Uterine artery embolization for pure adenomyosis: An analysis of predictive factors affecting procedure outcomes

Wednesday, April 2, 2025

11:42 AM – 11:51 AM CT

Location: Music City Center, 204

Presenting Author(s)

KH

Kichang Han, MD, PhD

Associate Professor
Severance Hospital, Yonsei University, College of Medicine, Republic of Korea

Author/Co-author(s)

Man-Deuk Kim, MD, PhD, FSIR

Professor
Severance Hospital, Yonsei University College of Medicine, Republic of Korea
JK

Joon Ho Kwon, MD

Clinical assistant professor
Severance hospital, Republic of Korea
JP

Juil Park, MD

Clinical Assistant Professor
Severance Hospital, Yonsei University, College of Medicine, Republic of Korea
HK

Hyung Cheol Kim, MD

Clinical assistant professor
Severance hospital, South Korea
JJ

Jaesung Jo, MD

Clinical assistant professor
Severance hospital, Republic of Korea
GK

Gyoung Min Kim, MD, PhD

Assistant Professor
Yonsei University Severance Hospital, Republic of Korea
Jong Yun Won, MD, PhD

Professor
Yonsei University College of Medicine, Severance H, Republic of Korea

Purpose:

To determine predictive factors associated with post-procedure necrosis after uterine artery embolization (UAE) for pure adenomyosis.

Materials and Methods: This retrospective study included patients who underwent UAE for symptomatic pure adenomyosis between January 2011 and May 2024. Adenomyosis characteristics, including T2-weighted signal intensity (homogeneous or heterogeneous), adenomyosis classification (classified as type I (continuous from the endometrium), type II (continuous from the subserosa), and type III (others such as intramural location), focal versus diffuse location were evaluated on pre-procedural MRI. Contrast-enhanced MRI at 3 months post-UAE was used to assess necrosis of adenomyosis. Symptom severity scores (SSS) and health-related quality of life (HRQOL) scores were evaluated before and 3 months after the procedure. Univariate and multivariate analyses were performed to identify factors associated with adenomyosis necrosis.

Results:

Among the 136 patients (mean age: 42.7 years ± 4.2) who underwent UAE for adenomyosis, 105 patients (77.2%) exhibited complete necrosis. In the multivariate analysis, type 2 adenomyosis (odd ratio; 10.492, 95% CI: 3.492-31.523, p< 0.001) and heterogeneous T2 signal intensity (odd ratio; 3.541, 95% CI: 1.354–9.263, p=0.01) were significant predictive factors for incomplete necrosis. By adenomyosis classification, the rates of complete necrosis were 86% (92/107) in type I, 33% (7/21) in type II, and 75% (6/8) in type III, respectively. Both SSS and HRQOL scores post procedure were significantly better in patients with complete necrosis compared to those with incomplete necrosis (SSS: 20.7 ± 14 vs. 30 ± 17.1, p=0.023; QOL: 86.7 ± 13 vs. 79.3 ± 12.6, p=0.038).

Conclusion:

Type I adenomyosis, originating from the endometrium, and homogeneous T2 signal intensity were favorable predictive factors for complete necrosis of adenomyosis after UAE.