Before UAE: fibroid map, enhancement (non-enhancing fibroids respond poorly), pedunculated subserosal or submucosal fibroids at risk, adenomyosis, and alternatives; after UAE: infarction percentage, expulsion and complications.
Orient first
- Complete fibroid infarction on post-UAE MRI predicts durable symptom relief.
- Pedunculated fibroids with a thin stalk and large submucosal fibroids carry specific risks (detachment, expulsion).
- Ovarian artery supply to fibroids causes incomplete infarction.
Acquire the study
- Pelvic MRI: sagittal and axial T2, T1, post-gadolinium T1 (with subtraction); MRA for ovarian collaterals where relevant.
The manoeuvre
- Pre-UAE T2: size in cm and FIGO type of the dominant fibroids; uterine volume in ml.
- Post-contrast T1: enhancing vs non-enhancing fibroids.
- Stalk width of pedunculated fibroids in mm; submucosal fibroid cavity contact.
- Post-UAE subtraction images: % non-enhancing (infarcted) fibroid volume.
- Complications: expulsion, endometritis, pyomyoma (gas), non-target infarction.
What confirms it
- Pre-procedure map and post-procedure infarction percentage.
What licenses you to exclude it
- Complete absence of enhancement after UAE indicates complete infarction.
The classic misread
- T1-bright haemorrhagic infarction mistaken for enhancement without subtraction.