T2-weighted MR image (5700/81) obtained prior to UAE shows low-signal-intensity fibroids (F) embedded within the myometrium. (b) On an axial gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (180/1.5, 90° flip angle) obtained prior to UAE, both the index fibroid (F) and the adjacent myometrium (M) demonstrate enhancement. (c) On a sagittal fast SE T2-weighted MR image (6000/85) obtained 4 days after UAE, the myometrium has diffusely higher signal intensity than the index fibroid (F). (d) Delayed sagittal gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (195/1.6, 90° flip angle) shows no enhancement of the fibroids, endometrium, or myometrium, a finding that is consistent with uterine necrosis (N). Note the peripheral area of enhancement (arrow), a finding that is thought to represent a serosal rim of viable myometrium. (Reprinted, with permission, from reference 43.)

 

View larger version (154K): [in a new window]   Figure 12c.  Uterine necrosis. (a) Sagittal fast SE T2-weighted MR image (5700/81) obtained prior to UAE shows low-signal-intensity fibroids (F) embedded within the myometrium. (b) On an axial gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (180/1.5, 90° flip angle) obtained prior to UAE, both the index fibroid (F) and the adjacent myometrium (M) demonstrate enhancement. (c) On a sagittal fast SE T2-weighted MR image (6000/85) obtained 4 days after UAE, the myometrium has diffusely higher signal intensity than the index fibroid (F). (d) Delayed sagittal gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (195/1.6, 90° flip angle) shows no enhancement of the fibroids, endometrium, or myometrium, a finding that is consistent with uterine necrosis (N). Note the peripheral area of enhancement (arrow), a finding that is thought to represent a serosal rim of viable myometrium. (Reprinted, with permission, from reference 43.)

 

View larger version (159K): [in a new window]   Figure 12d.  Uterine necrosis. (a) Sagittal fast SE T2-weighted MR image (5700/81) obtained prior to UAE shows low-signal-intensity fibroids (F) embedded within the myometrium. (b) On an axial gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (180/1.5, 90° flip angle) obtained prior to UAE, both the index fibroid (F) and the adjacent myometrium (M) demonstrate enhancement. (c) On a sagittal fast SE T2-weighted MR image (6000/85) obtained 4 days after UAE, the myometrium has diffusely higher signal intensity than the index fibroid (F). (d) Delayed sagittal gadolinium-enhanced fat-suppressed gradient-echo T1-weighted MR image (195/1.6, 90° flip angle) shows no enhancement of the fibroids, endometrium, or myometrium, a finding that is consistent with uterine necrosis (N). Note the peripheral area of enhancement (arrow), a finding that is thought to represent a serosal rim of viable myometrium. (Reprinted, with permission, from reference 43.)

 

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