Uterine artery embolization for the treatment of adenomyosis: Clinical response and evaluation with MR imaging

OBJECTIVE. This study was performed to evaluate the MR imaging appearance a nd clinical response of patients undergoing uterine artery embolization for the treatment of menorrhagia due to adenomyosis. MATERIALS AND METHODS. A retrospective review of 15 patients with adenomyos is and menorrhagia who underwent uterine artery embolization was performed. The diagnosis of adenomyosis was based on established MR imaging criteria. Clinical response was assessed at a minimum of 3 months after embolization . Follow-up MR imaging was per formed 6 months after embolization. RESULTS. Of the 15 patients in this study, five had diffuse adenomyosis wit hout evidence of uterine fibroids, one had focal adenomyosis without eviden ce of uterine fibroids, and the remaining nine had adenomyosis with one or more fibroids. At follow-up, 12 (92.3%) of the 13 patients reported signifi cant improvement in presenting symptoms and quality of life. One patient co ntinued experiencing menorrhagia, and one patient experienced amenorrhea du ring the 5 months of follow-up after embolization. MR imaging in nine patie nts, performed at a mean of 5.9 months after embolization, revealed signifi cant reductions in median uterine volume (42%), median fibroid volume (71%) , and mean-junctional-zone thickness (11 mm; 33%; p < 0.5). Six of the nine patients had subendometrial regions of decreased T2 signal intensity after embolization. CONCLUSION. Uterine artery embolization is a promising nonsurgical alternat ive for patients with menorrhagia and adenomyosis. Significant improvement in presenting symptoms and in quality of life is associated with decreases in uterine size and junctional zone thickness. Larger prospective studies a re needed to establish the safety and efficacy of this procedure for patien ts with adenomyosis.