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Toprani SM, Kelkar Mane V. Role of DNA damage and repair mechanisms in uterine fibroid/leiomyomas: a review. Biol Reprod 2020; 104:58-70. [PMID: 32902600 DOI: 10.1093/biolre/ioaa157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
There has been a significant annual increase in the number of cases of uterine leiomyomas or fibroids (UF) among women of all races and ages across the world. A fortune is usually spent by the healthcare sector for fibroid-related treatments and management. Molecular studies have established the higher mutational heterogeneity in UF as compared to normal myometrial cells. The contribution of DNA damage and defects in repair responses further increases the mutational burden on the cells. This in turn leads to genetic instability, associated with cancer risk and other adverse reproductive health outcomes. Such and many more growing bodies of literature have highlighted the genetic/molecular, biochemical and clinical aspects of UF; none the less there appear to be a lacuna bridging the bench to bed gap in addressing and preventing this disease. Presented here is an exhaustive review of not only the molecular mechanisms underlying the predisposition to the disease but also possible strategies to effectively diagnose, prevent, manage, and treat this disease.
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Affiliation(s)
- Sneh M Toprani
- Department of Biotechnology, University of Mumbai, Kalina, Mumbai, India
| | - Varsha Kelkar Mane
- Department of Biotechnology, University of Mumbai, Kalina, Mumbai, India
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Eze CU, Odumeru EA, Ochie K, Nwadike UI, Agwuna KK. Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria. Afr Health Sci 2014; 13:453-60. [PMID: 24235949 DOI: 10.4314/ahs.v13i2.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uterine myomas co-existing with pregnancy could cause obstetric complications. OBJECTIVES To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy. METHODS A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented. RESULTS Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1(st) scan sequence to the 2(nd) scan sequence and a reduction from 63mm to 59mm in the 3(rd) scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas. CONCLUSION Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.
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Affiliation(s)
- C U Eze
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
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Zhao D, Rogers PAW. Is fibroid heterogeneity a significant issue for clinicians and researchers? Reprod Biomed Online 2013; 27:64-74. [PMID: 23669014 DOI: 10.1016/j.rbmo.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/17/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022]
Abstract
The clinical and scientific literature overwhelmingly deals with fibroids as a single entity or disease. This convenient assumption of homogeneity may be an important oversight given that substantial evidence exists for heterogeneity between fibroids at many levels. Failure to recognize and accommodate fibroid heterogeneity can have significant ramifications for both clinical treatment decisions and research protocol design. The aim of this article is to review the current knowledge of fibroid heterogeneity and to identify key areas where fibroid heterogeneity should be taken into consideration both clinically and when designing research protocols. Uterine leiomyomata display significant and well-documented heterogeneity in symptoms, diagnostic imaging appearance, pathology, genetic background and therapeutic requirements. Additional research is needed to better understand fibroid heterogeneity as it relates to pathogenesis, molecular targets for potential new therapies, patient symptoms and, ultimately, treatment. To this list should also be added heterogeneity of genetics, lifestyle and individual clinical characteristics of the fibroid. Increasingly, an understanding of uterine leiomyoma heterogeneity will be of importance for clinicians who see patients with this common and costly disease.
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Affiliation(s)
- Dong Zhao
- Department of Minimally Invasive Gynecological Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, PR China
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Allison SJ, Wolfman DJ. Sonographic Evaluation of Patients Treated with Uterine Artery Embolization. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cult.2010.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Uterine fibroid embolization imaging: interventionalist's perspective. Ultrasound Q 2009; 25:185-94. [PMID: 19956051 DOI: 10.1097/ruq.0b013e3181c47de4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Uterine fibroid embolization (UFE) is a minimally invasive and well-accepted form of treatment for patients with symptoms from fibroids. Imaging is routinely performed before the procedure for various reasons and after the procedure in cases with either complications or incomplete response to UFE. The interventionalists performing the procedure require specific information from these imaging studies. This article describes the imaging workup of patients referred for UFE, specifically the information from these imaging examinations before the procedure that are necessary to the interventionalist and the complications seen after the procedure.
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Keeling AN, Reidy JF. Imaging and treatment of uterine fibroids, including the role of uterine artery embolization. IMAGING 2007. [DOI: 10.1259/imaging/80403836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wolfman DJ, Ascher SM. Magnetic resonance imaging of benign uterine pathology. Top Magn Reson Imaging 2007; 17:399-407. [PMID: 17417087 DOI: 10.1097/rmr.0b013e31805003f5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging is commonly used for the identification and characterization of many pelvic abnormalities. Magnetic resonance provides the most comprehensive and detailed view of the uterus of any imaging modality. This article focuses on the magnetic resonance imaging features used to recognize and describe congenital uterine anomalies and benign conditions of the uterus.
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Affiliation(s)
- Darcy J Wolfman
- Division of Abdominal Imaging, Department of Radiology, Georgetown University Hospital, Washington, DC 20007, USA
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Abstract
Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for debilitating adenomyosis. Magnetic resonance imaging (MRI) is the most accurate modality for identifying leiomyomas and adenomyosis. T2-weighted sequences often are diagnostic. For leiomyomas, MRI reliably identifies their number, size, and location. These features help triage patients to appropriate therapy. For adenomyosis, MRI establishes the diagnosis in cases of equivocal or nondiagnostic ultrasounds. MRI also has been used to confirm an ultrasound diagnosis of adenomyosis when curative surgery is being considered. Intravenous gadolinium chelates are not necessary to make the diagnosis of either adenomyosis or leiomyomas, but it provides useful information about vascularity of lesions, a factor that may impact the type of treatment undertaken.
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Affiliation(s)
- Susan M Ascher
- Department of Radiology, Georgetown University Hospital, Washington, DC 20007, USA.
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Lee JH, Jeong YK, Park JK, Hwang JC. "Ovarian vascular pedicle" sign revealing organ of origin of a pelvic mass lesion on helical CT. AJR Am J Roentgenol 2003; 181:131-7. [PMID: 12818843 DOI: 10.2214/ajr.181.1.1810131] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the "ovarian vascular pedicle" sign as a way of differentiating ovarian from subserosal uterine lesions on single-detector helical CT. SUBJECTS AND METHODS We prospectively evaluated 131 patients who had a pelvic mass suspected of originating in the ovary or subserosal zone of the uterus and had undergone helical CT before surgery. A total of 108 ovarian lesions and 23 subserosal uterine myomas were confirmed. CT images were analyzed prospectively by consensus of two radiologists who thoroughly evaluated the retrograde tracing of the gonadal veins to the ovary or pelvic mass. To assess the value of analyzing the ovarian vascular pedicle sign in identifying the organ of origin of a pelvic mass, we compared statistical proportions for the frequencies of the sign in ovarian tumors and subserosal uterine myomas by performing the chi-square test. The probabilities for the presence of the ovarian vascular pedicle sign as a positive finding for a pelvic mass of ovarian origin were calculated. RESULTS The presence of the ovarian vascular pedicle sign was identified in 92% (99/108) of ovarian masses and in 13% (3/23) of subserosal uterine myomas. The sign was statistically significant (p < 0.01) for differentiating a mass of ovarian origin from a mass of subserosal uterine origin. When the ovarian vascular pedicle sign on helical CT confirmed the ovarian origin, the sensitivity, specificity, positive predictive value and negative predictive value, and diagnostic accuracy were 92% (99/108), 87% (20/23), 97% (99/102), 69% (20/29), and 91% (119/131), respectively. CONCLUSION The presence of the ovarian vascular pedicle sign on helical CT is valuable for confirming the ovarian origin of a pelvic tumor and for differentiating an ovarian tumor from subserosal uterine myoma.
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Affiliation(s)
- Jong Hwa Lee
- Department of Diagnostic Radiology, Ulsan University Hospital, Ulsan University College of Medicine, 290-3 Choenha-Dong, Dong-Gu, Ulsan, 682-714, Korea
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Hughes JL, Reidy JF. Imaging and treatment of uterine fibroids including the role of uterine artery embolisation. IMAGING 2003. [DOI: 10.1259/img.15.2.150079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Weintraub JL, Romano WJ, Kirsch MJ, Sampaleanu DM, Madrazo BL. Uterine artery embolization: sonographic imaging findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:633-640. [PMID: 12054299 DOI: 10.7863/jum.2002.21.6.633] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To examine the sonographic and angiographic imaging findings before and after uterine fibroid embolization for symptomatic leiomyoma. METHODS This prospective study involved 14 premenopausal women who underwent uterine fibroid embolization for symptomatic leiomyoma. Preprocedure sonography with color Doppler imaging was performed. Bilateral uterine artery embolization was successfully performed with the use of polyvinyl alcohol. Follow-up sonographic examinations were performed between 1 and 3 months after the procedure. The correlation between the sonographic appearance before and after embolization and the degree of decrease in uterine size was evaluated by using the Jonckheere-Terpstra 2-sided P test. RESULTS Preprocedure sonographic imaging showed a varied appearance to the fibroids. Color Doppler imaging primarily showed the fibroids to be vascular with marked peripheral blood flow. Postprocedure sonographic imaging showed decreased uterine size and echogenicity. Color Doppler imaging showed a marked decrease in the blood flow to the leiomyoma. There was no statistical significance in the relationship between echogenicity and vascularity shown before the procedure and the percent decrease in the size of the uterus. CONCLUSIONS Although sonography is an efficient method for identifying leiomyomata and determining the reduction in size after uterine artery embolization, we were unable to identify any predictive characteristics of success for aiding the preprocedural assessment.
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Affiliation(s)
- Joshua L Weintraub
- New York Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York 10032, USA
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Becker E, Lev-Toaff AS, Kaufman EP, Halpern EJ, Edelweiss MI, Kurtz AB. The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:237-247. [PMID: 11883534 DOI: 10.7863/jum.2002.21.3.237] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. METHODS Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. RESULTS The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. CONCLUSIONS We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.
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Affiliation(s)
- Eduardo Becker
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Bradley LD, Falcone T, Magen AB. Radiographic imaging techniques for the diagnosis of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27:245-76. [PMID: 10857118 DOI: 10.1016/s0889-8545(00)80019-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The introduction of SIS has been a significant advance in TVUS evaluation of the endometrial cavity in the 1990s. SIS provides an unparalleled, clear, enhanced view of the endomyometrial complex that cannot be obtained with TVUS alone. Focal and global endometrial pathology can be differentiated with SIS. Saline infusion improves the sensitivity for the detection of endometrial abnormalities. The continuing challenge for gynecologists is to provide patients with cost-effective, minimally invasive evaluation and directed therapy for menstrual dysfunction. SIS targets patients needing biopsy, directs the surgical approach, and minimizes office diagnostic hysteroscopy--all with a quick office procedure. For patients, the benefits include minimal and brief discomfort and a better understanding of intrauterine pathology through viewing the ultrasound monitor. Patients also appreciate the ease of scheduling, the minimal time away from work, and that no escort is needed after the procedure. SIS provides an extension of the pelvic gynecologic examination. SIS is the most important imaging modality for evaluating endometrial pathology. Although there is no perfect test to evaluate the endometrium, overall, SIS is superior to other imaging and diagnostic procedures. It is less expensive than D&C or hysteroscopy. It is a safe, efficient, convenient, and well-tolerated procedure. In some instances, however, neither TVUS nor SIS is definitive in determining the location of fibroids or able to discern adenomyosis. In these instances, MR imaging triage is helpful. MR imaging is gaining widespread acceptance and, in many instances, is a cost-effective tool in the evaluation of abnormal uterine bleeding. It is noninvasive, differentiates uterine anatomy in response to exogenous hormones or the normal menstrual cycle, and reliably localizes pelvic pathology and size of lesions. When uterine conservation is desired in women with fibroids and TVUS or SIS is indeterminate in localizing depth of myometrial involvement of a fibroid, MR imaging should be considered as a part of the clinical algorithm. The precision of MR imaging localization of submucosal fibroids can obviate the need for hysterectomy and permit a skilled surgeon to hysteroscopically resect the fibroids. If the clinical examination is suspicious for adenomyosis and the US is nondiagnostic, the clinician should consider MR imaging strongly. When the results of the imaging study would influence surgical route and planning, MR imaging should be considered in the preoperative evaluation.
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Affiliation(s)
- L D Bradley
- Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, Ohio, USA
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Caoili EM, Hertzberg BS, Kliewer MA, DeLong D, Bowie JD. Refractory shadowing from pelvic masses on sonography: a useful diagnostic sign for uterine leiomyomas. AJR Am J Roentgenol 2000; 174:97-101. [PMID: 10628461 DOI: 10.2214/ajr.174.1.1740097] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to determine the diagnostic usefulness of sonography for revealing a recurrent acoustic shadowing pattern when imaging for possible uterine leiomyoma. SUBJECTS AND METHODS During an 18-month period, all pelvic masses discovered on sonography were prospectively examined for recurrent refractory shadows. Sonograms of 222 masses with a definitive final diagnosis were reviewed by two radiologists unaware of the follow-up results. Each mass was analyzed for the presence of three or more recurrent refractory shadows, each of which did not arise from an echogenic lead point. After all masses were rated independently, a consensus rating was reached for any discrepancy between observers. RESULTS Of the 222 masses, 152 (68%) were leiomyomas. The remainder resulted from a wide variety of other uterine and adnexal disorders. Agreement between the two observers regarding refractory shadows was excellent. Kappa coefficients were 0.86 at transabdominal and 0.96 at transvaginal approaches. Sensitivity of the refractory shadow pattern for leiomyomas was higher for transvaginal (87%) than for transabdominal (52%) sonography. Specificity of the refractory shadow pattern was 89% for transvaginal and 92% for transabdominal sonography. Using logistic regression analysis, we found a statistically significant association between a refractory shadowing pattern and leiomyoma for both transabdominal and transvaginal sonography (p < 0.001). CONCLUSION Recurrent refractory shadowing in a pelvic mass on sonography is highly suggestive of leiomyoma and can be a useful diagnostic clue for distinguishing leiomyomas from other pelvic masses.
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Affiliation(s)
- E M Caoili
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Advances in diagnostic imaging of the female genital tract facilitate characterization of many pelvic masses. Preoperative assessment of gynecologic malignant tumors provides information that may alter the surgical approach or timing of radiation therapy. Image-guided biopsy accurately confirms recurrent malignant lesions. Transcervical techniques have improved diagnostic assessment of infertile couples; thus, effective and inexpensive treatment options can be offered. Postoperative complications of gynecologic procedures can be detected with imaging, and many can be treated with image-guided techniques.
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Affiliation(s)
- L A Binkovitz
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905
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Williams IA, Shaw RW. Effect of nafarelin on uterine fibroids measured by ultrasound and magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 1990; 34:111-7. [PMID: 2137421 DOI: 10.1016/0028-2243(90)90014-r] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Administration of the LHRH agonist, Nafarelin (D-(Nal2)6 GnRH), at a dosage of 200 micrograms twice daily intranasally in 13 patients with uterine leiomyomata resulted in a reduction in uterine volume to a mean of 55.1% at 3 months and 44.5% at 6 months as measured using ultrasound. Re-enlargement occurred on discontinuing therapy and the uterus was back to the original volume at three months. Magnetic resonance imaging (MRI) performed in five patients showed advantages over ultrasound in identification of fibroid number in two patients. Mean reduction in uterine area measured using MRI was 61.3%, and mean reduction of fibroid area 57%. Oestradiol was suppressed with treatment to a mean of 69 pmol/l.
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Affiliation(s)
- I A Williams
- Academic Department of Obstetrics & Gynaecology, Royal Free Hospital, London, U.K
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Zawin M, McCarthy S, Scoutt LM, Comite F. High-field MRI and US evaluation of the pelvis in women with leiomyomas. Magn Reson Imaging 1990; 8:371-6. [PMID: 2202877 DOI: 10.1016/0730-725x(90)90044-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Magnetic resonance imaging (MRI) and real-time transabdominal ultrasonography (US) were performed on 23 women with uterine leiomyomas. The uterus, ovaries, and cul de sac were evaluated. Accurate determination of uterine volume was possible in all cases by MRI, but was limited on US in uteri larger than 140 cc. Marked enlargement also prevented visualization of contour abnormalities in eight patients on US, but none on MRI. The endometrial stripe and junctional zone could not be adequately visualized in 21/23 US examinations, whereas they were identified in all 23 MRI (8 normal and 15 distorted). Individual leiomyomas were clearly depicted on 4 US and 19 MR scans, the smallest being 1.1 cm and 0.8 cm, respectively. Of the 31 fibroids present on MRI: 13 were intramural, 4 subserosal, and 14 submucosal. MRI successfully identified 44/46 ovaries as compared to 21/46 on US. Cul de sac fluid was noted in seven women by MRI alone. This data suggests that MRI is superior to US in examination of the entire pelvis in women with leiomyomas.
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Affiliation(s)
- M Zawin
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510
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Abstract
In a retrospective review of 6706 pregnancies between 1981 and 1985, uterine leiomyomas were documented by antenatal sonography in 93 (1.4%) patients. The obstetric records and sonograms of patients with documented leiomyomas were reviewed and compared with data from matched control patients managed at our institution during the same time period. Among the 93 patients with leiomyomas, 14 (15.1%) had one or more leiomyomas subjacent to the maternal surface of the placenta. Significantly, eight of 14 (57%) of these patients with retroplacental leiomyomas subsequently developed abruptio placentae, which resulted in the deaths of four fetuses. Conversely, among the remaining 79 patients whose leiomyomas were not retroplacental, abruptio placentae occurred in only two patients (2.5%), neither of which resulted in fetal death. Clinically significant pain requiring narcotic analgesia developed in 14 of 93 (15.1%) patients and premature labor occurred in 20 of 93 (21.5%); pain and premature labor correlated positively with the size of the largest myoma. Delivery by cesarean section and vacuum assistance occurred significantly more frequently in patients with leiomyomas than in those without documented leiomyomas. In this population uterine myomas did not significantly alter the incidence of intrauterine growth retardation and low Apgar scores.
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Affiliation(s)
- J P Rice
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Answer Diagnostic Challenge: Calcified Fibroids. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1989. [DOI: 10.1177/875647938900500209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ezra Y, Fields S, Kopolovic J, Anteby SO. Benign uterine leiomyoma suspected of sarcomatous change on an ultrasound scan and computerized tomography. Arch Gynecol Obstet 1988; 241:255-8. [PMID: 3284487 DOI: 10.1007/bf00931356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a 54-year-old postmenopausal woman with a leiomyoma which on an ultrasound scan and on computed tomography (CT) had cystic areas and extensive necrosis suggesting sarcomatous change.
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Affiliation(s)
- Y Ezra
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
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