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Imaging and treatment of uterine fibroids, including the role of uterine artery embolization

Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, St Thomas Street, London SE1 9RT, UK

• Uterine fibroids occur in up to 80% of women by the age of menopause, with the majority being asymptomatic.
  
• Magnetic resonance imaging (MRI) gives superior imaging when compared with ultrasound, and can exclude other causes of pelvic masses.
  
• Uterine artery embolization (UAE) is now a well-established technique for treating fibroids and is suitable for the majority of women.
  
• 80–85% of women are satisfied with the clinical result following UAE and require no further treatment.
  
• Myomectomy is the alternative uterus-preserving treatment and must be considered in all cases.
  
• Significant complications post-UAE can occur but are rare.
  

Uterine leiomyomata, otherwise known as fibroids, are benign tumours that arise from uterine smooth muscle cells. Fibroids occur in up to 80% of women by time of menopause, and most are asymptomatic. Clinical examination is the mainstay of diagnosis but, with the availability of newer imaging modalities, both ultrasound and MRI are increasingly being utilized. Hysterectomy remains a viable treatment option for symptomatic fibroids; however, uterus-conserving techniques are often more desirable. Uterine artery embolization (UAE) is now a well-established technique for treating fibroids and is suitable for the majority of women. Myomectomy is the alternative uterus-preserving treatment that must also be considered in all cases. During the course of this article, we discuss the biology of these tumours and the increasing role that imaging plays in the diagnosis and therapeutic management of fibroids, and review the available UAE literature. With the advent of new therapies, especially UAE, the role of diagnostic and interventional radiology is now much more important in the investigation and treatment of these common tumours.