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승대 사
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양승부 외: 자궁근종색전술 후 초기 초음파 소견 입자로 색전하였다. 시술 다음날부터 2주일간 회색조 및 색도 플러초음파 검사를 시행하였다.

사용된 초음파기는 HDI 5000(Advanced Technology Laboratories, Bothell, Washington, U.S.A.)이었고, 2-5 MHz 탐촉자를 사용하였다.

Ultrasonographic Findings after Uterine Fibroid Embolization Ultrasonographic Findings Presence of air No of Patient(%) myoma myometrium

signal none 11/11 (100) 0/11 (0) 4/11 (36) 7/11 (64) 9/11 (82) 2/11 (18) 0/11 (0) 0/11 (0) B C D Fig. 1. A 32-year-old woman with huge uterine myoma.

2 양승부 외: 자궁근종색전술 후 초기 초음파 소견 입자로 색전하였다. 시술 다음날부터 2주일간 회색조 및 색도 플러초음파 검사를 시행하였다. 모든 예에서 시술 후 1일, 3 일, 1주일에 초음파 검사를 시행하였으며 2예에서는 10일과 14일에 초음파 검사를 시행하였다. 사용된 초음파기는 HDI 5000(Advanced Technology Laboratories, Bothell, Washington, U.S.A.)이었고, 2-5 MHz 탐촉자를 사용하였다. 초음파 소견에서 공기 음영의 여부, 공기 음영의 분포 형태, 공기 음영의 소실 시기, 자궁강 내 체액 저류 및 색도플러초 음파상 혈류 신호를 분석하였다. A Table 1. Ultrasonographic Findings after Uterine Fibroid Embolization Ultrasonographic Findings Presence of air No of Patient(%) myoma myometrium Distribution pattern of air branching linear numerous scattered Time of air loss 7 day 14 day Fluid collection in uterine cavity none Color signal none 11/11 (100) 0/11 (0) 4/11 (36) 7/11 (64) 9/11 (82) 2/11 (18) 0/11 (0) 0/11 (0) B C D Fig. 1. A 32-year-old woman with huge uterine myoma. A. Sagittal T2-weighted MR image shows a 12 cm sized leiomyoma. B. Pelvic aortogram of delayed phase shows a huge hypervascular tumor staining. C. One day after embolization, transabdominal sonography (TAS) shows numerous branching linear echoes with reverberation artifact within the myoma. D. Seven days after embolization, TAS shows no longer visible air shadow within myoma. 298

대한영상의학회지 2008;58:297-302 결 과 본 연구에서 분석한 자궁근종색전술 후의 초음파소견을 Table 1에 요약하였다.

공기 음영의 분포는 가지 치는 모양(Fig. 1) 혹은 산개한 모양으로 자궁근종 내에서만 보였다. 자궁 근층에서는 공기 음영이 보이지 않았다(Fig. 2).

자궁강 내의 비정상적인 체액 저류는 없었다. 모든 예에서 근 B D Fig. 2. A

Transvaginal sonography shows a well defined hypoechoic leiomyoma in uterine body. B.

3 대한영상의학회지 2008;58: 결 과 본 연구에서 분석한 자궁근종색전술 후의 초음파소견을 Table 1에 요약하였다. 총 11예 중 모든 예에서 시술 다음날 부터 무수히 많은 강한 에코와 반향 인공물(reverberation A C artifact)을 보이는 공기들이 보였다. 공기 음영의 분포는 가지 치는 모양(Fig. 1) 혹은 산개한 모양으로 자궁근종 내에서만 보였다. 자궁 근층에서는 공기 음영이 보이지 않았다(Fig. 2). 공기 음영은 9예(82%)에서 7일 이내에 모두 소실되었고(Fig. 1), 나머지 2예(18%)에서는 14일에 모두 소실되었다(Fig. 2). 자궁강 내의 비정상적인 체액 저류는 없었다. 모든 예에서 근 B D Fig. 2. A 31-year-old woman with intramural myoma. A. Transvaginal sonography shows a well defined hypoechoic leiomyoma in uterine body. B. One day after embolization, TAS shows numerous scattered echoes with reverberation artifact within the myoma. C. Seven days after embolization, TAS shows decreased air shadow within the myoma. D. Ten days after embolizaion, TAS shows much decreased air shadow, except single high echo with reverberation artifact suggesting remained air. E. Two weeks after emboliztion, TAS shows no high echo with reverberation artifact. E 299

4 A B Fig. 3. A 37-year-old woman with intramural myoma. A. Color doppler image (CDI) before embolization depicts increased blood flow in the myoma. B. Three days after embolization, CDI depicts numerous scattered high echoes within the myoma, but no visible blood flow signals in the myoma. 300

5 2. Brunereau L, Herbreteau D, Gallas S, Cottier JP, Lebrun JL, Tranquart F, et al. Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 pa- tients. AJR Am J Roentgenol 2000;175: Gross BH, Silver TM, Jaffee MH. Sonographic features of uterine leiomyomas: analysis of 41 proven cases. J Ultrasound Med 1983;2: Goodwin SC, Vedantham S, McLucas B, Forno AE, Perrella R. Preliminary experience with uterine artery embolization of uterine fibroids. J Vasc Interv Radiol 1997;8: Worthington-Kirsch RL, Popky GL, Hutchins FL Jr. Uterine arterial embolization for the management of fibroids: quality-of-life as- sessment and clinical response. Radiology 1998;208: Pelage JP, Soyer P, Le Dref O, Kardache M, Dahan H, Abitbol M, et al. Uterine arteries: bilateral catheterization with a single femoral approach and a single 5-F catheter: technical note. Radiology 1992;210: Buttram VC, Reiter RC. Uterine fibroid aetiology, symptomatology and management. Fertil Steril 1981;36: Verkauf BS. Myomectomy for infertility enhancement and preservation. Fertil Steril 1992;58: Sutton CJ. Treatment of large uterine fibroids. Br J Obstet Gynaecol 1996;103: Hutchins FZ. Abdominal myomectomy as a treatment for symptomatic uterine fibroids. Obstet Gynecol Clin North Am 1995;22: Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet 1995;346: Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy- Skrynarz K. Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 2002;100: Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radiographics 2001;21: Hovsepian DM, Siskin GP, Bonn J, Cardella JF, Cardella JF, Clark T, et al. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. Cardiovasc Intervent Radiol 2004;27: Hemingway AP. Complications of embolotherapy. In Kadir S. Current practice of interventional radiology. Philadelphia: B. C. Decker Inc, 1991: Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 2002;109: Kitamura Y, Ascher SM, Cooper C, Allison SJ, Jha RC, Flick PA, et al. Imaging manifestations of complications associated with uterine artery embolization. Radiographics 2005;25: Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radiographics 2001;21: Worthington-Kirsch RL, Hutchins FL Jr, Berkowitz RP. Uterine interstitial gas after uterine artery embolization: a benign finding. J Intervent Radiol 1999;14: Caruso A, Caforio L, Testa AC, Pomini F, Ciampelli M, Mancuso S. Conventional ultrasonography and color Doppler velocimetry of uterine leiomyomas. Rays 1998;23:

6 Early Ultrasonographic Findings after a Uterine Fibroid Embolization: The Value of Differentiate from Procedure-Related Uterine Infection 1 Seung Boo Yang, M.D., Dong Erk Goo, M.D. 2, Yun Woo Chang, M.D. 2, Jin Soo Choi, M.D. 3 1 Department of Radiology, Soonchunhyang University, Gumi Hospital 2 Department of Radiology, Soonchunhyang University Hospital 3 Department of Radiology, School of Medicine, Keimyung University Purpose: To evaluate the early ultrasonographic (US) findings from the uterus and myoma after a uterine fibroid embolization (UFE). Materials and Methods: From March 2004 to January 2006, eleven patients (2748 years, mean: 37 years) with UFE to treat symptomatic uterine myoma, were retrospectively reviewed. A serial follow up gray-scale and color Doppler US were performed from one day to two weeks following a UFE. The US findings were evaluated for the presence and distribution pattern of air, time of air loss, and presence of fluid collection in the uterine cavity and color Doppler signal. Results: Numerous high echoes with reverberation artifacts (which suggest air), were observed within the myoma (in all cases), one day after UFE. A branching linear echo pattern was observed in 4 cases (36%), whereas scattered echoes were observed in 7 cases (64%). Progressive loss of air, within 7 days of a UFE, was observed in 9 cases (82%), whereas 2 cases (12%) were observed within 14 days of a UFE. Abnormal fluid collection in the uterine cavity and a color Doppler signal within the myoma was not observed for all cases. Conclusion: Branching or scattered echoes (suggesting air), are normally found within the myoma after a UFE, but these echoes disappeared within 2 weeks. These early US findings can be useful in differentiating from myoma infections after a UFE. Index words : Uterine neoplasms Leiomyoma Ultrasonography, interventional Embolization, therapeutic Address reprint requests to : Seung Boo Yang, M.D., Department of Radiology, Soonchunhyang University Gumi Hospital 250, Gongdan-dong, Gumi, Kyungbuk , Korea. Tel Fax ysbysb@sch.ac.kr 302

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¾ç½ÂºÎ 229 A B C D Fig. 1. Intramural type uterine myoma in a 32-year-old woman presented with hypermenorrhea and vaginal bleeding. A. Left uterine artery angiogram shows collateral vessel(arrow) to the the left