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Three-dimensional Color Doppler Sonography and Uterine Artery Arteriography of Fibroids

Assessment of Changes in Vascularity Before and After Embolization

Departments of Radiology and Radiological Sciences (C.J.M., A.C.F., E.F.D., M.J.M.) and Obstetrics and Gynecology (A.C.F.), Vanderbilt University Medical Center, Nashville, Tennessee

Address correspondence and reprint requests to C. Joseph Muniz, MD, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 21st Avenue South and Garland Street, R-1318 Medical Center North, Nashville, TN 37232-2675.

Objective. To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. Methods. Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. Results. In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography. The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%–78%). Conclusions. Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.

Key Words: uterine fibroids • color Doppler sonography • uterine artery embolization • three-dimensional sonography

Abbreviations: CDS, color Doppler sonography • MR, magnetic resonance • 3D, three-dimensional • UAA, uterine artery arteriography • UAE, uterine artery embolization

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