Treatment of adenomyosis, abdominal wall endometriosis and uterine leiomyoma with interventional radiology: A review of current evidences

Imaging in France: 2024 Update

Radiology in France has made major advances in recent years through innovations in research and clinical practice. French institutions have developed innovative imaging techniques and artificial intelligence applications in the field of diagnostic imaging and interventional radiology. These include, but are not limited to, a more precise diagnosis of cancer and other diseases, research in dual-energy and photon-counting computed tomography, new applications of artificial intelligence, and advanced treatments in the field of interventional radiology. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of radiology in France. By highlighting key contributions in diagnostic imaging, artificial intelligence, and interventional radiology, we provide a comprehensive overview of how these innovations are improving patient outcomes, enhancing diagnostic accuracy, and expanding the possibilities for minimally invasive therapies. As the field continues to evolve, France's position at the forefront of radiological research ensures that these innovations will play a central role in addressing current healthcare challenges and improving patient care on a global scale.

Percutaneous image-guided cryoablation of venous malformation and fibro-adipose vascular anomaly: prognostic factors of clinical efficacy

OBJECTIVE

To assess the prognostic factors for clinical and radiological responses to percutaneous image-guided cryoablation (CA) in treating venous malformation (VM) and fibro-adipose vascular anomaly (FAVA).

MATERIALS AND METHODS

Fifty-five patients (12 males, 43 females; median age: 30 years) with symptomatic lesions (median VAS pain score: 70; median initial volume: 12.2 mm³) underwent CA between 2012 and 2023. CA was a first-line treatment in 23 patients (42%) and second-line in 32 (58%). Lesions were Goyal grade 1 in 24 cases (43%) and located on extremities in 44 (80%). Technical efficacy was assessed using MRI and applying RECIST criteria, while clinical efficacy was based on changes in VAS pain scores. Prognostic factors for residual pain were analyzed using univariable and multivariable analyses.

RESULTS

With a median follow-up of 13 months, technical success was achieved in all cases, and 20% of patients underwent multiple sessions. Technical efficacy was observed in 69% of cases, with 33% achieving complete response and 36% partial response (mean volume reduction: 47%). Clinical efficacy was reached in 72% of cases. Univariable analysis linked residual pain to sex (female, p = 0.013), initial pain level (p = 0.014), Goyal grade (p = 0.029), and residual volume (p = 0.012). Multivariable analysis revealed that grade (p = 0.035), post-therapeutic volume (p = 0.048), and completeness of treatment (p = 0.029) were statistically significant predictors.

CONCLUSION

Cryoablation is an effective management strategy for venous malformation and FAVA, with residual volume emerging as a significant indicator of clinical success.

KEY POINTS

Question Venous malformations (VA) and fibro-adipose vascular anomalies (FAVA) often cause chronic pain, with limited effective treatment options. Identifying predictors of pain relief following cryoablation could optimize patient outcomes. Findings Cryoablation achieved 72% pain relief for VA and FAVA. High lesion grade, treatment completeness, and residual volume were significantly associated with residual pain. Clinical relevance Cryoablation provides an effective, minimally invasive treatment for VA and FAVA, achieving significant pain relief while identifying predictors to optimize patient selection and outcomes.

Benign Soft Tissue Lesions Responsible for Pain: When and How Should the IR Intervene

In most of the cases Interventional Radiology techniques and therapies are proposed for the management of symptomatic soft tissue benign tumors responsible for pain and/or compression symptoms aiming to offer a curative intent by means of tumor necrosis with subsequent symptoms' management and improvement of life quality. The ablative therapies include chemical, thermal and non-thermal approaches while, trans-arterial (chemo)embolization also has a distinct role. Adjunct ancillary techniques should be performed whenever necessary to increase efficacy and safety and avoid or reduce complications. The purpose of the current review is to identify the basis for treating soft tissue benign tumors with Interventional Radiology therapies, to offer a detailed review of them, to explain the expected outcomes and describe techniques for avoiding complications. Furthermore, a reflection upon future directions will be suggested.

Long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis

OBJECTIVE

To retrospectively evaluate the long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis (AWE).

METHOD

The Institutional Review Board approved this retrospective observational review of 40 consecutive patients, of a median age of 37 years (interquartile range [IQR] 32-40 years), presenting with a total of 52 symptomatic AWE nodules. All patients underwent cryoablation between January 2013 and May 2022 with a minimum follow-up period of 12 months. Outcomes were assessed using a visual analog scale (VAS) that measured pain, as well as by magnetic resonance imaging (MRI). The pain-free survival rates were derived using the Kaplan-Meier estimator. Adverse events were analyzed and graded using the classification system of the Cardiovascular and Interventional Radiological Society of Europe.

RESULTS

The median follow-up time was 40.5 months (IQR 26.5-47.2 months). The median VAS score before cryoablation was 8 (IQR 7-9). Complete relief of symptoms was documented in 80% (32/40) of patients at 3 months after initial cryoablation and correlated with the absence of residual endometriosis nodules on MRI. The median pain-free survival rates were 89.2% [95% CI, 70.1-96.4%] at 36 months and 76.8% [95% CI, 55.3-83.8%] after 60 months. No patient or lesion characteristics were found to be prognostic of failure. No major adverse events or side effects were reported in long term.

CONCLUSION

Cryoablation safely and effectively afforded long-term pain relief for patients with AWE nodules.

CLINICAL RELEVANCE STATEMENT

AWE cryoablation was found to be safe and effective in the long-term.

KEY POINTS

• Cryoablation is highly effective with 80% of patients experiencing complete relief of AWE symptoms after a single procedure. • Cryoablation is safe without long-term adverse events or side effects. • The median pain-free survival rates are 89.2% at 36 months and 76.8% at 60 months.

Alternative treatments of adenomyosis - an update in procedural management and clinical outcomes

PURPOSE OF REVIEW

Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes.

RECENT FINDINGS

Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy.

SUMMARY

This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.