Fibroids Treated With Uterine Artery Embolization: Do Imaging Findings Correlate With Patient Outcomes?

Objective: To evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). Materials and Methods: Sixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. Results: Changes in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P > 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P < 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P < 0.05). Conclusion: We found poor correlation between imaging findings and patient-perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE.