Is contrast-enhanced ultrasound (CEUS) effective in the assessment of outcomes and in the follow up of uterine fibroids after superselective uterine fibroids embolization (SUFE) when compared to dynamic magnetic resonance (MR)?

Purpose: MR is the standard of reference in the assessment of fibroids embolization outcomes but it is expensive and not widely available. The purpose of our work is to describe CEUS findings before and after SUFE and to understand if CEUS can play a role in the assessment of outcomes and in SUFE follow up.

Methods and materials: We assessed 51 fibroids in 26 patients by CEUS immediately before and after embolization directly in the angiographic room. Due to fibroids size (range 3.4–8.9cm, mean size 5.1cm), all ultrasound examinations were performed with a transabdominal approach. We assessed only the three largest fibroids in case of multiple lesions. In all patients, a single bolus of contrast agent (4.8ml of SonoVue®, Bracco, Italy) was injected. Follow up protocol included CEUS evaluation after one month and CEUS and dynamic magnetic resonance (MR) evaluation after six months.

Results: In 48/51 cases, CEUS showed total devascularization of the fibroids immediately after embolization, with non significant intralesional signals delayed in comparison to myometrial enhancement. In 3/51 cases of multiple lesions, one among the embolized fibroids mantained its vascularization. These findings are consistent with angiographic data and with the purpose of performing a complete devascularization. No recurrence was observed during follow up. One patient reported the reappearance of symptoms after 18 months and CEUS showed the persistence of intralesional vascularization.

Conclusion: CEUS is effective to demonstrate the degree of vascular occlusion at the end of SUFE procedures. CEUS findings correlate with clinical results at one and six months. CEUS is reliable and cost-effective when compared to MR.