Evaluating uterine fibroids with contrast-enhanced ultrasound imaging (CEUS) and superb microvascular imaging (SMI) pre and post uterine artery embolization (UAE)

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Uterine fibroids affect approximately 30% of all women in the United States or about 45 million individuals. The clinical diagnoses of uterine fibroids are from two to three times more common in African-American women than in Caucasian women. Uterine artery embolization (UAE) is a nonsurgical therapy that shrinks fibroids by blocking arterial blood flow to the fibroids. The goal of the technique is the occlusion or marked reduction in blood flow to the fibroids causing selective ischemic necrosis acting at the arteriolar level to minimize uterine damage. UAE has equivalent reduction in symptoms, improvement in quality of life, and lower risk of infection than a hysterectomy. After the UAE, the current strategy is to request a gadolinium-enhanced MRI to evaluate the efficacy of the treatment. However, an MRI is not always available and remains very expensive, which has resulted in fewer and fewer insurance companies allowing this follow-up leaving physicians as well as patients to rely on clinical signs to determine successful of treatment. Using contrast-enhanced ultrasound imaging (CEUS) to characterize uterine fibroid microvascularization before and after UAE may be similar to MRI results. Recently, an ultrasound technique, which provides a precise microvascular map without the use of contrast agents – superb microvascular imaging (SMI), has been developed. SMI combines multi-dimensional filtering and advanced clutter suppression to extract flow signals from large to small vessels and depicts this information at high frame rates as a color overlay image (color SMI) or as a grayscale map of flow (monochrome SMI). Thus, the scientific premise of this project is that CEUS and/or SMI can be used to describe the characteristics of fibroid microvascularization before and after UAE in order to determine the success of the procedure. We expect to enroll 40 subjects scheduled for a UAE procedure, out of which the vast majority will be African-American (around 35 subjects), since the demographics specific for UAE procedures at TJU is 80-85% African- American women and 15-20% other (Caucasian, Asian and Hispanic). These women will be studied with abdominal and/or endovaginal CEUS and SMI (color and monochrome) to evaluate fibroid microvascularity before, 2 weeks and 3 months after UAE (consistent with patient's clinical follow-up) to evaluate the success of the UAE (specific aim 1). Results will be compare with clinical outcomes and when available with MRI studies (specific aim 2). Hence, this project will determine patterns of uterine fibroids microvasculation pre and post UAE using CEUS and SMI as an alternative to gadolinium-enhanced MRI that is less expensive, has less contra-indications and side effects, and noninvasive helping physicians to evaluate the result of UAE procedures.