ABSTRACT
PURPOSE: The aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI. METHODS: This was an institutional review board-approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years). RESULTS: There was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306). CONCLUSIONS: After initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups.
Subject(s)
Leiomyoma/epidemiology , Leiomyoma/therapy , Magnetic Resonance Imaging, Interventional/statistics & numerical data , Physician Self-Referral/statistics & numerical data , Uterine Artery Embolization/statistics & numerical data , Uterine Neoplasms/epidemiology , Uterine Neoplasms/therapy , Adult , Female , Humans , Incidental Findings , Leiomyoma/diagnostic imaging , Marketing of Health Services/statistics & numerical data , Middle Aged , North Carolina/epidemiology , Pelvis/diagnostic imaging , Pelvis/pathology , Prevalence , Retrospective Studies , Treatment Outcome , United States , Uterine Neoplasms/diagnostic imaging , Utilization ReviewABSTRACT
The imaging modality used to diagnose and monitor brain gliomas is magnetic resonance imaging (MRI), with standard protocols including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) image sequences. Many clinical trials are currently using contrast-enhanced T1-weighted MR image sequences to evaluate tumor response to treatment, but it is our hypothesis that FLAIR sequences will detect higher tumor volumes and, therefore, should be the preferred image sequence for this purpose. In this retrospective study, a volumetric analysis was conducted on the post-contrast T1-weighted and FLAIR MR image sequences of 38 patients with confirmed brain gliomas. The two volumes were subsequently found to have a statistically significant positive correlation. The FLAIR volume was also found to be greater than the post-contrast T1-weighted volume in all 38 patients. As a result, FLAIR image sequences provide a more complete characterization of gliomas and may be more beneficial when observing tumor response after treatment.
