E-ISSN 1305-3612
1 Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China  
2 Department of Radiology, Huangpu Division, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China  
3 Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China  
Diagn Interv Radiol ; : -

Abstract

 

PURPOSE: To identify predisposing factors that could help predict the therapeutic response of adenomyosis after uterine artery embolization (UAE).

 

METHODS: This was a retrospective, single-institute study of patients admitted to the hospital for adenomyosis between 2013 and 2015. Sixty-eight patients with adenomyosis who underwent UAE with tris-acryl gelatin microspheres were divided into two groups based on their therapeutic response (complete necrosis or incomplete necrosis of lesions), and pre- and post-procedural pelvic magnetic resonance imaging (MRI) data. Patients were followed-up for 12 months after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the symptom relief criteria. Improvement rates in both groups were analyzed and compared. Multivariate logistic regression analysis was used to identify the predisposing factors from retrospectively gathered baseline data that might affect the therapeutic response, including MRI features, clinical symptoms, biochemical index, and accompanying diseases of adenomyosis. Then, a prognostic model was established, and the receiver operating characteristic (ROC) curve of identified factors was drawn to determine the predictive value.

 

RESULTS: Forty-six (67.65%) patients showed complete necrosis after UAE; the other 22 (32.35%) patients showed incomplete necrosis. Improvement rates for dysmenorrhea in both groups were 94.74% (complete necrosis) and 50.0% (incomplete necrosis) at 12-month follow-up (P < 0.001). Improvement rates for menorrhagia for the two groups were 96.15% (complete necrosis) and 57.14% (incomplete necrosis) at 12-month follow-up (P = 0.004). Predisposing factors determined from the multivariate logistic regression analysis were serum cancer antigen 125 (CA125) levels (odds ratio [OR], 1.006; 95% confidence interval [CI], 1.002-1.010; P = 0.005) and accompanying endometriosis (OR, 6.869; 95% CI, 1.881-25.016; P = 0.004). The areas under the ROC curve of CA125, endometriosis, and these two indicators combined were 0.785, 0.708, and 0.845, which corresponded to sensitivities and specificities of 95.5% and 52.2%, 66.7% and 80.0%, and 68.20% and 87.0% at optimal cut-off values, respectively.

 

CONCLUSION: Symptom relief of dysmenorrhea and menorrhagia for patients with complete necrosis was significantly better than that for patients with incomplete necrosis. Serum CA125 levels and accompanying endometriosis can effectively distinguish complete necrosis from incomplete necrosis.

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