Please use this link to preregister for your initial consultation, MRI and/or UFE procedure at St. Luke's Episcopal Hospital. Please note that if you are registering to see Dr. Fischer for an initial consultation, you will also need to go to the "online forms" section, print out the forms there, complete them and bring them with you to the office. Both of these processes will make your visit to our office more efficient. Please contact us with any questions or problems with preregistration or completion of the forms. Thank you.
Most fibroid tumors do not cause symptoms and are diagnosed incidentally during a normal pelvic examination or pelvic ultrasound. Some patients go to their gynecologist with symptoms as a result of fibroids, such as heavy menstrual bleeding, pelvic pain, pelvic pressure, urinary frequency, constipation, back pain, or painful intercourse. The presence of fibroids suspected by physical examination can be confirmed using non-invasive imaging techniques such as ultrasound and/or MRI. Most patients are imaged using ultrasound initially but a pelvic MRI is required in all patients being evaluated as potential candidates for uterine fibroid embolization. MRI provides more information concerning the size, number, location, and vascular supply of the fibroids.
An MRA (magnetic resonance angiogram) of the pelvis is performed simultaneously with the MRI of the uterus to show the vascular anatomy and blood supply to the fibroids. This image is an example of such a study and shows enlarged uterine arteries on the left and right sides.
This sagittal (cut lengthwise) MRI image through the pelvis shows a dominant submucosal fibroid anteriorly indenting the endometrial stripe and a small intramural fibroid posteriorly. Several other fibroids were also present but are not visible in this single slice.
This sagittal MRI image obtained through the pelvis after contrast administration shows the marked vascularity of the fibroids as they take up the administered contrast agent.
MRI also provides valuable information concerning other disease processes that may mimic the symptoms caused by fibroids, such as adenomyosis and endometrial polyps. Magnetic resonance angiography (MRA) provides valuable information about the blood supply to the fibroids. Fibroid blood supply is usually obtained from the uterine arteries but on occasion the ovarian arteries can provide the dominant supply. This is extremely useful information to have prior to the procedure to increase the likelihood of a successful outcome. Please see the following examples of other disease processes and atypical blood supply to fibroid tumors.
This patient was diagnosed with a large fibroid in the uterus and was referred as a potential candidate for uterine fibroid embolization. Sagittal (cut lengthwise) MRI image obtained through the pelvis shows a markedly enlarged uterus but no fibroids. The study does show a condition called adenomyosis, which is an abnormal proliferation of the endometrial glands into the normal uterine muscular tissue. This can be seen as a thickening of the "junctional zone" of the uterus with multiple tiny cystic appearing areas within it. This diagnosis cannot reliably be made using ultrasound and significantly altered the patient's treatment options.
This sagittal (cut lengthwise) and axial (cut crosswise) images through the pelvis show an enlarged uterus containing multiple small to moderate sized fibroids. Additionally, a small approximately 1.5 cm polyp was noted in the upper part of the endometrial canal. This patient underwent hysteroscopic resection of the endometrial polyp prior to embolization to treat the remaining intramural fibroids.
This MRA (magnetic resonance angiogram) image shows markedly enlarged ovarian arteries on the left and right originating from the aorta and providing the dominant blood supply to the fibroid uterus. The patient also had a small amount of supply from the right uterine artery. The left uterine artery did not provide significant flow to the fibroids. An ultrasound would not have provided this crucial information about the source of the fibroids' blood supply prior to the procedure.
What are fibroids?
An MRA (magnetic resonance angiogram) of the pelvis is performed simultaneously with the MRI of the uterus to show the vascular anatomy and blood supply to the fibroids. This image is an example of such a study and shows enlarged uterine arteries on the left and right sides.
This sagittal (cut lengthwise) MRI image through the pelvis shows a dominant submucosal fibroid anteriorly indenting the endometrial stripe and a small intramural fibroid posteriorly. Several other fibroids were also present but are not visible in this single slice.
This sagittal MRI image obtained through the pelvis after contrast administration shows the marked vascularity of the fibroids as they take up the administered contrast agent.
This patient was diagnosed with a large fibroid in the uterus and was referred as a potential candidate for uterine fibroid embolization. Sagittal (cut lengthwise) MRI image obtained through the pelvis shows a markedly enlarged uterus but no fibroids. The study does show a condition called adenomyosis, which is an abnormal proliferation of the endometrial glands into the normal uterine muscular tissue. This can be seen as a thickening of the "junctional zone" of the uterus with multiple tiny cystic appearing areas within it. This diagnosis cannot reliably be made using ultrasound and significantly altered the patient's treatment options.
This sagittal (cut lengthwise) and axial (cut crosswise) images through the pelvis show an enlarged uterus containing multiple small to moderate sized fibroids. Additionally, a small approximately 1.5 cm polyp was noted in the upper part of the endometrial canal. This patient underwent hysteroscopic resection of the endometrial polyp prior to embolization to treat the remaining intramural fibroids.
This MRA (magnetic resonance angiogram) image shows markedly enlarged ovarian arteries on the left and right originating from the aorta and providing the dominant blood supply to the fibroid uterus. The patient also had a small amount of supply from the right uterine artery. The left uterine artery did not provide significant flow to the fibroids. An ultrasound would not have provided this crucial information about the source of the fibroids' blood supply prior to the procedure.