Post-uterine artery embolization: 3-day MRI changes and their predictive value for therapeutic efficacy in symptomatic uterine fibroids

Objectives: To summarize and discuss 3-day MRI changes after uterine artery embolization (UAE) and their predictive value for efficacy. Methods: From August 2016 to April 2023, 52 patients underwent enhanced MRI within 3 days post-embolization. We retrospectively analysed clinical and imaging data, focusing on MR characteristics at the 3-day mark, comparing preand post-embolization images. Patients were categorized based on 3-day MR findings into complete and incomplete necrosis groups, with clinical efficacy compared over 6 months. Results: Our study included 30 cases of multiple leiomyomas and 22 of single leiomyomas. Postoperative MRI revealed complete necrosis in 31 tumours and incomplete necrosis in 21 tumours. At 3 days, MR ADC imaging showed increased signals in necrotic areas, mildly increased signals on T2-weighted images, and minimal changes on T1-weighted images. Six-month follow-up showed no significant difference in symptom improvement between groups (P = .524, P = .587, P = .615). However, a significant difference was found in leiomyoma volume reduction, with 70.63 +/- 15.53% in the complete necrosis group and 51.36 +/- 25.20% in the incomplete necrosis group (P < .001), highlighting the impact of necrosis extent on volumetric reduction. Conclusion: Short-term MRI changes after UAE can reflect changes in blood supply to fibroids and normal uterine tissue, and have good predictive value for medium-term embolization efficacy. Advances in knowledge: This study describes short-term MR manifestations of complete and incomplete embolism, aiding in predicting longterm outcome.