Research question

What is the evolution of adenomyosis on magnetic resonance imaging (MRI) after a 3-month treatment course of daily 5 mg doses of ulipristal acetate (UPA) for symptomatic fibroids?

Design

A monocentric prospective pilot study on patients who underwent a 3-month treatment course of UPA for symptomatic fibroids between January 2014 and December 2017. Patients underwent pelvic MRI shortly before (pre-MRI) and after treatment (post-MRI). The diagnosis of adenomyosis on MRI was defined by the observation of intramyometrial cysts and/or haemorrhagic foci within these cystic cavities and/or a thickening of the junctional zone >12 mm. The progression of adenomyosis was defined by the presence of at least one of the aforementioned criteria of adenomyosis on the pre-MRI and by at least one of the following on the post-MRI: (i) increased thickness of the junctional zone ≥20% and/or (ii) increased number of intramyometrial cysts. The appearance of adenomyosis was defined by the absence of the aforementioned criteria of adenomyosis on the pre-MRI and the presence of at least one of these criteria on the post-MRI.

Results

Seventy-two patients were included. The MRI features of adenomyosis progressed for 12 of 15 patients (80.0%) for whom adenomyosis was identified on the pre-MRI. An appearance of adenomyosis was identified after treatment for 15 of 57 patients (26.3%) for whom adenomyosis was not identified on the pre-MRI.

Conclusions

A 3-month treatment course of daily 5 mg doses of UPA could provoke a short-term progression or an emergence of typical adenomyosis intramyometrial cysts on MRI examinations.

中文翻译：

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醋酸乌利司他治疗症状性肌瘤子宫腺肌病磁共振成像特征的进展

研究问题

每天 5 毫克剂量的醋酸乌利司他 (UPA) 治疗有症状的肌瘤 3 个月后，磁共振成像 (MRI) 上子宫腺肌病的进展如何？

设计

一项针对 2014 年 1 月至 2017 年 12 月期间接受 3 个月 UPA 治疗症状性肌瘤的患者的单中心前瞻性试点研究。 患者在治疗前（MRI 前）和治疗后（MRI 后）不久接受了盆腔 MRI。MRI 上子宫腺肌病的诊断是通过观察到这些囊腔内的肌层内囊肿和/或出血病灶和/或交界区增厚 > 12 mm 来定义的。子宫腺肌病的进展定义为在 MRI 前至少存在上述子宫腺肌病标准之一，在 MRI 后至少存在以下一项： (i) 交界区厚度增加≥20%和/或 (ii) 肌层内囊肿数量增加。

结果

包括 72 名患者。15 名患者中有 12 名 (80.0%) 在 MRI 前发现子宫腺肌病，其 MRI 特征进展。57 名患者中有 15 名 (26.3%) 在 MRI 前未发现子宫腺肌病，在治疗后发现了子宫腺肌病的出现。

结论

每天服用 5 毫克 UPA 的 3 个月疗程可能会引起短期进展或在 MRI 检查中出现典型的子宫腺肌病肌层内囊肿。