Assessment of the uterine artery before uterine arterial embolization: Comparison of unenhanced 3D water-excitation sensitivity-encoding time-of-flight (WEST) and gadolinium-enhanced 3D sensitivity-encoding water-excitation multishot echo-planar (SWEEP) MR angiography

Purpose: To compare unenhanced 3D water-excitation sensitivity-encoding time-of-flight (WEST) and gadolinium-enhanced 3D sensitivity-encoding water-excitation multi-shot echo-planar (SWEEP) MR angiography (MRA) with regard to conspicuity of uterine arteries in correlation with digital subtraction angiography (DSA). Materials and Methods: Eleven consecutive patients with symptomatic uterine fibroids underwent 2 types of MRA before uterine arterial embolization (UAE). From these MRA an interventional radiologist predicted the optimal degrees for oblique DSA projections to reveal uterine arterial origins. Qualitatively, three independent observers reviewed two types of MRA assessing the conspicuity of uterine arterial origins and descending portions using a 3-point scale. Quantitatively, the visualized uterine arteries were measured from their orifice to the end of their descending portions. Results: At UAE, knowing the optimal degrees from MRA, the uterine arterial origins were clearly visualized on all first oblique DSA projections. Mean conspicuity levels of the uterine arterial origins and descending portions were significantly higher and mean length of the visualized uterine arteries was significantly longer for unenhanced WEST MRA than for gadolinium-enhanced SWEEP MRA. Conclusion: Unenhanced 3D-WEST MRA was superior to gadolinium-enhanced 3D-SWEEP MRA in demonstrating uterine arteries. The optimal degrees for DSA projections to reveal uterine arterial origins could be accurately predicted using this noninvasive technique.