15.4. Uterine artery embolisation for leiomyomas – an alternetive to hysterectomy

 Public examination of a doctoral dissertation in the field of clinical radiology

Doctoral candidate: Lic Med, Radiologist Anu Ruuskanen

Time and venue: 15.4.2011 at 12 noon, Kuopio University Hospital, Auditorium 2

 Uterine leiomyomas constitute a substantial health issue for women and represent the most common single indication for hysterectomy. New treatment option, uterine artery embolisation (UAE) has been developed to substitute for major surgery but not evaluated in Finland.

The aim of this study was to compare the efficacy and safety of UAE and hysterectomy for the treatment of symptomatic leiomyomas in a prospective, randomised, controlled single-center trial with a 2-year follow-up. Further, magnetic resonance imaging (MRI) measures were used to assess the association of symptoms with MRI findings of leiomyomas, to evaluate the role of uterine ischaemia for the post-UAE pain, and to predict leiomyoma and uterus size reductions after UAE. Altogether 137 of 529 consecutive patients ready for hysterectomy were recruited to the study during 2002-2007 in Kuopio University Hospital in Finland. Twenty-seven patients were randomised to UAE and 30 to hysterectomy.

Analysed according to intention to treat, no major complications were encountered after UAE, while 7% of patients encountered major complications after hysterectomy. The mean hospitalisation and length of sick leave were shorter after UAE than after hysterectomy (1.3 vs 3.5 days, P=0.001; 11 vs 35 days, P=0.001; respectively). Menorrhagia relieved in 67% of UAE patients. Improvement of pressure symptoms was reported more frequently by UAE patients than by hysterectomy patients (95% vs 69%, P=0.029). Overall relief of symptoms (82% UAE vs 93% hysterectomy) and satisfaction of the treatments (89% UAE vs 97% hysterectomy) were good in both groups. Additional interventions were needed in 19% after UAE and in 10% after hysterectomy. Of preinterventional MRI characteristics, presence of a leiomyoma ≥50% protruding into uterine cavity, intense contrast enhancement of leiomyomas and smaller leiomyoma size were associated with menorrhagia. The large uterine and leiomyoma size were associated with increased urinary frequency, while urinary stress incontinence, abdominal pain, and pressure to back were not associated with any MRI finding. Myometrial ischaemia on 24-hour MRI and large volume of embolic material were associated with post-UAE pain that was often severe. Leiomyoma and uterus size reductions after UAE were predicted by leiomyoma-to-skeletal muscle T2 SI-ratio and T1-time of the pre-UAE MRI.

In summary, UAE is a safe and effective treatment for leiomyomas being preferable for patients with pressure symptoms. MRI findings of leiomyomata uteri give anatomical base for menorrhagia and increased urinary frequency. Post-UAE pain is partly explained by myometrial ischaemia. Uterus and leiomyoma size reduction after UAE can be predicted from pre-UAE MRI measures.

The doctoral dissertation of Licenciate of Medicine , Radiologist Anu Ruuskanen, entitled Uterine Artery Embolisation for Leiomyomas: Magnetic Resonance Imaging Studies and a Randomised Prospective Comparison with Hysterectomy will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Lars Lönn of the University of Copenhagen and the custos will be Professor Hannu Manninen of the University of Eastern Finland.

Dissertation (PDF)

Photo available for download at http://www.uef.fi/vaitoskuvat  

Contact: Anu Ruuskanen, tel. 044 7174360, anu.ruuskanen@kuh.fi.

Publishing year: 2011

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