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Purpose Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. Materials and Methods Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. Results Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. Conclusion The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Purpose To evaluate the prevalence of inferior mesenteric artery (IMA) collaterals to the uterus found during uterine artery embolization (UAE), associated risk factors, and clinical outcomes. Materials and Methods The records of 559 women who underwent UAE during the period 2008–2011 for uterine fibroids or adenomyosis found on magnetic resonance imaging were retrospectively analyzed. If IMA collaterals to the uterus were suspected on aortography performed after embolization, selective angiography was performed. Risk factors for IMA collaterals to the uterus were analyzed, including the presence of adenomyosis, baseline uterine volume, or prior pelvic surgery. Results Collaterals to the uterus were found from the ovarian artery (n = 21; 3.8%), IMA (n = 7; 1.3%), round ligament artery (n = 1; 0.2%), and internal pudendal artery (n = 1; 0.2%). IMA collaterals were found in seven patients. Of 185 patients, 6 (3.2%) had adenomyosis, with or without fibroids, which was significantly more frequent than the 1 (0.27%) of 374 patients who had fibroids only ( P = .006). On multiple logistic regression analysis, the presence of adenomyosis (odds ratio, 19.556; P = .0168) and uterine volume (odds ratio, 1.003; P = .0069) were independent factors for the presence of IMA collaterals. Of the seven patients with IMA collaterals, embolization was not attempted in six, resulting in clinical failure in four. One patient who underwent IMA embolization with coils experienced clinical improvement. Conclusions The IMA was the second most common (1.3%) source of collaterals to the uterus. IMA collaterals were more frequent in patients with adenomyosis than in patients with fibroids only, resulting in high frequency of treatment failure.

To assess contrast-enhanced magnetic resonance (MR) angiographic findings of uterine arteries (UAs) and to evaluate the diagnostic utility of this imaging modality for the prediction of ovarian artery (OA) embolization (OAE).The authors retrospectively evaluated 349 patients who underwent contrast-enhanced MR angiography before UA embolization (UAE) for symptomatic fibroid tumors or adenomyosis. The diameters of the UAs were compared with those of the inferior mesenteric arteries (IMAs) and classified into two groups: group I, in which the diameters of both UAs were the same as or greater than that of the IMA; and group II, in which at least one UA was smaller than the IMA or was not visible. The presence of an enlarged OA was also evaluated. Sensitivity and specificity were calculated for UA diameter, enlarged OA, and the combination of the two.Nine of 22 patients (40.9%) in group II underwent OAE, which was a significantly higher incidence (P.001) than in group I (nine of 327; 2.8%). Among eight patients with enlarged OAs, six (75%) underwent OAE. Relative UA diameter had a sensitivity of 50% and specificity of 96.1%; the respective values for enlarged OAs were 33.3% and 99.3%. The combination of UA diameter and enlarged OAs showed a sensitivity and specificity of 72.2% and 95.4%, respectively.In addition to the identification of enlarged OAs, contrast-enhanced MR angiography allows a comparison between UA and IMA diameters and therefore can be helpful for the prediction of OAE.

Purpose To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT). Materials and Methods All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1–36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed. Results Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed. Conclusions The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.

Objective: To evaluate the effectiveness of uterine artery embolization (UAE) for treating symptomatic fibroids with high signal intensity (SI) on magnetic resonance (MR) T2-weighted imaging (T2WI). Materials and Methods: A total of 537 cases, consisting of 14 patients with high SI fibroids on T2WI (T2 high group), were retrospectively included and compared with 28 randomly selected patients with low SI fibroids on T2WI (control group). High SI of a predominant fibroid on T2WI was defined as having the same or higher SI than the myometrium. Patient ages ranged from 28 to 52 years (mean, 38.1 years). All patients underwent MRI before and after UAE. Predominant fibroid and uterine volumes were calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, with 0 being no symptoms and 10 being the baseline, or initial symptoms. Results: Of the patients in the T2 high group, 13 out of 14 (92.9%) patients demonstrated complete necrosis of the predominant fibroids. The mean volume reduction rates of the predominant fibroids in the T2 high group was 61.7% at three months after UAE, which was significantly higher than the volume reduction rates of 42.1% noted in the control group (p < 0.05). Changes in symptom scores for menorrhagia and dysmenorrhea after UAE (baseline score minus follow-up score) were 4.9 and 7.5 in T2 high group and they were 5.0 and 7.7 in control group, suggesting a significant resolution of symptoms (p < 0.01) in both groups but no significant difference between the two groups. Conclusion: UAE is effective for uttering fibroids showing high SI on T2WI. The mean volume reduction rate of the predominant fibroids three months after UAE was greater in the T2 high group than in the control group. Index terms: Fibroid uterus; Uterine artery embolization; Magnetic resonance imaging; Radiology, Interventional

To explore the effectiveness of uterine artery embolization (UAE) in treating symptomatic fibroids in the uterine cervix.Among 537 patients who underwent UAE, 10 who had fibroids located in the cervix were retrospectively analyzed. The mean diameter of the fibroids was 6.0 cm. Seven of the 10 patients presented a total of 10 fibroids in the uterine body or fundus simultaneously. Fibroids of the cervix and fibroids in the body or fundus were compared in terms of the effects of UAE on the treatment thereof and vascularity on angiographic findings. Cervical leiomyomas were classified into three grades based on the vascularity seen on aortography, from grade I, indicating poor vascularity, to grade III, indicating hypervascularity. Necrosis of fibroids was assessed by magnetic resonance imaging 3 months after UAE.Complete necrosis of leiomyomas in the uterine cervix was seen in only two of the 10 patients (20%), whereas all fibroids in the uterine body or fundus were completely infarcted (P.05). Partial necrosis (PN) of the fibroid with a thin viable rim was seen in two patients, whereas PN with a thick rim was seen in four and no necrosis was seen in two. Grade I (ie, poor) vascularity was noted in five of nine patients (55.6%) with cervical fibroids larger than 3 cm.Poor vascularity was a frequent finding among cervical leiomyomas, and the outcomes of UAE for cervical leiomyomas were disappointing, indicating a need for caution in selecting and counseling patients for this treatment.

Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function.

Constrictive pericarditis is caused by fibrosis and calcification of the pericardium, processes that inhibit diastolic filling of the heart. For the diagnosis of constrictive pericarditis, a combined approach is used to evaluate the morphologic pericardial abnormalities in conjunction with assessment of the functional and hemodynamic changes. We report novel findings of chest computed tomography (CT) and chest roentgenogram with respect to a ring-shaped pericardial calcification on atrioventricular groove causing strangulation of the heart in the patient with constrictive pericarditis, which is anatomically rarer than other severe cases of constrictive pericarditis encasing the entire heart.