Uterine artery embolization for symptomatic adenomyosis: A new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes

ManDeuk Kim, Yong Min Kim, Hyun Cheol Kim, Jung Hyun Cho, Hyung Gon Kang, Chan Lee, Hee Jin Kim, Jong Tae Lee

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: To evaluate the safety and effectiveness of a new embolization technique named the 1-2-3 protocol to achieve complete necrosis of adenomyosis after uterine artery embolization (UAE) and to determine predictive factors on magnetic resonance (MR) imaging. Materials and Methods: A total of 40 patients with adenomyosis without leiomyomas diagnosed on MR imaging were prospectively enrolled. They were subdivided into three categories based on MR signal intensity (SI) of the adenomyosis on T2-weighted imaging: dark, low, and heterogeneous SI or SI equal to that of the myometrium. Nonspherical polyvinyl alcohol particles were used in all cases, beginning with 150-250-μm particles and progressively increasing to 250-355-μm and then 355-500-μm particles to the endpoint. Patients were assessed for extent of devascularization on MR imaging and for durability of symptom control. Results: Of the 40 patients who underwent UAE for adenomyosis with the 1-2-3 protocol, 33 (82.5%) exhibited complete necrosis of adenomyosis. All six patients with dark SI of adenomyosis exhibited complete necrosis (100%). Of the 28 patients with low SI of adenomyosis, 25 (89.3%) showed complete necrosis. Among the six patients with heterogenous SI or SI equal to that of myometrium, only two (33.3%) showed complete necrosis (P < .01). Of 16 patients with complete necrosis followed up to 18 months, none reported recurrent menorrhagia. Of the five patients without necrosis, only one had no symptoms at 18 months. Conclusions: UAE with the 1-2-3 protocol is safe and highly effective to achieve complete necrosis of adenomyosis. Dark SI of adenomyosis is the most favorable predictive factor for UAE on MR imaging, followed by low SI. Heterogenous SI or SI equal to that of the myometrium is an unfavorable predictive factor.

Original languageEnglish
Pages (from-to)497-502
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume22
Issue number4
DOIs
Publication statusPublished - 2011 Apr 1

Fingerprint

Uterine Artery Embolization
Adenomyosis
Magnetic Resonance Imaging
Necrosis
Myometrium
Menorrhagia
Polyvinyl Alcohol
Leiomyoma
Magnetic Resonance Spectroscopy
Safety

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, ManDeuk ; Kim, Yong Min ; Kim, Hyun Cheol ; Cho, Jung Hyun ; Kang, Hyung Gon ; Lee, Chan ; Kim, Hee Jin ; Lee, Jong Tae. / Uterine artery embolization for symptomatic adenomyosis : A new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. In: Journal of Vascular and Interventional Radiology. 2011 ; Vol. 22, No. 4. pp. 497-502.
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title = "Uterine artery embolization for symptomatic adenomyosis: A new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes",
abstract = "Purpose: To evaluate the safety and effectiveness of a new embolization technique named the 1-2-3 protocol to achieve complete necrosis of adenomyosis after uterine artery embolization (UAE) and to determine predictive factors on magnetic resonance (MR) imaging. Materials and Methods: A total of 40 patients with adenomyosis without leiomyomas diagnosed on MR imaging were prospectively enrolled. They were subdivided into three categories based on MR signal intensity (SI) of the adenomyosis on T2-weighted imaging: dark, low, and heterogeneous SI or SI equal to that of the myometrium. Nonspherical polyvinyl alcohol particles were used in all cases, beginning with 150-250-μm particles and progressively increasing to 250-355-μm and then 355-500-μm particles to the endpoint. Patients were assessed for extent of devascularization on MR imaging and for durability of symptom control. Results: Of the 40 patients who underwent UAE for adenomyosis with the 1-2-3 protocol, 33 (82.5{\%}) exhibited complete necrosis of adenomyosis. All six patients with dark SI of adenomyosis exhibited complete necrosis (100{\%}). Of the 28 patients with low SI of adenomyosis, 25 (89.3{\%}) showed complete necrosis. Among the six patients with heterogenous SI or SI equal to that of myometrium, only two (33.3{\%}) showed complete necrosis (P < .01). Of 16 patients with complete necrosis followed up to 18 months, none reported recurrent menorrhagia. Of the five patients without necrosis, only one had no symptoms at 18 months. Conclusions: UAE with the 1-2-3 protocol is safe and highly effective to achieve complete necrosis of adenomyosis. Dark SI of adenomyosis is the most favorable predictive factor for UAE on MR imaging, followed by low SI. Heterogenous SI or SI equal to that of the myometrium is an unfavorable predictive factor.",
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Uterine artery embolization for symptomatic adenomyosis : A new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. / Kim, ManDeuk; Kim, Yong Min; Kim, Hyun Cheol; Cho, Jung Hyun; Kang, Hyung Gon; Lee, Chan; Kim, Hee Jin; Lee, Jong Tae.

In: Journal of Vascular and Interventional Radiology, Vol. 22, No. 4, 01.04.2011, p. 497-502.

Research output: Contribution to journalArticle

TY - JOUR

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T2 - A new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes

AU - Kim, ManDeuk

AU - Kim, Yong Min

AU - Kim, Hyun Cheol

AU - Cho, Jung Hyun

AU - Kang, Hyung Gon

AU - Lee, Chan

AU - Kim, Hee Jin

AU - Lee, Jong Tae

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N2 - Purpose: To evaluate the safety and effectiveness of a new embolization technique named the 1-2-3 protocol to achieve complete necrosis of adenomyosis after uterine artery embolization (UAE) and to determine predictive factors on magnetic resonance (MR) imaging. Materials and Methods: A total of 40 patients with adenomyosis without leiomyomas diagnosed on MR imaging were prospectively enrolled. They were subdivided into three categories based on MR signal intensity (SI) of the adenomyosis on T2-weighted imaging: dark, low, and heterogeneous SI or SI equal to that of the myometrium. Nonspherical polyvinyl alcohol particles were used in all cases, beginning with 150-250-μm particles and progressively increasing to 250-355-μm and then 355-500-μm particles to the endpoint. Patients were assessed for extent of devascularization on MR imaging and for durability of symptom control. Results: Of the 40 patients who underwent UAE for adenomyosis with the 1-2-3 protocol, 33 (82.5%) exhibited complete necrosis of adenomyosis. All six patients with dark SI of adenomyosis exhibited complete necrosis (100%). Of the 28 patients with low SI of adenomyosis, 25 (89.3%) showed complete necrosis. Among the six patients with heterogenous SI or SI equal to that of myometrium, only two (33.3%) showed complete necrosis (P < .01). Of 16 patients with complete necrosis followed up to 18 months, none reported recurrent menorrhagia. Of the five patients without necrosis, only one had no symptoms at 18 months. Conclusions: UAE with the 1-2-3 protocol is safe and highly effective to achieve complete necrosis of adenomyosis. Dark SI of adenomyosis is the most favorable predictive factor for UAE on MR imaging, followed by low SI. Heterogenous SI or SI equal to that of the myometrium is an unfavorable predictive factor.

AB - Purpose: To evaluate the safety and effectiveness of a new embolization technique named the 1-2-3 protocol to achieve complete necrosis of adenomyosis after uterine artery embolization (UAE) and to determine predictive factors on magnetic resonance (MR) imaging. Materials and Methods: A total of 40 patients with adenomyosis without leiomyomas diagnosed on MR imaging were prospectively enrolled. They were subdivided into three categories based on MR signal intensity (SI) of the adenomyosis on T2-weighted imaging: dark, low, and heterogeneous SI or SI equal to that of the myometrium. Nonspherical polyvinyl alcohol particles were used in all cases, beginning with 150-250-μm particles and progressively increasing to 250-355-μm and then 355-500-μm particles to the endpoint. Patients were assessed for extent of devascularization on MR imaging and for durability of symptom control. Results: Of the 40 patients who underwent UAE for adenomyosis with the 1-2-3 protocol, 33 (82.5%) exhibited complete necrosis of adenomyosis. All six patients with dark SI of adenomyosis exhibited complete necrosis (100%). Of the 28 patients with low SI of adenomyosis, 25 (89.3%) showed complete necrosis. Among the six patients with heterogenous SI or SI equal to that of myometrium, only two (33.3%) showed complete necrosis (P < .01). Of 16 patients with complete necrosis followed up to 18 months, none reported recurrent menorrhagia. Of the five patients without necrosis, only one had no symptoms at 18 months. Conclusions: UAE with the 1-2-3 protocol is safe and highly effective to achieve complete necrosis of adenomyosis. Dark SI of adenomyosis is the most favorable predictive factor for UAE on MR imaging, followed by low SI. Heterogenous SI or SI equal to that of the myometrium is an unfavorable predictive factor.

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