ABSTRACT
This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine artery embolization (UAE). The merits of magnetic resonance angiography (MRA) in demonstrating the pelvic vasculature to guide UAE are highlighted. MRI features of fibroids and their main differential diagnoses are presented. Fibroid characteristics, such as location, size, and enhancement, which may impact patient selection and outcome, are presented based on recent literature. Pelvic arterial anatomy relevant to UAE, including vascular variants are illustrated, with conventional angiography and MRA imaging correlation. MRA preprocedural determination of the optimal projection angles for uterine artery catheterization is straightforward and constitutes an important strategy to minimize ionizing radiation exposure during UAE. A reporting template for MRI/MRA preassessement of UAE for fibroid treatment is provided.
Subject(s)
Leiomyoma/diagnostic imaging , Magnetic Resonance Angiography/methods , Magnetic Resonance Imaging/methods , Pelvis/blood supply , Diagnosis, Differential , Female , Humans , Leiomyoma/therapy , Pelvis/diagnostic imaging , Treatment Outcome , Uterine Artery Embolization/methodsABSTRACT
Retrospective study to evaluate local tumor control and survival data after transcatheter arterial chemoembolization with doxorubicin eluting beads in the treatment of hepatocellular carcinoma. Between April 2007 and November 2008, a total of 47 patients (mean age 61,7 years; range 42-84 years) with hepatocellular carcinoma were treated with transcatheter arterial chemoembolization. In total 73 chemoembolization procedures were performed in superselective manner with microcatheter (mean 1,57 procedures per patient). The local chemoembolization protocol consisted of doxorubicin eluting beads mainly 300-500 micra but also 500-700 micra and 700-900 micra, to a maximum dose per session of 150 mg doxorubicin. Tumor response was evaluated with CT imaging. Change in tumor size was calculated and response was evaluated according to the European Association for the Study of the Liver (EASL) criteria. Survival from first chemoembolization was calculated in the subgroup treated between April 2007 and January 2008 (24 patients). Follow-up imaging was performed until January 2009 or patient death. Evaluation of tumor response resulted in complete response in 13 patients (27,7%), partial response in 15 patients (31,9%), stable disease in 9 patients (19,1%) and progressive disease in 10 patients (21,3%). The one year survival rate after chemoembolization in the 24-patient subgroup was 54%. Chemoembolization with doxorubicin eluting beads is a minimally invasive, safe and effective therapy option for palliative treatment of hepatocellular carcinoma.
