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Introduction: Uterine fibroids are the most common benign tumor in females of reproductive age. Uterine artery embolization (UAE) is a less-invasive alternative to hysterectomy. Our objective is to assess the ability of superb microvascular imaging (SMI) to characterize fibroid microvascularity before and after UAE compared to conventional Doppler modes using contrast-enhanced ultrasound (CEUS) and clinical outcomes as reference standards.

Methods: Participants will be 40 adult females who are scheduled for UAE. Participants receive three transabdominal ultrasounds at day 0, day 14 and day 90 post-UAE using an Aplio i800 scanner. Subjects undergo examination with four non-contrast ultrasound modalities— color doppler (CDI), power doppler (PDI), color SMI (cSMI) and monochrome SMI (mSMI)— followed by CEUS. Qualitative analysis is performed by two radiologists who score the fibroids as having internal, peripheral or no vascularity. ImageJ is used to quantify fractional vascularity (FV) and signal intensity (SI).

Results: Results from 31 fibroids in 22 subjects are currently available. In agreement with CEUS findings, analysis of the FV showed significant differences across modes and examination times (p<0.001). Though analysis of signal intensity across imaging modes showed no significant differences (p=0.9), differences were observed across examination times (p<0.001). Compared to the CEUS findings, one reader showed no difference for all modes (p=0.2), while the other reader showed no difference for CDI, PDI and cSMI (p>0.1), but did show a difference for mSMI (p=0.047).

Discussion: Preliminary results indicate that Doppler and SMI modes agree with CEUS findings when evaluating fibroid vascularity, and may provide clinical benefit.