The growth of a uterine fibroid is proportional to its vascularity, and determining growth potential of the fibroid is helpful in clinical decision making [79,80]. Uterine artery Doppler flow measurements with peak systolic velocity >64 cm/s in uteri with fibroids have been shown as a predictor of UFE failure [81]. In a study by Nieuwenhuis et al [82], fibroid vascularization evaluated by 3-D TVUS with power Doppler correlated with fibroid volume and predicted fibroid growth rate per year. However, MRI pelvis has a higher sensitivity and accuracy than US in identifying number, location, size, volume, and vascularity of uterine fibroids for treatment planning [24,49,59]. Variant 3: Known fibroids. Surveillance or posttreatment imaging. CT Pelvis Although CT pelvis has no direct role in routine surveillance or posttreatment follow-up of uterine fibroids, CT, preferably with IV contrast, may be used following UFE in patients with pelvic pain, fever for acute postprocedural complications such as infection, hemorrhage, or pelvic venous thrombosis [83]. The overall serious post-UFE complication rate is 1.25%, with pulmonary embolism and infection (endometritis, pyometra, pyomyoma) occurring in up to 0.25% and 2% of patients, respectively [25,41,83]. MRI Pelvis When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred [26]. Please see the ACR Manual on Contrast Media for additional information [27]. Routine posttreatment surveillance is controversial, and there is no consensus when to image asymptomatic women postintervention. Most studies evaluate patients immediately, 3 months, and/or 12 months after treatment and rely on T1-weighted, T2-weighted, and postcontrast sequences. Parameters commonly assessed include uterine volume, fibroid volume, percent infarcted/nonperfused volume, ovarian arterial collateral supply to the uterus, and fibroid location [25,41,67,70,83-87].
Fibroids. The growth of a uterine fibroid is proportional to its vascularity, and determining growth potential of the fibroid is helpful in clinical decision making [79,80]. Uterine artery Doppler flow measurements with peak systolic velocity >64 cm/s in uteri with fibroids have been shown as a predictor of UFE failure [81]. In a study by Nieuwenhuis et al [82], fibroid vascularization evaluated by 3-D TVUS with power Doppler correlated with fibroid volume and predicted fibroid growth rate per year. However, MRI pelvis has a higher sensitivity and accuracy than US in identifying number, location, size, volume, and vascularity of uterine fibroids for treatment planning [24,49,59]. Variant 3: Known fibroids. Surveillance or posttreatment imaging. CT Pelvis Although CT pelvis has no direct role in routine surveillance or posttreatment follow-up of uterine fibroids, CT, preferably with IV contrast, may be used following UFE in patients with pelvic pain, fever for acute postprocedural complications such as infection, hemorrhage, or pelvic venous thrombosis [83]. The overall serious post-UFE complication rate is 1.25%, with pulmonary embolism and infection (endometritis, pyometra, pyomyoma) occurring in up to 0.25% and 2% of patients, respectively [25,41,83]. MRI Pelvis When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred [26]. Please see the ACR Manual on Contrast Media for additional information [27]. Routine posttreatment surveillance is controversial, and there is no consensus when to image asymptomatic women postintervention. Most studies evaluate patients immediately, 3 months, and/or 12 months after treatment and rely on T1-weighted, T2-weighted, and postcontrast sequences. Parameters commonly assessed include uterine volume, fibroid volume, percent infarcted/nonperfused volume, ovarian arterial collateral supply to the uterus, and fibroid location [25,41,67,70,83-87].