UTERINE FIBROID EMBOLIZATION S99 Uterine Fibroid Vascu- larization and Clinical Relevance to Uterine Fibroid Embolization 1 Jean-Pierre Pelage, MD, PhD ● Julien Cazejust, MD ● Etienne Pluot, MD Olivier Le Dref, MD ● Alexandre Laurent, MD, PhD ● James B. Spies, MD ● Sophie Chagnon, MD ● Pascal Lacombe, MD Embolization has become a first-line treatment for symptomatic uter- ine fibroid tumors. Selective catheterization and embolization of both uterine arteries, which are the predominant source of blood flow to fibroid tumors in most cases, is the cornerstone of treatment. Although embolization for treatment of uterine fibroid tumors is widely ac- cepted, great familiarity with the normal and variant pelvic arterial anatomy is needed to ensure the safety and success of the procedure. The uterine artery classically arises as a first or second branch of the anterior division of the internal iliac artery and is usually dilated in the presence of a uterine fibroid tumor. Angiography is used for compre- hensive pretreatment assessment of the pelvic arterial anatomy; for noninvasive evaluation, Doppler ultrasonography, contrast material– enhanced magnetic resonance (MR) imaging, and MR angiography also may be used. After the uterine artery is identified, selective cathe- terization should be performed distal to its cervicovaginal branch. For targeted embolization of the perifibroid arterial plexus, injection of par- ticles with diameters larger than 500 m is generally recommended. Excessive embolization may injure normal myometrium, ovaries, or fallopian tubes and lead to uterine necrosis or infection or to ovarian failure. Incomplete treatment or additional blood supply to the tumor (eg, via an ovarian artery) may result in clinical failure. The common postembolization angiographic end point is occlusion of the uterine arterial branches to the fibroid tumor while antegrade flow is main- tained in the main uterine artery. © RSNA, 2005 RadioGraphics 2005; 25:S99 –S117 ● Published online 10.1148/rg.25si055510 ● Content Codes: 1 From the Department of Radiology, Ho ˆ pital Ambroise Pare ´, 9 ave Charles-de-Gaulle, 92104 Boulogne Cedex, France (J.P.P., J.C., E.P., S.C., P.L.); Departments of Body and Vascular Imaging (O.L.D.) and Neuroradiology (A.L.), Ho ˆ pital Lariboisie `re, Paris, France; and Department of Radiology, Georgetown University Medical Center, Washington, DC (J.B.S.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received February 15, 2005; revision requested March 25 and received June 7; accepted June 27. J.P.P. is a consultant with Biocompatibles, Biosphere Medical, and Boston Scientific, from which he has received research funding; J.B.S. is a consultant with Biosphere Medical and Boston Scientific, from which he has received research funding; and all remaining authors have no financial relationships to disclose. Address correspondence to J.P.P. (e-mail: jean-pierre.pelage@apr.aphp.fr). © RSNA, 2005 RadioGraphics See last page TEACHING POINTS