The power of proximity: Effects of a multidisciplinary fibroid clinic on inter-specialty perceptions and practice patterns.

BACKGROUND: Multidisciplinary collaboration has generally been shown to have positive effects on healthcare but can be difficult to facilitate. This study assessed the effects of a multidisciplinary fibroid clinic on practice patterns and clinician perceptions to better understand drivers of interspecialty collaboration. MATERIALS AND METHODS: Annual rates of hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs) performed in an urban healthcare system were collected from 2012-2019. Rates of each procedure were compared over time before and after launching a multidisciplinary fibroid clinic at the academic medical center. Referral rates were also compared. The gynecologists and interventional radiologists (IRs) involved in the clinic were interviewed 2 years prior to and after the clinic launch about their approaches to fibroids and perceptions of others who treat this condition. A phenomenological approach was used to identify and compare themes within the interviews by two researchers with excellent inter-rater agreement (κ = 0.80). RESULTS AND DISCUSSION: Annual rates of fibroid procedures increased over time (p<0.01) but the relative number of UFEs decreased (p = 0.01). UFE referrals by the clinic gynecologists significantly increased as did the number of combined fibroid procedures (p<0.01). However, the rates of one fibroid procedure relative to others were not different between the clinic and rest of the healthcare system (p = 0.55). Specialty-specific perceptions of fibroid treatments and inter-specialty dynamics did not change. Despite this, clinicians unanimously perceived the clinic and post-clinic practice patterns as positive and distinct from their previous work and relationships between gynecology and IR elsewhere. Limitations of this study included its single clinic design and potential confounder of differences in advertising pre- versus post-clinic. CONCLUSION: Creating the right practice environment may be more important for fostering inter-specialty collaboration and work satisfaction than shared mental models or procedural volumes in certain practice settings.

The growing pains of physician-administration relationships in an academic medical center and the effects on physician engagement.

BACKGROUND: Physician engagement has become a key metric for healthcare leadership and is associated with better healthcare outcomes. However, engagement tends to be low and difficult to measure and improve. This study sought to efficiently characterize the professional cultural dynamics between physicians and administrators at an academic hospital and how those dynamics affect physician engagement. MATERIALS AND METHODS: A qualitative mixed methods analysis was completed in 6 weeks, consisting of a preliminary analysis of the hospital system's history that was used to purposefully recruit 20 physicians across specialties and 20 healthcare administrators across management levels for semi-structured interviews and observation. Participation rates of 77% (20/26) and 83% (20/24) were achieved for physicians and administrators, respectively. Cohorts consisted of equal numbers of men and women with experience ranging from 1 to 35 years within the organization. Field notes and transcripts were systematically analyzed using an iterative inductive-deductive approach. Emergent themes were presented and discussed with approximately 400 physicians and administrators within the organization to assess validity and which results were most meaningful. RESULTS & DISCUSSION: This investigation indicated a professional cultural disconnect was undermining efforts to improve physician engagement. This disconnect was further complicated by a minority (10%) not believing an issue existed and conflicting connotations not readily perceived by participants who often offered similar solutions. Physicians and administrators felt these results accurately reflected their realities and used this information as a common language to plan targeted interventions to improve physician engagement. Limitations of the study included its cross-sectional nature with a modest sample size at a single institution. CONCLUSIONS: A qualitative mixed methods analysis efficiently identified professional cultural barriers within an academic hospital to serve as an institution-specific guide to improving physician engagement.

Cost-Effectiveness of a Guided Peripherally Inserted Central Catheter Placement System: A Single-Center Cohort Study.

PURPOSE: To assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs). MATERIALS AND METHODS: Sixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50% male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56% male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed. RESULTS: Guided PICC placements required less repositioning (1.5% vs 10.3%, P = .03) and resulted in more catheters positioned as desired (86.8% vs 67.6%, P = .01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P = .002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system. CONCLUSIONS: The guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution.

Fostering better policy adoption and inter-disciplinary communication in healthcare: A qualitative analysis of practicing physicians' common interests.

PURPOSE: In response to limited physician adoption of various healthcare initiatives, we sought to propose and assess a novel approach to policy development where one first characterizes diverse physician groups' common interests, using a medical student and constructivist grounded theory. METHODS: In 6 months, a medical student completed 36 semi-structured interviews with interventional radiologists, gynecologists, and vascular surgeons that were systematically analyzed according to constructivist grounded theory to identifying common themes. Common drivers of clinical decision making and professional values across 3 distinct specialty groups were derived from physicians' descriptions of their clinical decision making, stories, and concerns. RESULTS: Common drivers of clinical decision making included patient preference/benefit, experience, reimbursement, busyness/volume, and referral networks. Common values included honesty, trustworthiness, loyalty, humble service, compassion and perseverance, and practical wisdom. Although personal gains were perceived as important interests, such values were easily sacrificed for the good of patients or other non-financial interests. This balance was largely dependent on the incentives and security provided by physicians' environments. CONCLUSIONS: Using a medical student interviewer and constructivist grounded theory is a feasible means of collecting rich qualitative data to guide policy development. Healthcare administrators and medical educators should consider incorporating this methodology early in policy development to anticipate how value differences between physician groups will influence their acceptance of policies and other broad healthcare initiatives.

Why Vascular Surgeons and Interventional Radiologists Collaborate or Compete: A Look at Endovascular Stent Placements.

PURPOSE: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision making and inter-specialty relationships. METHODS: Twenty-four conversational interviews were conducted with IRs and VSs about their approaches to patient care, views of their specialty and others, and solutions to any expressed concerns. Interview transcripts were systematically analyzed to identify and compare key themes according to the constructivist grounded theory and content analysis using NVivo 10 software. These data were supplemented with a retrospective analysis of 3658 endovascular stent placements performed at a large medical academic center over 11 years. Aggregate counts were divided by provider specialty, and trends were assessed via correlation coefficients. RESULTS: Endovascular stent placements were relatively equally divided between IR and VS over 11 years with some variability from placements by cardiology. IRs tend to lay claim to treatments as masters of procedures, whereas VSs base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived competition was most associated with specialists' awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement. CONCLUSIONS: Understanding cultural differences between IRs and VSs is imperative for fostering better collaboration to grow shared territory rather than competing for the same slice of the pie.

Specialty-Specific Values Affecting the Management of Symptomatic Uterine Fibroids.

PURPOSE: To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids. METHODS: Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years. RESULTS: Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests. CONCLUSIONS: Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.

Greater Cephalad Extent of Thoracic Epidural Sensory Anesthesia After Lidocaine and Epinephrine Test Dose Correlates With Analgesic Consumption and Pain Burden After Uterine Fibroid Artery Embolization.

BACKGROUND AND OBJECTIVES: Ischemic pain after uterine fibroid artery embolization (UFAE) is often severe. We evaluated the sensory anesthesia extent from thoracic epidural catheter test injection of lidocaine 75 mg with epinephrine 25 µg as a predictor of analgesia effectiveness after UFAE. METHODS: One hundred patients were studied. Pinprick and cold insensitivity were assessed from L3 to T4 at 5-minute intervals for 30 minutes after the test dose. Thoracic epidural management was standardized. Total epidural infusate and numeric rating of pain (0-10) scores were recorded. RESULTS: Pinprick or cold insensitivity at T9 to T10 dermatome was present in 94% of patients. Forty-six subjects (45%) achieved a sensory level at or above the T6 dermatome at 30 minutes. Median analgesic consumption in the first hour and at catheter discontinuation was greater in subjects with a sensory level above T6 compared with those below T6: first hour difference, 7 mL (95% confidence interval [95% CI], 0-12 mL; P = 0.02); difference at discontinuation, 21 mL (95% CI, 4-35 mL; P = 0.02). The area under the pain score by time curve for the first 24 hours was greater in patients with sensory levels above T6: difference 32 score · hour (95% CI, 12 score · h - 60 score · h; P = 0.001). CONCLUSIONS: Sensory anesthesia spread above the T6 dermatome 30 minutes after a test dose of 1.5% lidocaine was an independent predictor of the analgesic consumption after UFAE. Pain burden and oral opioid consumption were also increased in subjects who demonstrated a high sensory spread after the test dose.

Cancer concepts and principles: primer for the interventional oncologist-part I.

A sophisticated understanding of the rapidly changing field of oncology, including a broad knowledge of oncologic disease and the therapies available to treat them, is fundamental to the interventional radiologist providing oncologic therapies, and is necessary to affirm interventional oncology as one of the four pillars of cancer care alongside medical, surgical, and radiation oncology. The first part of this review intends to provide a concise overview of the fundamentals of oncologic clinical trials, including trial design, methods to assess therapeutic response, common statistical analyses, and the levels of evidence provided by clinical trials.

Cancer concepts and principles: primer for the interventional oncologist-part II.

This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.

Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma.

BACKGROUND & AIMS: Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. METHODS: We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. RESULTS: Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). CONCLUSIONS: Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic.

PURPOSE: To test the hypothesis that an inferior vena cava (IVC) filter clinic increases the retrieval rate of optional IVC filters. MATERIALS AND METHODS: Patients who had optional IVC filters placed at the authors' institution between January 2000 and December 2008 were identified and retrospectively studied. A dedicated IVC filter clinic was established at this institution in January 2009, and there is a comprehensive database of prospectively acquired data for patients seen in the IVC filter clinic. Patients were chronologically classified into preclinic and postclinic groups. The number of optional filters retrieved and failed retrieval attempts were recorded. RESULTS: In the preclinic and postclinic periods, 369 and 100 optional IVC filters were placed. Median (interquartile range) number of optional filters placed per month for preclinic and postclinic periods was 3 (range 2-5) and 10 (range 6.5-10.5) (P < .001). Retrieval rates in preclinic and postclinic periods were 108 of 369 (29%) and 60 of 100 (60%) (P < .001). The median time to filter retrieval in the postclinic group was 1.5 months (95% confidence interval 1.2-1.8). The number of failed retrieval attempts in preclinic and postclinic periods was 23 of 369 (6%) and 5 of 100 (5%) (P = .823). CONCLUSIONS: The retrieval rate of optional IVC filters at this institution was significantly increased by the establishment of a dedicated IVC filter clinic. This retrieval increase is not related to a decrease in technical failures but more likely relates to more meticulous patient management and clinical follow-up.

Four-dimensional transcatheter intra-arterial perfusion MR imaging before and after uterine artery embolization in the rabbit VX2 tumor model.

PURPOSE: To test the hypothesis that four-dimensional (4D) transcatheter intra-arterial perfusion (TRIP) MR imaging can measure uterine fibroid perfusion changes immediately before and after uterine artery embolization (UAE) in the rabbit VX2 tumor model. MATERIALS AND METHODS: Eight VX2 uterine tumors were grown in six rabbits. After positioning a catheter within the uterine artery, we performed 4D TRIP-MRI measurements with 3-mL injections of 2.5% gadopentetate dimeglumine. We used a dynamic 3D spoiled-gradient echo sequence with in vivo B(1)-field correction for improved accuracy during perfusion quantification. We performed UAE using 1 mL of gelatin microspheres (2 x 10(6) particles; diameter 40-120 mum). Two regions-of-interest were drawn within each tumor upon perfusion maps. Functional embolic endpoints were reported as the mean percent reduction in fibroid tumor perfusion. Measurements before and after UAE were compared using paired t-tests (alpha = 0.05). RESULTS: VX2 uterine tumor perfusion decreased significantly from 27.1 at baseline to 7.09 after UAE (mL/min/100 mL of tissue, P < 0.0001). Overall perfusion reduction was 76.3% (95% confidence interval: 66.3-86.3%). CONCLUSION: Four-dimensional TRIP MRI can objectively quantify uterine fibroid perfusion reductions during UAE in VX2 rabbits. This technique could be used clinically to potentially determine an optimal embolic endpoint with the long-term goals of improving UAE success rates and minimizing procedure-related ischemic pain.

Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort.

PURPOSE: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems. RESULTS: Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001). CONCLUSION: The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.

Prospective evaluation of the embolic agent bead block in the treatment of uterine leiomyomas with uterine artery embolization: a phase II study.

PURPOSE: To assess symptom reduction and follow-up magnetic resonance (MR) imaging findings in patients who have undergone uterine artery embolization (UAE) for symptomatic leiomyomas with the use of Bead Block. MATERIALS AND METHODS: Symptomatic patients with uterine leiomyomas were treated with UAE with Bead Block. Degree of tumor infarction was assessed 3 months after treatment with contrast material-enhanced MR imaging. Each case was categorized as showing less than 25% infarction, 25%-89% infarction, or at least 90% infarction. Imaging-based failure was defined as tumor infarction of less than 90% (12). Symptom and quality status were determined by scores from symptom and quality of life (QOL) and health-related QOL questionnaires collected 1 and 3 months after embolization. RESULTS: This prospective trial enrolled 23 patients. Three-month follow-up MR imaging was completed in 22 patients. Tumor necrosis of 90% or greater occurred in 10 of 22 patients (45%), and 12 (54%) had partial necrosis of 25%-89%. The QOL subscale evaluation showed significant reduction of symptom severity from baseline to 1 month after treatment (P < .0001), with no significant difference between 1 and 3 months of follow-up (P = .42). Because of the unacceptably high imaging failure rate of 54%, enrollment was terminated before the anticipated 30-patient goal. CONCLUSIONS: The use of Bead Block in the manner described resulted in significant clinical improvement. However, there was an unacceptably high rate of imaging failure under the existing protocol. Modification of the existing protocol should be considered.

How to interpret thyroid biopsy results: a three-year retrospective interventional radiology experience.

Results of thyroid biopsy determine whether thyroid nodule resection is appropriate and the extent of thyroid surgery. At our institution we use 20/22-gauge core biopsy (CBx) in conjunction with fine-needle aspiration (FNA) to decrease the number of passes and improve adequacy. Occasionally, both ultrasound (US)-guided FNA and CBx yield unsatisfactory specimens. To justify clinical recommendations for these unsatisfactory thyroid biopsies, we compare rates of malignancy at surgical resection for unsatisfactory biopsy results against definitive biopsy results. We retrospectively reviewed a database of 1979 patients who had a total of 2677 FNA and 663 CBx performed by experienced interventional radiologists under US guidance from 2003 to 2006 at a tertiary-care academic center. In 451 patients who had surgery following biopsy, Fisher's exact test was used to compare surgical malignancy rates between unsatisfactory and malignant biopsy cohorts as well as between unsatisfactory and benign biopsy cohorts. We defined statistical significance at P = 0.05. We reported an overall unsatisfactory thyroid biopsy rate of 3.7% (100/2677). A statistically significant higher rate of surgically proven malignancies was found in malignant biopsy patients compared to unsatisfactory biopsy patients (P = 0.0001). The incidence of surgically proven malignancy in unsatisfactory biopsy patients was not significantly different from that in benign biopsy patients (P = 0.8625). In conclusion, an extremely low incidence of malignancy was associated with both benign and unsatisfactory thyroid biopsy results. The difference in incidence between these two groups was not statistically significant. Therefore, patients with unsatisfactory biopsy specimens can be reassured and counseled accordingly.

Infection control practices among interventional radiologists: results of an online survey.

PURPOSE: To assess current infection control practices of interventional radiologists (IRs) in the context of recommendations by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. MATERIALS AND METHODS: From November 2006 to January 2007, members of the Society of Interventional Radiology (SIR) were invited to participate in an anonymous, online infection control questionnaire. RESULTS: A total of 3,019 SIR members in the United States were contacted via e-mail, and 1,061 (35%) completed the 57-item survey. Of the respondents, 283 (25%) experienced a needlestick injury within the previous year, most often as a result of operator error (76%). Less than 65% reported compliance with annual tuberculosis skin testing; notably, those who received a yearly reminder were much more likely to receive annual testing than those who did not (odds ratio, 19.0; 95% CI, 12.6-28.7; P < .05). During central venous catheter placement, only 56% wore gowns, 50% wore caps, and 54% used full barrier precautions. Only 19% reported routine hand washing between glove applications. More than 40% noted a change in infection control practices within the previous 5 years, citing new hospital guidelines and recommendations by a professional organization as the reasons for change. Only 44% had infection control training at the onset of their practice. CONCLUSIONS: IRs demonstrate a wide variety of infection control practices that are not in accordance with current guidelines. IRs were most likely to change infection control practice if required to do so by their own hospitals or a professional organization. SIR can play an important role in the prevention of health care-associated infection by reinforcing current infection control guidelines as they pertain to interventional radiology.

Effect of postprocedural pelvic MR imaging on medical decision-making in women who have undergone uterine artery embolization.

The utility of magnetic resonance (MR) imaging in the follow-up of patients who have undergone uterine artery embolization (UAE) for leiomyomas is controversial. The present study was undertaken to determine how follow-up MR imaging affects interventional radiologists' (i) anticipated percentage of tumor necrosis, (ii) projected treatment plans, and (iii) confidence in treatment plans. Interventional radiologists completed questionnaires before and after reviewing MR images of patients treated with UAE to determine how imaging altered projected treatment plans. Follow-up MR imaging was found to significantly alter projected treatment plans, primarily as they relate to follow-up imaging; therefore, follow-up MR imaging should be considered for all patients after UAE.

Use of a combined MR imaging and interventional radiology suite for intraprocedural monitoring of uterine artery embolization.

PURPOSE: The optimal embolic endpoint for uterine artery embolization (UAE) is unknown. It is difficult to quantify substasis endpoints with the use of conventional x-ray interventional radiology (IR) guidance. Although magnetic resonance (MR) imaging can detect perfusion changes, intraprocedural perfusion changes within targeted uterine leiomyomas and the remaining uterine wall remain unknown. A hybrid MR/IR unit was used to test the hypothesis that MR imaging can detect changes in uterine perfusion-dependent signal enhancement immediately after UAE. MATERIALS AND METHODS: In this prospective study, UAE was performed in a hybrid MR/IR unit in women with symptomatic uterine leiomyomas. This MR/IR unit contains a wide-bore 1.5-T MR scanner connected by a sliding table to an adjacent x-ray digital subtraction angiography unit. Gadolinium-enhanced MR imaging was performed before and after UAE. Relative signal-to-noise ratio (SNR) was measured within each tumor and the adjacent uterine wall, and mean relative SNR changes were compared before and after UAE with the paired t test (alpha=0.05). RESULTS: UAE was technically successful in all six women, in whom 10 tumors were assessed (seven intramural, two submucosal, one subserosal). Mean relative SNR of the tumors before UAE was 62.2+/-25.0 and was reduced to 41.1+/-17.7 after UAE (P<.01). Mean relative SNR of the adjacent uterine wall was 64.2+/-14.3 before UAE and decreased to 28.8+/-14.9 after UAE (P<.01). CONCLUSIONS: Immediate reductions in perfusion-dependent enhancement in targeted uterine leiomyomas and the adjacent uterine wall can be detected during UAE with the use of a hybrid MR/IR unit. Further studies are now warranted to compare long-term clinical outcomes versus immediate changes in perfusion at the time of UAE.