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Uterine Artery Embolization for the Treatment of Adenomyosis

Clinical Response and Evaluation with MR Imaging

Gary P. Siskin1, Mitchell E. Tublin, Brian F. Stainken, Kyran Dowling and Eric G. Dolen

1 All authors: Department of Radiology, A-113, Albany Medical College, 47 New Scotland Ave., Albany, NY 12208.



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Fig. 1A. 45-year-old woman with menorrhagia and diffuse adenomyosis. Nonselective pelvic arteriogram reveals tortuous and dilated uterine arteries (arrows).

 


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Fig. 1B. 45-year-old woman with menorrhagia and diffuse adenomyosis. Selective images from right (B) and left (C) uterine arteriograms show spiral arteries coursing into myometrium (arrowheads). Note lack of evidence of focal uterine mass.

 


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Fig. 1C. 45-year-old woman with menorrhagia and diffuse adenomyosis. Selective images from right (B) and left (C) uterine arteriograms show spiral arteries coursing into myometrium (arrowheads). Note lack of evidence of focal uterine mass.

 


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Fig. 1D. 45-year-old woman with menorrhagia and diffuse adenomyosis. Nonselective pelvic arteriogram obtained after bilateral embolization with polyvinyl alcohol particles shows occlusion of both uterine arteries.

 


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Fig. 1E. 45-year-old woman with menorrhagia and diffuse adenomyosis. Sagittal fast spin-echo T2-weighted MR image obtained before embolization shows uterine enlargement and diffuse adenomyosis. Junctional zone thickness (arrowheads) is 20 mm.

 


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Fig. 1F. 45-year-old woman with menorrhagia and diffuse adenomyosis. Sagittal fast spin-echo T2-weighted MR image obtained 6 months after embolization shows decrease in uterine size. Note residual regions (arrowheads) of decreased T2 signal intensity.

 


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Fig. 2A. 48-year-old woman with menorrhagia and focal adenomyosis. Sagittal fast spin-echo T2-weighted MR image obtained before embolization shows uterine enlargement and broad region of decreased T2 signal intensity (arrowheads). Note indistinct junctional zone and multiple small myometrial cysts.

 


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Fig. 2B. 48-year-old woman with menorrhagia and focal adenomyosis. Axial fast spin-echo T2-weighted MR image obtained before embolization shows deformation of uterine cavity by focal adenomyoma (arrows). Note large endometrioma (E).

 


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Fig. 2C. 48-year-old woman with menorrhagia and focal adenomyosis. Sagittal fast spin-echo T2-weighted MR image obtained 6 months after embolization shows marked reduction in uterine size. Note replacement of focal adenomyoma with residual region of decreased T2 signal intensity (arrowheads).

 


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Fig. 2D. 48-year-old woman with menorrhagia and focal adenomyosis. Axial fast spin-echo T2-weighted image obtained 6 months after embolization shows residual regions of decreased T2 signal intensity (arrowheads). Note bilateral endometriomas (E).

 

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