Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit

Abstract

Purpose To compare radiation exposure of a state-of-the-art and a conventional angiography unit in patients undergoing uterine fibroid embolization (UFE).

Materials and Methods Between January 2009 and December 2016, 286 patients underwent UFE in our Interdisciplinary Fibroid Center. The inclusion criteria for this retrospective analysis were first-time transarterial embolization for symptomatic fibroids, bilateral embolization, procedures applying a state-of-the-art (Group 1) or a conventional angiography unit (Group 2), and bilateral technical success with an adequate embolization endpoint after the injection of microspheres. Study endpoints included radiation exposure, major complications, morphological success (MRI), and clinical success (questionnaire on quality-of-life). Propensity score matching controlled for confounders.

Results The inclusion criteria were met by 58 (Group 1) and 177 (Group 2) patients. After propensity score matching, there was no significant difference between Group 1 (n = 46) and Group 2 (n = 92) regarding age, body-mass index, volume of the dominant fibroid and the uterus, fluoroscopy time, and amount of embolic agent (p ≥ 0.10 each). The dose-area product was significantly lower in Group 1 than in Group 2 (1159.0 cGycm² vs. 3123.5 cGycm²; p < 0.001), while major complication rates (both groups 0 %) and dominant fibroid devascularization (both groups 100 %) were equal (p > 0.99). There were no significant differences between both groups regarding shrinkage of the dominant fibroid and the uterus and no relevant differences regarding patient-reported quality-of-life.

Conclusion A state-of-the-art angiography unit has the potential to reduce radiation exposure in patients undergoing UFE without increasing the risk of major complications and with comparably high morphological and clinical success.

Key Points 

• A state-of-the-art angiography unit potentially reduces radiation exposure in patients undergoing UFE.

• Reduced radiation exposure does not seem to negatively influence the rate of major complications.

• Reduced exposure does not seem to negatively affect morphological and clinical success.

Citation Format

• Sommer C, Voigt W, Oliger MK et al. Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit. Fortschr Röntgenstr 2018; 190: 250 – 258

Zusammenfassung

Ziel Vergleich der Strahlenexposition zwischen einem modernen und einem konventionellen Angiografiesystem bei Patientinnen, die sich einer Uterusmyomembolisation (UME) unterzogen.

Material und Methoden Zwischen Januar 2009 und Dezember 2016 unterzogen sich in unserem Interdisziplinären Myomzentrum insgesamt 286 Patientinnen einer UME. Einschlusskriterien für die retrospektive Analyse waren eine erstmalige transarterielle Embolisation aufgrund symptomatischer Myome, die bilaterale Embolisation, Prozeduren mittels modernem (Gruppe 1) oder konventionellem (Gruppe 2) Angiografiesystem sowie bilateraler technischer Erfolg mit adäquatem Embolisationsendpunkt nach Injektion von Mikrosphären. Studienendpunkte waren Strahlenexposition, Major-Komplikationen, morphologischer Erfolg (MRT) und klinischer Erfolg (Fragebogen zur Lebensqualität). Die Kontrolle von Störgrößen erfolgte mittels Propensity Score Matching.

Ergebnisse Die Einschlusskriterien wurden von 58 (Gruppe 1) bzw. 177 (Gruppe 2) Patientinnen erfüllt. Nach Propensity Score Matching ergaben sich keine signifikanten Unterschiede zwischen Gruppe 1 (n = 46) and Gruppe 2 (n = 92) bezüglich Alter, Body-Mass-Index, Volumen des dominanten Myoms, Uterusvolumen, Fluoroskopiezeit und Embolisatmenge (jeweils p ≥ 0,10). Das Dosisflächenprodukt war in Gruppe 1 signifikant geringer als in Gruppe 2 (1159,0 cGycm² vs. 3123,5 cGycm²; p < 0,001), während die Major-Komplikationsrate (0 % in beiden Gruppen) und der Grad der Devaskularisation des dominanten Myoms (100 % in beiden Gruppen) vergleichbar waren (p > 0,99). Außerdem ergaben sich vergleichbare Ergebnisse bezüglich Schrumpfung des dominanten Myoms und des Uterus und der patientenberichteten Lebensqualität.

Schlussfolgerung Ein modernes Angiografiesystem hat das Potenzial, die Strahlenexposition bei Patientinnen zu reduzieren, die sich einer UME unterziehen, ohne Erhöhung des Risikos für Major-Komplikationen und mit vergleichbarem morphologischen und klinischen Erfolg.

Kernaussagen 

• Ein modernes Angiografiesystem kann die Strahlenexposition bei UME-Patientinnen reduzieren.

• Die reduzierte Strahlenexposition scheint keinen negativen Einfluss auf die Major-Komplikationsrate zu haben.

• Die reduzierte Strahlenexposition scheint den morphologischen und klinischen Erfolg nicht negativ zu beeinflussen.

Key words

radiation exposure - dose reduction - propensity score matching - quality-of-life - uterine fibroid embolization

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