Uterine fibroids and the role of radiology in detection and treatment
Uterine fibroids are benign tumours which grow in the muscle layers of the uterus (womb). They are most likely to occur in females during their reproductive years and then dramatically reduce in size after menopause.
Symptoms
The symptoms of the presence of uterine fibroids depend on the size and location of the fibroids in the womb. Generally, uterine fibroids begin within the muscle tissue surrounding the womb. They then develop inwards or outwards from the womb. Uterine fibroids developing outwards press on the organs surrounding the womb such as the bladder, resulting in increased urinary frequency or general pain. Uterine fibroids developing inwards towards the womb tend to have the more serious implications as these could lead to bleeding, and in some cases infertility. During pregnancy, they may also induce premature labour, cause miscarriage, or interfere with the positioning of the foetus.
How are they diagnosed?
The diagnosis of uterine fibroids is made using ultrasound imaging to detect the presence of fibroids, and to establish their size and location. Further tests may be performed using MRI scanning.
What is the treatment available?
Uterine fibroid embolisation
In the late nineties, a minimally invasive procedure which requires no open surgery was developed to treat fibroids. This method is called uterine fibroid embolisation. The procedure is performed by Interventional Radiologists, who are specialist doctors trained in the use of medical imaging technology to diagnose and treat diseases. The technologies used include MRI* (Magnetic resonance imaging), CT** (Computed Tomography) and ultrasound***.
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During the embolisation procedure, the blood vessels to the fibroid are identified and blocked so that the tissue is starved of nutrients delivered by the blood stream. Firstly, a catheter (a tiny plastic tube) is inserted into an artery in the groin area. Contrast or X ray dye is then directly injected into the artery and an angiogram or X ray image of the pelvic arteries is obtained to map out the blood supply to the fibroids. The angiogram serves as a road map which allows the interventional radiologist to manoeuvre the catheter to the blood vessels supplying the fibroids, and the release of tiny particles which block the flow of blood to the fibroids, causing them to die after they become starved of blood. Once the blood vessels are blocked, the catheter is withdrawn and the groin is compressed for 10 to 15 minutes to prevent bleeding. As the puncture wound is very small, there is no need for stitching of the wound. Over time, the dead cells are absorbed back into the body, leading to a reduction in the size of the fibroid.
The procedure is performed under local anaesthesia and is usually completed within one to two hours. Over three to six months, the average size reduction of the fibroids is about 40-50%, and this leads to the symptoms of the patient subsiding over time. As there is no surgery involved, there is no need for general anaesthesia, recovery is faster and hospitalisation stay of one to two nights is much shorter when compared to surgery.
MRI guided focused ultrasound treatment
Another non surgical treatment procedure for treating uterine fibroids is the use of high intensity ultrasound beams. This procedure is performed by a Radiologist using MRI guidance. These ultrasound beams are directed and focused at the fibroid with the purpose of raising the temperature within the fibroid sufficiently such that the tissues within the fibroid are killed. The dead cells are then slowly absorbed by the body. This procedure is even less invasive than the embolisation procedure as there is no need for arterial puncture. However, the procedure takes much longer (typically four to six hours per session) and repeated sessions may be necessary to shrink the fibroids.
