الفهرس 
Radiological anatomy of the Uterus
Clinical manifestationsOnly 14 pages are availabe for public view
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Abstract
Uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short- and mid-term outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay, and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures.
It is of paramount importance to obtain thorough information of the presence and nature of uterine myomas to precisely counsel women as to the risks and benefits of UFE. Sonography as the first line of management is readily available, can accurately confirm the presence of uterine fibroids and concomitant uterine enlargement. However, the pre-procedural evaluation of the size, number, and location of uterine fibroids can be made with much greater accuracy using pelvic Magnetic resonance imaging (MRI) as compared with sonography. MRI is the best imaging modality to diagnose, map, and characterize fibroids. It can also diagnose benign and malignant concurrent pelvic pathology, which may also be responsible for the symptoms. Some of these pathologies may preclude UFE, or change the embolization protocol, such as the presence of adenomyosis.
Pre-procedure MR imaging has also proved advantageous in evaluating the features pertinent to UFE success, as well as assessing potential risks for complications. We found out that Pre-embolization size is the most important factor that is associated with variability in volume reduction following UFE rather than location and enhancement. Moreover, non-enhancing myomas respond well to UFE.
For technically successful UFE, a microcatheter should be inserted into transverse portion of uterine artery without complications, like arterial spasm, dissection, or perforation. It is essential to portray the origin of the uterine artery, that is variable, and to comprehend its three-dimensional configuration. Although conventional angiography considered to be the gold standard for vascular assessment, preprocedural three-dimensional (3D) magnetic resonance
angiography (MRA) can afford pertinent preliminary information on uterine, ovarian, and pelvic vascular anatomy, shortening the operative time and ameliorating technical success rates.
The MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities is typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE.