Department of Radiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553 Berlin, Germany.
Radiology. 2010 Jun;255(3):834-41. doi: 10.1148/radiol.10090977. Epub 2010 Apr 14.
To determine the effect of partial versus complete leiomyoma infarction on relief of leiomyoma-related symptoms and freedom from invasive reinterventions and to assess if patient age, location of the dominant leiomyoma, number of leiomyomas, or baseline uterine and dominant leiomyoma volume were associated with clinical failure.
Study protocol was approved by the institutional review board, and informed consent was obtained. One hundred fifteen consecutive women (median age, 42 years; range, 34-61 years) with symptomatic uterine leiomyomas underwent contrast material-enhanced magnetic resonance (MR) imaging at baseline and 24-72 hours after uterine artery embolization (UAE) to determine the percentage of infarction of leiomyoma tissue (complete = 100%, almost complete = 90%-99%, and partial = 0%-89%). Clinical outcome and frequency of reinterventions were compared for up to 36 months.
One hundred thirteen patients completed at least one clinical follow-up. Twenty-four months after UAE, 50% +/- 15.2 (standard error) of the patients with partial infarction and 80% +/- 13.4 (standard error) of patients with almost complete infarction had undergone no reintervention. No patient with complete infarction needed a second treatment (P < .001). The hazard ratios for reintervention between the complete infarction group and the almost complete and partial infarction groups were 15.88 (95% confidence interval [CI]: 1.22, 2225.54; P = .034) and 73.08 (95% CI: 8.33, 9636.35; P < .001), respectively. There were significant differences in hazard ratios between patients with partial and those with complete infarction for persistence or recurrence of menorrhagia (hazard ratio, 7.45; 95% CI: 2.08, 28.31; P = .002) and bulk-related symptoms (hazard ratio, 5.90; 95% CI: 1.66, 21.92; P = .007). There was no significant correlation between patient age, number of leiomyomas, location of the dominant leiomyoma, or baseline uterine and dominant leiomyoma volume and clinical failure.
Women with leiomyoma infarction above 90% on contrast-enhanced MR images after UAE show significantly better symptom control and fewer reinterventions than do patients with a lower infarction rate.
确定子宫肌瘤部分与完全梗死对缓解子宫肌瘤相关症状和避免侵入性再干预的效果,并评估患者年龄、优势子宫肌瘤位置、肌瘤数量以及基线子宫和优势子宫肌瘤体积是否与临床失败相关。
本研究方案获得了机构审查委员会的批准,并获得了患者的知情同意。115 例有症状的子宫肌瘤女性患者(中位年龄 42 岁;范围,34-61 岁)在子宫动脉栓塞术(UAE)前后进行了对比增强磁共振成像(MR)检查,以确定肌瘤组织梗死的百分比(完全=100%,几乎完全=90%-99%,部分=0%-89%)。比较了长达 36 个月的临床结果和再干预频率。
113 例患者完成了至少一次临床随访。在 UAE 后 24 个月,50%±15.2(标准误差)的部分梗死患者和 80%±13.4(标准误差)的几乎完全梗死患者未接受再干预。没有完全梗死的患者需要进行第二次治疗(P<.001)。完全梗死组与几乎完全和部分梗死组之间的再干预风险比分别为 15.88(95%置信区间[CI]:1.22,2225.54;P=0.034)和 73.08(95% CI:8.33,9636.35;P<.001)。在持续性或复发性月经过多(风险比,7.45;95% CI:2.08,28.31;P=0.002)和肿块相关症状(风险比,5.90;95% CI:1.66,21.92;P=0.007)方面,部分梗死患者与完全梗死患者之间的风险比存在显著差异。患者年龄、肌瘤数量、优势子宫肌瘤位置以及基线子宫和优势子宫肌瘤体积与临床失败之间无显著相关性。
在 UAE 后对比增强磁共振成像上显示肌瘤梗死率超过 90%的女性患者,其症状控制明显更好,再干预率也较低。