Date of Award
2013
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Sudhir Vinayak
Second Supervisor/Advisor
William Stones
Department
Imaging and Diagnostic Radiology (East Africa)
Abstract
Background: Uterine fibroid embolization, though a widely available option in high income countries in managing symptomatic fibroids is relatively new in the East African region. It is currently offered at only one tertiary facility for the past three years. The symptom and radiological response in these patients, who literature suggests may have bigger fibroid burden and worse symptoms, is the subject of this study.
Objective: Characterization of MRI imaging features in women undergoing uterine fibroid embolization and identification of clinical correlates in an African population.
Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short term imaging outcome and mid-term symptom scores were analysed for interval changes. Assessment of potential associations between short term imaging features and the mid-term symptom scores were also done.
Results: UFE resulted in statistically significant reductions (P< 0.001) of dominant fibroid and uterine volumes and in symptom severity scores of 43.7%, 40.1% and 37.8% respectively. Strong enhancement at baseline was a strong predictor of response to UFE.59% of respondents had more than ten fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome.
Discussion: UFE is a new treatment option for treatment of uterine fibroids in Kenya. This study was aimed at assessing outcomes to this treatment option compared to other parts of the world. The response of uterine fibroids to embolization in the African population is good but not different from findings reported in other studies in the West. The presence of multiple and large fibroids seen here is consistent with the case mix described in studies of African-American populations. No significant association is seen between radiological and clinical outcomes to UFE.
Conclusion: UFE treatment for fibroids has good outcome. Further studies lasting beyond one year are indicated for further detailed outcome in the local African population.
Recommendations: Patient counselling should emphasise the independence of volume reduction and symptom improvement. Volume changes are of relevance for the Radiologist in aiding understanding of the evolution of the condition and identifying potential technical treatment failures but should not be the main basis of evaluation of treatment success.
Recommended Citation
Mutai, J. K. (2013). Uterine fibroid embolization for symptomatic fibroids; correlation of mid-term changes in disease-specific symptoms and magnetic resonance imaging results at a teaching hospital in Kenya (Unpublished master's dissertation). Aga Khan University, East Africa.