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Can 1H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?

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Abstract

Purpose

Absence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6 months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether 1H MR spectroscopy (1H MRS) can also indicate the success of UAE.

Method

20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5 T) were acquired pre-, 24-h and 6 months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p < 0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed.

Results

Choline was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6 months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6 months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6 months (mean/min/max 396.5/84.1/997.5 cm3, p = 0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6 months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/−230.6/382.6 cm3, p = 0.15). The negative minimum value indicates fibroid growth.

Conclusions

This study has demonstrated the potential of 1H MRS to provide an additional marker of the success of UAE.

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Acknowledgments

The authors gratefully acknowledge the funding received from the British Society of Interventional Radiology to carry out this study (Grant Reference 985345).

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Authors and Affiliations

  1. Clinical Research Imaging Centre, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK

    Gillian Macnaught

  2. Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK

    G. Ananthakrishnan, R. Yadavali, M. Ritchie & J. G. Moss

  3. Radiology Department, Wishaw General Hospital, 50 Netherton Street, Wishaw, ML2 0DP, UK

    L. Hinksman

  4. Radiology Department, Stobhill Hospital, 133 Balornock Road, Glasgow, G21 3UW, UK

    F. Bryden

  5. Radiology Department, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, UK

    S. Lassman

  6. School of Mathematics and Statistics, University Gardens, University of Glasgow, Glasgow, G12 8QW, UK

    K. Gallacher

  7. Interventional Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    C. Hay

Authors
  1. Gillian Macnaught
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  2. G. Ananthakrishnan
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  3. L. Hinksman
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  4. R. Yadavali
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  7. M. Ritchie
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  8. K. Gallacher
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  9. C. Hay
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  10. J. G. Moss
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Corresponding author

Correspondence to Gillian Macnaught.

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Conflict of interest

This study was funded by the British Society of Interventional Radiology (grant number 985345). This is reported in the disclosure forms for authors 1, 4 and 10. All authors declare that they have no conflicts of interest.

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Macnaught, G., Ananthakrishnan, G., Hinksman, L. et al. Can 1H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?. Cardiovasc Intervent Radiol 39, 376–384 (2016). https://doi.org/10.1007/s00270-015-1179-z

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  • DOI: https://doi.org/10.1007/s00270-015-1179-z

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