HAL Id: dumas-02273562 https://dumas.ccsd.cnrs.fr/dumas-02273562 Submitted on 29 Aug 2019 HAL is a multi-disciplinary open access archive for the deposit and dissemination of sci- entific research documents, whether they are pub- lished or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Évolution de l’adénomyose en IRM chez les patientes traitées par Ulipristal Acétate pour myomes symptomatiques Lisa Calderon To cite this version: Lisa Calderon. Évolution de l’adénomyose en IRM chez les patientes traitées par Ulipristal Acétate pour myomes symptomatiques. Sciences du Vivant [q-bio]. 2019. dumas-02273562
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HAL Id: dumas-02273562https://dumas.ccsd.cnrs.fr/dumas-02273562
Submitted on 29 Aug 2019
HAL is a multi-disciplinary open accessarchive for the deposit and dissemination of sci-entific research documents, whether they are pub-lished or not. The documents may come fromteaching and research institutions in France orabroad, or from public or private research centers.
L’archive ouverte pluridisciplinaire HAL, estdestinée au dépôt et à la diffusion de documentsscientifiques de niveau recherche, publiés ou non,émanant des établissements d’enseignement et derecherche français ou étrangers, des laboratoirespublics ou privés.
Évolution de l’adénomyose en IRM chez les patientestraitées par Ulipristal Acétate pour myomes
symptomatiquesLisa Calderon
To cite this version:Lisa Calderon. Évolution de l’adénomyose en IRM chez les patientes traitées par Ulipristal Acétatepour myomes symptomatiques. Sciences du Vivant [q-bio]. 2019. �dumas-02273562�
Évolution de l’adénomyose en IRM chez les patientes traitées
par Ulipristal Acétate pour myomes symptomatiques.
T H È S E A R T I C L E
Présentée et publiquement soutenue devant
LA FACULTÉ DES SCIENCES MEDICALES ET PARAMEDICALES
DE MARSEILLE
Le 24 Mai 2019
Par Madame Lisa CALDERON
Née le 16 février 1991 à Marseille 05ème (13)
Pour obtenir le grade de Docteur en Médecine
D.E.S. de RADIODIAGNOSTIC ET IMAGERIE MÉDICALE
Membres du Jury de la Thèse :
Monsieur le Professeur BARTOLI Jean-Michel Président
Monsieur le Professeur VIDAL Vincent Assesseur
Monsieur le Professeur AGOSTINI Aubert Assesseur
Madame le Docteur GROB Anaïs Directeur
Évolution de l’adénomyose en IRM chez les patientes traitées
par Ulipristal Acétate pour myomes symptomatiques.
T H È S E A R T I C L E
Présentée et publiquement soutenue devant
LA FACULTÉ DES SCIENCES MEDICALES ET PARAMEDICALES
DE MARSEILLE
Le 24 Mai 2019
Par Madame Lisa CALDERON
Née le 16 février 1991 à Marseille 05ème (13)
Pour obtenir le grade de Docteur en Médecine
D.E.S. de RADIODIAGNOSTIC ET IMAGERIE MÉDICALE
Membres du Jury de la Thèse :
Monsieur le Professeur BARTOLI Jean-Michel Président
Monsieur le Professeur VIDAL Vincent Assesseur
Monsieur le Professeur AGOSTINI Aubert Assesseur
Madame le Docteur GROB Anaïs Directeur
Mis à jour 01/01/2019
AIX-MARSEILLE UNIVERSITE
Président : Yvon BERLAND
FACULTE DES SCIENCES MEDICALES ET PARAMEDICALES
Doyen Georges LEONETTI
Vice-doyen aux Affaires Générales et aux Sciences Médicales : Patrick DESSI Vice-doyen aux Sciences Paramédicales : Philippe BERBIS
Direction d’école : Ecole de Médecine : Jean-Michel VITON Ecoles de Maïeutique : Carole ZAKARIAN Ecoles des Sciences de la Réadaptation : Philippe SAUVAGEON Ecoles des Sciences Infirmières : Sébastien COLSON
Assesseurs : aux Etudes : Kathia CHAUMOITRE à la Recherche : Jean-Louis MEGE aux Prospectives Hospitalo-Universitaires : Frédéric COLLART aux Enseignements Hospitaliers : Patrick VILLANI à l’Unité Mixte de Formation Continue en Santé : Fabrice BARLESI pour le Secteur Nord : Stéphane BERDAH aux centres hospitaliers non universitaires : Jean-Noël ARGENSON
Chargés de mission : 1er cycle : Jean-Marc DURAND et Marc BARTHET 2ème cycle : Marie-Aleth RICHARD 3eme cycle DES/DESC : Pierre-Edouard FOURNIER Licences-Masters-Doctorat : Pascal ADALIAN DU-DIU : Véronique VITTON Stages Hospitaliers : Franck THUNY Sciences Humaines et Sociales : Pierre LE COZ Préparation à l’ECN : Aurélie DAUMAS Démographie Médicale et Filiarisation : Roland SAMBUC Relations Internationales : Philippe PAROLA Etudiants : Arthur ESQUER
Chef des services généraux : Déborah ROCCHICCIOLI Chefs de service :
Communication : Laetitia DELOUIS Examens : Caroline MOUTTET Intérieur : Joëlle FAVREGA Maintenance : Philippe KOCK Scolarité : Christine GAUTHIER
DOYENS HONORAIRES
M. Yvon BERLAND M. André ALI CHERIF M. Jean-François PELLISSIER
MM AGOSTINI Serge MM FAVRE RogerALDIGHIERI René FIECHI MariusALESSANDRINI Pierre FARNARIER GeorgesALLIEZ Bernard FIGARELLA JacquesAQUARON Robert FONTES MichelARGEME Maxime FRANCOIS GeorgesASSADOURIAN Robert FUENTES PierreAUFFRAY Jean-Pierre GABRIEL BernardAUTILLO-TOUATI Amapola GALINIER LouisAZORIN Jean-Michel GALLAIS HervéBAILLE Yves GAMERRE MarcBARDOT Jacques GARCIN MichelBARDOT André GARNIER Jean-MarcBERARD Pierre GAUTHIER AndréBERGOIN Maurice GERARD RaymondBERNARD Dominique GEROLAMI-SANTANDREA AndréBERNARD Jean-Louis GIUDICELLI RogerBERNARD Pierre-Marie GIUDICELLI SébastienBERTRAND Edmond GOUDARD AlainBISSET Jean-Pierre GOUIN FrançoisBLANC Bernard GRILLO Jean-MarieBLANC Jean-Louis GRISOLI FrançoisBOLLINI Gérard GROULIER PierreBONGRAND Pierre HADIDA/SAYAG JacquelineBONNEAU Henri HASSOUN JacquesBONNOIT Jean HEIM MarcBORY Michel HOUEL JeanBOTTA Alain HUGUET Jean-FrançoisBOURGEADE Augustin JAQUET PhilippeBOUVENOT Gilles JAMMES YvesBOUYALA Jean-Marie JOUVE PauletteBREMOND Georges JUHAN ClaudeBRICOT René JUIN PierreBRUNET Christian KAPHAN GérardBUREAU Henri KASBARIAN MichelCAMBOULIVES Jean KLEISBAUER Jean-PierreCANNONI Maurice LACHARD JeanCARTOUZOU Guy LAFFARGUE PierreCAU Pierre LAUGIER RenéCHABOT Jean-Michel LE TREUT YvesCHAMLIAN Albert LEVY SamuelCHARREL Michel LOUCHET EdmondCHAUVEL Patrick LOUIS RenéCHOUX Maurice LUCIANI Jean-MarieCIANFARANI François MAGALON GuyCLEMENT Robert MAGNAN JacquesCOMBALBERT André MALLAN- MANCINI JosetteCONTE-DEVOLX Bernard MALMEJAC ClaudeCORRIOL Jacques MARANINCHI DominiqueCOULANGE Christian MARTIN ClaudeDALMAS Henri MATTEI Jean FrançoisDE MICO Philippe MERCIER ClaudeDESSEIN Alain METGE PaulDELARQUE Alain MICHOTEY GeorgesDEVIN Robert MILLET YvesDEVRED Philippe MIRANDA FrançoisDJIANE Pierre MONFORT GérardDONNET Vincent MONGES AndréDUCASSOU Jacques MONGIN MauriceDUFOUR Michel MONTIES Jean-RaoulDUMON Henri NAZARIAN SergeENJALBERT Alain NICOLI René
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M. le Professeur LEVY Samuel 31/08/2011Mme le Professeur JUHAN-VAGUE Irène 31/08/2011M. le Professeur PONCET Michel 31/08/2011M. le Professeur KASBARIAN Michel 31/08/2011M. le Professeur ROBERTOUX Pierre 31/08/2011
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2013
M. le Professeur BRANCHEREAU Alain 31/08/2016M. le Professeur CARAYON Pierre 31/08/2016M. le Professeur COZZONE Patrick 31/08/2016M. le Professeur DELMONT Jean 31/08/2016M. le Professeur HENRY Jean-François 31/08/2016M. le Professeur LE GUICHAOUA Marie-Roberte 31/08/2016M. le Professeur RUFO Marcel 31/08/2016M. le Professeur SEBAHOUN Gérard 31/08/2016
2014
M. le Professeur FUENTES Pierre 31/08/2017M. le Professeur GAMERRE Marc 31/08/2017M. le Professeur MAGALON Guy 31/08/2017M. le Professeur PERAGUT Jean-Claude 31/08/2017M. le Professeur WEILLER Pierre-Jean 31/08/2017
2015
M. le Professeur COULANGE Christian 31/08/2018M. le Professeur COURAND François 31/08/2018M. le Professeur FAVRE Roger 31/08/2016M. le Professeur MATTEI Jean-François 31/08/2016M. le Professeur OLIVER Charles 31/08/2016M. le Professeur VERVLOET Daniel 31/08/2016
PROFESSEURS EMERITE
2016
M. le Professeur BONGRAND Pierre 31/08/2019M. le Professeur BOUVENOT Gilles 31/08/2017M. le Professeur BRUNET Christian 31/08/2019M. le Professeur CAU Pierre 31/08/2019M. le Professeur COZZONE Patrick 31/08/2017M. le Professeur FAVRE Roger 31/08/2017M. le Professeur FONTES Michel 31/08/2019M. le Professeur JAMMES Yves 31/08/2019M. le Professeur NAZARIAN Serge 31/08/2019M. le Professeur OLIVER Charles 31/08/2017M. le Professeur POITOUT Dominique 31/08/2019M. le Professeur SEBAHOUN Gérard 31/08/2017M. le Professeur VIALETTES Bernard 31/08/2019
2017
M. le Professeur ALESSANDRINI Pierre 31/08/2020M. le Professeur BOUVENOT Gilles 31/08/2018M. le Professeur CHAUVEL Patrick 31/08/2020M. le Professeur COZZONE Pierre 31/08/2018M. le Professeur DELMONT Jean 31/08/2018M. le Professeur FAVRE Roger 31/08/2018M. le Professeur OLIVER Charles 31/08/2018M. le Professeur SEBBAHOUN Gérard 31/08/2018
2018
M. le Professeur MARANINCHI Dominique 31/08/2021M. le Professeur BOUVENOT Gilles 31/08/2019M. le Professeur COZZONE Pierre 31/08/2019M. le Professeur DELMONT Jean 31/08/2019M. le Professeur FAVRE Roger 31/08/2019M. le Professeur OLIVER Charles 31/08/2019
AGOSTINI FERRANDES Aubert CHINOT Olivier GRIMAUD Jean-CharlesALBANESE Jacques CHOSSEGROS Cyrille GROB Jean-JacquesALIMI Yves CLAVERIE Jean-Michel Surnombre GUEDJ EricAMABILE Philippe COLLART Frédéric GUIEU RégisAMBROSI Pierre COSTELLO Régis GUIS SandrineANDRE Nicolas COURBIERE Blandine GUYE MaximeARGENSON Jean-Noël COWEN Didier GUYOT LaurentASTOUL Philippe CRAVELLO Ludovic GUYS Jean-Michel ATTARIAN Shahram CUISSET Thomas HABIB GilbertAUDOUIN Bertrand CURVALE Georges HARDWIGSEN JeanAUQUIER Pascal DA FONSECA David HARLE Jean-RobertAVIERINOS Jean-François DAHAN-ALCARAZ Laetitia HOFFART Louis DisponibilitéAZULAY Jean-Philippe DANIEL Laurent HOUVENAEGHEL GillesBAILLY Daniel DARMON Patrice JACQUIER AlexisBARLESI Fabrice D'ERCOLE Claude JOURDE-CHICHE NoémieBARLIER-SETTI Anne D'JOURNO Xavier JOUVE Jean-LucBARTHET Marc DEHARO Jean-Claude KAPLANSKI GillesBARTOLI Christophe DELAPORTE Emmanuel KARSENTY GillesBARTOLI Jean-Michel DELPERO Jean-Robert KERBAUL FrançoisBARTOLI Michel DENIS Danièle KRAHN MartinBARTOLOMEI Fabrice DISDIER Patrick LAFFORGUE PierreBASTIDE Cyrille DODDOLI Christophe LAGIER Jean-ChristopheBENSOUSSAN Laurent DRANCOURT Michel LAMBAUDIE EricBERBIS Philippe DUBUS Jean-Christophe LANCON ChristopheBERDAH Stéphane DUFFAUD Florence LA SCOLA BernardBERLAND Yvon Surnombre DUFOUR Henry LAUNAY FranckBERNARD Jean-Paul DURAND Jean-Marc LAVIEILLE Jean-PierreBEROUD Christophe DUSSOL Bertrand LE CORROLLER ThomasBERTUCCI François EUSEBIO Alexandre LECHEVALLIER EricBLAISE Didier FAKHRY Nicolas LEGRE RégisBLIN Olivier FAUGERE Gérard Surnombre LEHUCHER-MICHEL Marie-PascaleBLONDEL Benjamin FELICIAN Olvier LEONE MarcBONIN/GUILLAUME Sylvie FENOLLAR Florence LEONETTI GeorgesBONELLO Laurent FIGARELLA/BRANGER Dominique LEPIDI HubertBONNET Jean-Louis FLECHER Xavier LEVY NicolasBOTTA/FRIDLUND Danielle SurnombreFOURNIER Pierre-Edouard MACE LoïcBOUBLI Léon FRANCES Yves Surnombre MAGNAN Pierre-EdouardBOUFI Mourad FRANCESCHI Frédéric MATONTI Frédéric DisponibilitéBOYER Laurent FUENTES Stéphane MEGE Jean-LouisBREGEON Fabienne GABERT Jean MERROT ThierryBRETELLE Florence GABORIT Bénédicte METZLER/GUILLEMAIN CatherineBROUQUI Philippe GAINNIER Marc MEYER/DUTOUR AnneBRUDER Nicolas GARCIA Stéphane MICCALEF/ROLL JoëlleBRUE Thierry GARIBOLDI Vlad MICHEL FabriceBRUNET Philippe GAUDART Jean MICHEL GérardBURTEY Stéphane GAUDY-MARQUESTE Caroline MICHEL JustinCARCOPINO-TUSOLI Xavier GENTILE Stéphanie MICHELET PierreCASANOVA Dominique GERBEAUX Patrick MILH MathieuCASTINETTI Frédéric GEROLAMI/SANTANDREA René MOAL ValérieCECCALDI Mathieu GILBERT/ALESSI Marie-Christine MONCLA AnneCHAGNAUD Christophe GIORGI Roch MORANGE Pierre-EmmanuelCHAMBOST Hervé GIOVANNI Antoine MOULIN GuyCHAMPSAUR Pierre GIRARD Nadine MOUTARDIER VincentCHANEZ Pascal GIRAUD/CHABROL Brigitte MUNDLER Olivier SurnombreCHARAFFE-JAUFFRET Emmanuelle GONCALVES Anthony NAUDIN JeanCHARREL Rémi GORINCOUR Guillaume NICOLAS DE LAMBALLERIE XavierCHARPIN Denis Surnombre GRANEL/REY Brigitte NICOLLAS RichardCHAUMOITRE Kathia GRANVAL Philippe OLIVE DanielCHIARONI Jacques GREILLIER Laurent OUAFIK L'Houcine
PROFESSEURS DES UNIVERSITES-PRATICIENS HOSPITALIERS
PAGANELLI Franck ROCHE Pierre-Hugues THOMAS PascalPANUEL Michel ROCH Antoine THUNY FranckPAPAZIAN Laurent ROCHWERGER Richard TREBUCHON-DA FONSECA AgnèsPAROLA Philippe ROLL Patrice TRIGLIA Jean-MichelPARRATTE Sébastien Disponibilité ROSSI Dominique TROPIANO PatrickPELISSIER-ALICOT Anne-Laure ROSSI Pascal TSIMARATOS MichelPELLETIER Jean ROUDIER Jean TURRINI OlivierPERRIN Jeanne SALAS Sébastien VALERO RenéPETIT Philippe SAMBUC Roland Surnombre VAROQUAUX Arthur DamienPHAM Thao SARLES Jacques VELLY LionelPIERCECCHI/MARTI Marie-DominiqueSARLES/PHILIP Nicole VEY NorbertPIQUET Philippe SARLON-BARTOLI Gabrielle VIDAL VincentPIRRO Nicolas SCAVARDA Didier VIENS PatricePOINSO François SCHLEINITZ Nicolas VILLANI PatrickRACCAH Denis SEBAG Frédéric VITON Jean-MichelRANQUE Stéphane SEITZ Jean-François VITTON VéroniqueRAOULT Didier SIELEZNEFF Igor VIEHWEGER Heide ElkeREGIS Jean SIMON Nicolas VIVIER EricREYNAUD/GAUBERT Martine STEIN Andréas XERRI LucREYNAUD Rachel TAIEB DavidRICHARD/LALLEMAND Marie-Aleth THIRION Xavier
PROFESSEUR DES UNIVERSITES
ADALIAN PascalAGHABABIAN Valérie
BELIN PascalCHABANNON Christian
CHABRIERE EricFERON FrançoisLE COZ Pierre
LEVASSEUR AnthonyRANJEVA Jean-Philippe
SOBOL Hagay
PROFESSEUR CERTIFIE
BRANDENBURGER Chantal
PRAG
TANTI-HARDOUIN Nicolas
PROFESSEUR ASSOCIE DE MEDECINE GENERALE A MI-TEMPS
ADNOT SébastienFILIPPI Simon
ACHARD Vincent (disponibilité) EBBO Mikaël NGUYEN PHONG KarineAHERFI Sarah FABRE Alexandre NINOVE LaetitiaANGELAKIS Emmanouil (dispo oct 2018)FAURE Alice NOUGAIREDE AntoineATLAN Catherine (disponibilité) FOLETTI Jean- Marc OLLIVIER MatthieuBARTHELEMY Pierre FOUILLOUX Virginie OVAERT CarolineBEGE Thierry FROMONOT Julien PAULMYER/LACROIX OdileBELIARD Sophie GASTALDI Marguerite PESENTI SébastienBERBIS Julie GELSI/BOYER Véronique RESSEGUIER NoémieBERGE-LEFRANC Jean-Louis GIUSIANO Bernard REY MarcBERTRAND Baptiste GIUSIANO COURCAMBECK Sophie ROBERT PhilippeBEYER-BERJOT Laura GONZALEZ Jean-Michel SABATIER RenaudBIRNBAUM David GOURIET Frédérique SARI-MINODIER IrèneBONINI Francesca GRAILLON Thomas SAVEANU AlexandruBOUCRAUT Joseph GRISOLI Dominique SECQ VéroniqueBOULAMERY Audrey GUERIN Carole SUCHON PierreBOULLU/CIOCCA Sandrine GUENOUN MEYSSIGNAC Daphné TABOURET EmelineBUFFAT Christophe GUIDON Catherine TOGA CarolineCAMILLERI Serge HAUTIER/KRAHN Aurélie TOGA IsabelleCARRON Romain HRAIECH Sami TOMASINI PascaleCASSAGNE Carole KASPI-PEZZOLI Elise TOSELLO BarthélémyCHAUDET Hervé L'OLLIVIER Coralie TROUSSE DelphineCHRETIEN Anne-Sophie LABIT-BOUVIER Corinne TUCHTAN-TORRENTS LucileCOZE Carole LAFAGE/POCHITALOFF-HUVALE Marina VELY FrédéricCUNY Thomas LAGIER Aude (disponibilité) VION-DURY JeanDADOUN Frédéric (disponibilité) LAGOUANELLE/SIMEONI Marie-Claude ZATTARA/CANNONI HélèneDALES Jean-Philippe LEVY/MOZZICONACCI AnnieDAUMAS Aurélie LOOSVELD MarieDEGEORGES/VITTE Joëlle MANCINI JulienDELLIAUX Stéphane MARY CharlesDESPLAT/JEGO Sophie MASCAUX CélineDEVILLIER Raynier MAUES DE PAULA AndréDUBOURG Grégory MILLION MatthieuDUFOUR Jean-Charles MOTTOLA GHIGO Giovanna
MAITRES DE CONFERENCES DES UNIVERSITES
(mono-appartenants)ABU ZAINEH Mohammad DEGIOANNI/SALLE Anna RUEL Jérôme
BARBACARU/PERLES T. A. DESNUES Benoît THOLLON Lionel
BERLAND/BENHAIM Caroline MARANINCHI Marie THIRION Sylvie
PROFESSEURS DES UNIVERSITES et MAITRES DE CONFERENCES DES UNIVERSITES - PRATICIENS HOSPITALIERSPROFESSEURS ASSOCIES, MAITRES DE CONFERENCES DES UNIVERSITES mono-appartenants
CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 5002 GUERIN Carole (MCU PH)
ARGENSON Jean-Noël (PU-PH) CHIRURGIE INFANTILE 5402BLONDEL Benjamin (PU-PH)CURVALE Georges (PU-PH) GUYS Jean-Michel (PU-PH) FLECHER Xavier (PU PH) JOUVE Jean-Luc (PU-PH)PARRATTE Sébastien (PU-PH) Disponibilité LAUNAY Franck (PU-PH)ROCHWERGER Richard (PU-PH) MERROT Thierry (PU-PH)TROPIANO Patrick (PU-PH) VIEHWEGER Heide Elke (PU-PH)
FAURE Alice (MCU PH)OLLIVIER Matthieu (MCU-PH) PESENTI Sébastien (MCU-PH)
CANCEROLOGIE ; RADIOTHERAPIE 4702
BERTUCCI François (PU-PH) CHIRURGIE MAXILLO-FACIALE ET STOMATOLOGIE 5503CHINOT Olivier (PU-PH)COWEN Didier (PU-PH) CHOSSEGROS Cyrille (PU-PH)DUFFAUD Florence (PU-PH) GUYOT Laurent (PU-PH)GONCALVES Anthony PU-PH)HOUVENAEGHEL Gilles (PU-PH) FOLETTI Jean-Marc (MCU-PH)LAMBAUDIE Eric (PU-PH)SALAS Sébastien (PU-PH)
VIENS Patrice (PU-PH)
SABATIER Renaud (MCU-PH)
TABOURET Emeline (MCU-PH)
CHIRURGIE THORACIQUE ET CARDIOVASCULAIRE 5103 CHIRURGIE PLASTIQUE, RECONSTRUCTRICE ET ESTHETIQUE ; BRÛLOLOGIE 5004
ALIMI Yves (PU-PH)AMABILE Philippe (PU-PH) BARTHET Marc (PU-PH)BARTOLI Michel (PU-PH) BERNARD Jean-Paul (PU-PH)BOUFI Mourad (PU-PH) BOTTA-FRIDLUND Danielle (PU-PH) SurnombreMAGNAN Pierre-Edouard (PU-PH) DAHAN-ALCARAZ Laetitia (PU-PH)PIQUET Philippe (PU-PH) GEROLAMI-SANTANDREA René (PU-PH)SARLON-BARTOLI Gabrielle (PU PH) GRANDVAL Philippe (PU-PH)
GONZALEZ Jean-Michel ( MCU-PH)ACHARD Vincent (MCU-PH) disponibilité
PAULMYER/LACROIX Odile (MCU-PH) GENETIQUE 4704
DERMATOLOGIE - VENEREOLOGIE 5003 BEROUD Christophe (PU-PH)KRAHN Martin (PU-PH)
BERBIS Philippe (PU-PH) LEVY Nicolas (PU-PH)GAUDY/MARQUESTE Caroline (PU-PH) MONCLA Anne (PU-PH)GROB Jean-Jacques (PU-PH) SARLES/PHILIP Nicole (PU-PH)RICHARD/LALLEMAND Marie-Aleth (PU-PH)
FILIPPI Simon (PR associé Méd. Gén. à mi-temps) BRUNET Philippe (PU-PH)
BURTEY Stépahne (PU-PH)DUSSOL Bertrand (PU-PH)
BARGIER Jacques (MCF associé Méd. Gén. À mi-temps) JOURDE CHICHE Noémie (PU PH)
BONNET Pierre-André (MCF associé Méd. Gén à mi-temps) MOAL Valérie (PU-PH)
CALVET-MONTREDON Céline (MCF associé Méd. Gén. à temps plein)GUIDA Pierre (MCF associé Méd. Gén. à mi-temps)JANCZEWSKI Aurélie (MCF associé Méd. Gén. À mi-temps)
NUTRITION 4404 NEUROCHIRURGIE 4902
DARMON Patrice (PU-PH) DUFOUR Henry (PU-PH)RACCAH Denis (PU-PH) FUENTES Stéphane (PU-PH)VALERO René (PU-PH) REGIS Jean (PU-PH)
CECCALDI Mathieu (PU-PH)EUSEBIO Alexandre (PU-PH)FELICIAN Olivier (PU-PH)PELLETIER Jean (PU-PH)
OPHTALMOLOGIE 5502 PEDOPSYCHIATRIE; ADDICTOLOGIE 4904DENIS Danièle (PU-PH)HOFFART Louis (PU-PH) Disponibilité DA FONSECA David (PU-PH)MATONTI Frédéric (PU-PH) Disponibilité POINSO François (PU-PH)
OTO-RHINO-LARYNGOLOGIE 5501DESSI Patrick (PU-PH) PHARMACOLOGIE FONDAMENTALE -FAKHRY Nicolas (PU-PH) PHARMACOLOGIE CLINIQUE; ADDICTOLOGIE 4803GIOVANNI Antoine (PU-PH)LAVIEILLE Jean-Pierre (PU-PH) BLIN Olivier (PU-PH)MICHEL Justin (PU-PH) FAUGERE Gérard (PU-PH) SurnombreNICOLLAS Richard (PU-PH) MICALLEF/ROLL Joëlle (PU-PH)TRIGLIA Jean-Michel (PU-PH) SIMON Nicolas (PU-PH)DEVEZE Arnaud (MCU-PH) Disponibilité BOULAMERY Audrey (MCU-PH)REVIS Joana (MAST) (Orthophonie) (7ème Section)
PARASITOLOGIE ET MYCOLOGIE 4502
PHILOSPHIE 17RANQUE Stéphane (PU-PH)
LE COZ Pierre (PR) (17ème section)CASSAGNE Carole (MCU-PH)L’OLLIVIER Coralie (MCU-PH) MATHIEU Marion (MAST)MARY Charles (MCU-PH)TOGA Isabelle (MCU-PH)
PEDIATRIE 5401
ANDRE Nicolas (PU-PH) PHYSIOLOGIE 4402CHAMBOST Hervé (PU-PH)DUBUS Jean-Christophe (PU-PH) BARTOLOMEI Fabrice (PU-PH)GIRAUD/CHABROL Brigitte (PU-PH) BREGEON Fabienne (PU-PH)MICHEL Gérard (PU-PH) GABORIT Bénédicte (PU-PH)MILH Mathieu (PU-PH) MEYER/DUTOUR Anne (PU-PH)REYNAUD Rachel (PU-PH) TREBUCHON/DA FONSECA Agnès (PU-PH)SARLES Jacques (PU-PH)TSIMARATOS Michel (PU-PH) BARTHELEMY Pierre (MCU-PH)
inflammatory drugs, tranexamic acid, danazol and GnRH agonists.
Since a few years, a new class of medications has become available for treatment of uterine
fibroids: the selective progesterone receptor modulators, including UPA.
UPA is a selective progesterone receptor modulator (SPRM) drug that is used for medical
treatment of symptomatic uterine fibroids and has proven its efficiency in controlling
symptoms, reducing the size of fibroids, and improving the quality of life (10).
UPA is able to reduce bleeding, reduce the size of fibroids which can make surgery less
invasive or postpone the surgery (9). Efficacy and safety of UPA have been proven by 4
multicenter randomized double blind trials PEARL I to IV (11–13).
Clinical trials have shown that SPRM administration can lead to a pattern of benign non-
physiological, non-proliferative, histological features of the endometrium termed
“Progesteron receptor modulator associated endometrial changes” (PAEC). These effects
induced by SPRM are the results of mixed agonist/antagonist effects on progesteron
receptor and they are histologically characterized by cystically dilatated glands, epithelial
distortion, apoptosis and low mitotic activity in glands and stroma (14–16).
They are present in almost 70% of patients at the end of treatment. They have proved to be
benign and reversible, as they disappeared 2 months after the end of therapy (17).
Surgeons and radiologists in our center felt that there was an increase in adenomyosis in
patients receiving UPA therapy.
Many studies about the effect of UPA-treatment on adenomyosis are underway or recently
published (18,19) but we did not find any studies in the literature about the effects of UPA
on MRI features of adenomyosis.
Consequently, our objective was to evaluate the appearance and increase of adenomyosis
MRI findings in patients treated with UPA for symptomatic uterine fibroids.
4
MATERIEL AND METHODS:
Population and design
This was a prospective cohort study carried out in the Radiology Department and
Gynecology Department of two university hospitals.
We enrolled all pre-menopausal women over 18 years old with at least one symptomatic
uterine fibroid requiring surgical treatment.
Patients received pre-operative drug therapy with UPA over a 3-month period with MRI
before treatment and MRI at the end of 3-month therapy before surgical management.
Population was defined by every patient treated by UPA for symptomatic fibroids and having
benefited from two MRIs (one prior and one after UPA-treatment) and for whom a surgery
was being considered.
Exclusion criteria were: contraindication to treatment by UPA, premature termination of
treatment, absence of MRI pre-treatment, failure to perform MRI after treatment, refusal to
participate in the study.
Clinical data collected were age, number of pregnancies, number of children born.
Treatment by UPA
Patients were offered a 3-month treatment with oral UPA (5mg/day) prior to laparoscopic or
hysteroscopic treatment of uterine fibroids.
In case of poor tolerance of treatment, it was stopped.
At the beginning of our study, UPA treatment was given pre-operatively during 3 months.
During our study (since 2016), UPA got a new marketing authorization (MA) and it was
possible to give it sequentially with long-term repeated intermittent treatment. The long-
term intermittent treatment consists in 1 to 4 courses of 3 months treatment each
separated by an off-treatment period. Subsequent courses were started with the second
menstruation during the off treatment period (15,20).
Control group
We used a control group to overcome the possibility of a spontaneous increase in
adenomyosis MRI features.
5
The inclusion criteria were: patients followed for fibroids on MRI, who had at least 2 MRIs,
with adenomyosis on the 1st MRI, who had never received UPA treatment or any other
treatment likely to modify the aspects of adenomyosis.
This control group was compared to UPA-treated patients who had adenomyosis on initial
MRI.
MRI assessment
Primary judgment criterion/endpoint was the appearance or the increase of adenomyosis on
MRI.
MRI of the pelvis was performed with MRI Siemens SPECTRA 3T with T2-weighted turbo
spin-echo (TSE) sequences in sagittal, axial, and T1-weighted TSE in axial planes.
MRI sections were acquired every 4 mm with a gap of 1.4 mm. Data were collected in a
320×320 matrix and a 250 mm field of view.
Antispasmodic drugs (1ml of intravenous Glucagon 1mg/mL) and abdomen compression
(3.5kg sandbag) were used on 3T MRI.
The first MRI was realized before introducing UPA and the second after the beginning of the
treatment for each patient.
Two radiologists evaluated the MR images independently and blindly: a junior and senior
specialized in pelvic imaging.
Junctional zone (JZ) thickness was defined as the greatest antero-posterior dimension as
measured on sagittal T2-weighted images (21).
Adenomyosis on MRI was defined by : high signal intensity intramyometrial foci on T2 and or
T1 weighted sequences and/or diffuse or focal thickening (>12 mm) of the junctional zone
(22).
Subtypes of adenomyosis were classified: internal adenomyosis comprised focal or
multifocal adenomyosis (A), superficial asymmetric (B) or symmetric (C) adenomyosis,
diffuse asymmetric (D) or symmetric (E) adenomyosis, solid (F) or cystic (G) intramural
adenomyomas, submucosal (H) or subserosal (I) adenomyomas, external posterior (J) or
external anterior adenomyosis (K) (associated respectively with posterior or anterior deep
endometriosis) (4).
6
Junctional zone thickness was measured and myometrial cystic implants were searched and
counted on MRI before and after treatment.
Typical aspect of PAEC was assessed and defined as increased thickness of endometrium and
multiple cystic dilatations of the endometrium after UPA treatment (6).
Clinical evaluation after treatment
Clinical symptoms (pains and bleeding particularly) were re-evaluated after treatment.
Statistical analysis
The treated and control group were compared using Mann-Whitney test. The results before
and after treatment were also compared using Mann-Whitney test.
Inter-rater agreement was assessed using intraclass correlation (ICC).
RESULTS
The study period was from 1st of January 2014 to December 31, 2017.
Population
During the study period a total of 151 patients were referred to Radiologic Department for
control MRI as part of the UPA treatment.
Of these 151 patients enrolled, 72 were screened.
The most common reason for screening failure was absence of MRI pre or post UPA
treatment.
There was no significant difference between the patients included and excluded regarding,
number of gestation and children, or initial presence of adenomyosis (Table 1). The only
difference between the included and excluded population was the age, indeed the included
patients had an average age of 39 years against 42 (p = 0.02) in the excluded patients.
7
Included Excluded p-value Age (years) 39 42 0.02 Gestity (number of pregnancy) 2 2 0.6 Parity (number of children born) 1 1 0.3 Adénomyosis (%) 21 17 0.6
Table 1 Patients characteristic before inclusion.
Control group
The control group (15 patients) was compared to the group of patients initially presenting
with adenomyosis and treated by UPA (16 patients).
The two groups of patients were comparable in terms of age and number of children (Table
2).
UPA Control p-value Age (years) 42 43 1 Gestity (number of pregnancy) 3 1 0.04 Parity (number of children born) 2 1 0.08 Delay between MRIs (months) 4 16 <0.001
Table 2 Characteristics comparison of UPA group and control group
They differed in terms of the number of pregnancies.
The delay between the two MRIs was also different: 4 months in the group treated with
ESMYA and 16 months in the control group.
None of the patients showed increase of adenomyosis. Eight showed decrease and 7 showed
a stable adenomyosis on the second MRI. Fifty-three percent of the control group showed a
decrease of adenomyosis including 33% of complete regression and 47% showed stability
(Figure 1).
8
Figure 1 Comparison of the evolution of adenomyosis between the UPA group and the control group (p<0.01).
Before and after UPA treatment MRI comparison
After 4 months of treatment on average, they had an MRI and a gynecological consultation.
All of the concordance coefficients were between 0.8 and 1, which mean that both readers
showed good agreement. The results presented are those of the senior reader.
In 19 patients (26.4%) the junctional zone was not measurable.
Increase of adenomyosis
On the initial MRI, out of 72 included, 15 patients (21%) had adenomyosis.
Three had only thickening of junctional zone, 10 had internal adenomyosis focal or
multifocal, 1 had diffuse symmetric adenomyosis, 1 had adenomyoma.
Of the 15 patients with initial adenomyosis 12 showed an increase characterized by a largest
number of cystic implants. The thickness of the junctional zone was not modified.
Three patients showed no modification of adenomyosis features in MRI.
Changes in adenomyosis were mainly in the number of cystic inclusions with no change in
adenomyosis subtype most of the times: 3 patients with only thickening of the junctional
zone on the first MRI showed an increase with apparition of internal adenomyosis focal or
multifocal for one and apparition of diffuse symmetric adenomyosis for the two others.
0
20
40
60
80
100
120
UPA Control
Increase
Stability
Decrease
9
One patient with internal focal or multifocal adenomyosis showed a modification for diffuse
asymmetric adenomyosis.
The other patients, with mostly internal focal or multifocal adenomyosis increased
adenomyosis with the number of cystic inclusions without changing the subtype of
adenomyosis.
Figure 2 MRI before and after UPA treatment.
T2-weighted sagittal sequence showing myomous (asterisk) uterus with adenomyosis:
thickening of the JZ on the left (before treatment) and appearance of multiple T2-high signal
intensity foci (arrowhead) on the right (after treatment).
10
MRI preUPA MRI postUPA p-value Patients with adenomyosis 15 (21%) 30 (42%) <0.01 Adenomyosis subtypes A 10 24 B 0 1 D 0 1 E 1 3 F 1 1 Thickening of ZJ 3 0
Number of cystic inclusion <0.01 0 60 42 1 to 5 9 15 5 to 10 1 3 10 to 20 0 6 20 to 30 1 3 >30 1 3
Thickness of JZ (average on cm) 8,4 7,9 0.2
Table 3 MRI Features before and after UPA treatment.
Appearance of adenomyosis
Fifty-seven patients had no sign of adenomyosis on the first MRI, of these 57 patients, 15
showed appearance of adenomyosis signs in the post-treatment MRI.
In the same way as for the modification, the appearance of the adenomyosis was seen by
the appearance of cystic implants and not by the increase of the thickness of the junctional
zone.
Fourteen patients showed an apparition of internal adenomyosis focal or multifocal and one
patient showed an apparition of superficial asymmetric adenomyosis.
11
Figure 3 MRI before and after UPA treatment
T2-weighted sagittal sequence showing myomous uterus on the left (before treatment) and
appearance of multiple T2-high signal intensity foci (arrowhead) concerning the anterior wall
on the right (after treatment). Note the decrease in size of the intracavitary fibroid (asterisk)
in the post-treatment MRI.
In total, 27 patients (38%) over 72 showed an increase (p<0.001) of adenomyosis during UPA
treatment, including 15 cases (21%) of appearance of adenomyosis. These changes
concerned only the cystic side of adenomyosis. After UPA-treatment, 42% of patients had
adenomyosis on MRI compared to only 21% before treatment (p=0.002).
12
Figure 4 MRI before and after UPA treatment
T2-weighted sagittal sequence showing fibromatous uterus on the left (before treatment)
and appearance of multiple T2-high signal intensity foci (arrowhead) concerning the anterior
wall on the right (after treatment). Note the thickening of the endometrium associated with
cystic dilatation.
PAEC
We found PAEC in 24 patients on the MRI post treatment. PAEC were associated with more
adenomyosis pre-treatment (42%) than the rest of population (10%) and this was significant
(p=0.004).
Patients with PAEC were associated with more adenomyosis post-treatment with 63% of
adenomyosis post-treatment versus 31% of adenomyosis in the population without PAEC.
Concerning the appearance of adenomyosis: there was more appearance of adenomyosis in
the patients with PAEC (36% versus 23% in the population without PAEC) but this difference
was not significant (p = 0.4).
Concerning the increase of adenomyosis: there was also more increase of adenomyosis in
the patients with PAEC (58%) than in the patient without PAEC (27%) but this difference was
not significant (p = 0.2).
13
The increase of adenomyosis was significantly (p = 0.02) increased in PAEC group (58%
versus 27%) if cumulative occurrence and increase of adenomyosis were taken into account.
Figure 5 Adenomyosis evolution according to the PAEC status
DISCUSSION
Results
Our study was the first to show the MRI features of adenomyosis under UPA-treatment.
We showed that UPA treatment was responsible for changes in adenomyosis in MRI with
increase or appearance of cystic inclusions characteristic of adenomyosis in 27 patients over
72.
In 19 patients (26%) the junctional zone was not measurable which is consistent with data
from literature, according to Bazot and al, the junctional zone is not measurable in 20% to
30% of women of reproductive age and in up to 50% in menopausal women (4).
The included patients showed in comparison with the excluded patients an average age of 3
years younger that does not explain the results found. This small age difference does not
change that both included and excluded patients are made up of women in childbearing age.
72 patients
NO PAEC(48)
No initial adenomyosis
(43)
No adenomyosis(33)
Appearance of adenomyosis
(10)
Initial adenomyosis
(5)
No increase(2)
Increased adenomyosis
(3)
PAEC(24)
No initial adenomyosis
(14)
No adenomyosis(9)
Appearance of adenomyosis
(5)
Initial adenomyosis
(10)
No increase(1)
Increased adenomyosis
(9)
14
Concerning our control group, the delay between the two MRIS was different from the delay
in the included group. Four months in the group treated with UPA versus 16 months in the
control group. This does not explain the absence of evolution of adenomyosis in the control
group, on the contrary, a longer delay could have made it easier to detect the appearance or
increase of adenomyosis. (This longer period can be explained by the absence of need for
short-term monitoring of patients followed for fibroids or adenomyosis in the absence of a
study protocol.)
The control group and the group of treated patients with adenomyosis initially differed in
the number of pregnancies (p=0.04). Indeed women in the control group had an average
G1P1 status against G3P2 in the treated group. This isolated factor alone, cannot explain the
entirely different evolution of adenomyosis in MRI in the two groups. And all the more so
since both groups were composed of women all with initial adenomyosis.
The absence of increase of adenomyosis in the control group showed that adenomyosis is
not a disease that tends to increase spontaneously.
Regarding the clinical data, a large number of missing data prevented us from obtaining
significant results. However, a majority of patients concerned by the onset or increase of
adenomyosis (17 out of 27) showed an improvement in symptoms. Only one patient was
finally operated after two UPA-courses because she was still suffering from bleeding. Data
was missing for the other eight.
UPA treatment and PAEC
UPA is a selective progesterone receptor modulator drug that is used for medical treatment
of symptomatic uterine fibroids whose efficacy and safety have been proven. Medical
management of uterine fibroids and gynecological disorders in general is increasingly
marked by the importance of preserving fertility.
Our study showed an increase or appearance of adenomyosis under UPA treatment, only on
the cystic side.
It has been proven that UPA is involved in PAEC and that these modifications are reversible
and no cause for pre-malignant lesions.
15
SPRMs exert direct pharmacodynamics effects on the endometrium and consequently cause
changes in its histological appearance (14,15).
According to Williams and al (23), mixed agonist/antagonist activity on the progesterone
receptor explains the histological appearance of the endometrium in UPA-treated women:
poorly developed secretory differentiation, tortuosity of glands (as in the mid-secretory
phase) and focal cytoplasmic vascularization of endometrial glandular cells.
Knowing these endometrium modifications induced by UPA, it seems obvious to look for
modification of adenomyosis under UPA-treatment. Indeed, these endometrium
modifications should also be present in endometrial implants in the myometrium in
adenomyosis condition. The fact that the changes observed in our study only concern the
cystic side of adenomyosis reinforces the hypothesis that PAECs and adenomyosis increase
are related.
Moreover, we have shown that patients with PAEC had more increase of adenomyosis under
UPA-treatment than patients without PAEC.
Our results and literature data
A recent study by Conway and al published in November 2018 showed that UPA treatment
increases the ultrasound features of adenomyotic uterine lesions, enhancing aspects such as
intramyometrial cysts, which confirm our findings in MRI. This study only looked to the US
features but they find that all sonographic features of adenomyosis appeared enhanced at
the end of UPA treatment especially myometrial wall thickness, vascularity and the intra-
myometrial cysts (18).
Another recent study by Gracia and al, found that UPA was effective for the relief of clinical
symptoms commonly associated with adenomyosis in a population of women with baseline
uterine fibroids (6).
In our cohort, even thought UPA increased lesions of adenomyosis on MRI, most post-
treatment clinical data showed improved both bleeding and pain. These informations are to
be compared to studies that focus on clinical effects but suggest that UPA may be effective
on the symptoms of adenomyosis or at least that the MRI features are not a sign of
worsening clinical symptoms.
16
Actually there are clinical trials such as the FRA-IIT-UPA exploring the efficiency of UPA in
bleeding control and pain management in women with adenomyosis but no results are
available yet (19).
Already in 2016, Donnez has suggested, in his expert opinion review on the safety of UPA,
how SPRMs will probably be effective in the reduction adenomyosis associated pain by
inducing amenorrhea (15).
Recently, in 2018, UPA was suspected for a time to be the cause of severe liver toxicity but
the European Medicines Agency (EMA) review said that the benefit/risk ratio of UPA remains
positive, considering that currently there is no other long-term medical treatment as an
alternative to surgery for the treatment of moderate and severe symptoms of uterine
fibroids (24,25).
Biases and limitations of our study
The limits of our study were a small number of patients included because of the difficulty in
having MRI done before and after treatment. Our recruitment was monocentric.
The delays between the 2 MRIs and the number of courses of UPA-treatment were variable
between the patients.
Follow-up was short, including a single post-treatment MRI at 4 months on average after the
first one. It would be interesting to control our results on remote MRIs.
CONCLUSION
This study using MRI has demonstrated that UPA treatment is responsible for an increase or
an appearance of adenomyosis.
This is the first prospective study to have used MRI to evaluate the changes in adenomyosis
in patients under UPA.
It is important for radiologists performing pelvis MRI to be familiar with the MRI changes due
to UPA treatment: not only PAEC but also the increase in cystic lesions of adenomyosis.
These MRI features should not lead to the cessation of treatment if it is otherwise effective.
DISCLOSURE STATEMENT
The authors reported no potential conflict of interest.
17
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18
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19. Adenomyosis and Ulipristal Acetate (FRA-IIT-UPA).
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19
LISTE OF TABLES AND FIGURES
TABLE 1 PATIENTS CHARACTERISTICS BEFORE INCLUSION. ..................................................................................................... 7 TABLE 2 CHARACTERISTICS COMPARISON OF UPA GROUP AND CONTROL GROUP ...................................................................... 7 TABLE 3 MRI FEATURES BEFORE AND AFTER UPA TREATMENT. .......................................................................................... 10
FIGURE 1 COMPARISON OF THE EVOLUTION OF ADENOMYOSIS BETWEEN THE UPA GROUP AND THE CONTROL GROUP (P<0.01). ...... 8 FIGURE 2 MRI BEFORE AND AFTER UPA TREATMENT. ......................................................................................................... 9 FIGURE 3 MRI BEFORE AND AFTER UPA TREATMENT ........................................................................................................ 11 FIGURE 4 MRI BEFORE AND AFTER UPA TREATMENT ........................................................................................................ 12 FIGURE 5 ADENOMYOSIS EVOLUTION ACCORDING TO THE PAEC STATUS .............................................................................. 13
SERMENT D'HIPPOCRATE
Au moment d’être admis(e) à exercer la médecine, je promets et je jure d’être fidèle aux lois de l’honneur et de la probité.
Mon premier souci sera de rétablir, de préserver ou de promouvoir la
santé dans tous ses éléments, physiques et mentaux, individuels et
sociaux.
Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J’interviendrai
pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte, je ne ferai pas
usage de mes connaissances contre les lois de l’humanité.
J’informerai les patients des décisions envisagées, de leurs raisons et de leurs conséquences.
Je ne tromperai jamais leur confiance et n’exploiterai pas le pouvoir hérité
des circonstances pour forcer les consciences.
Je donnerai mes soins à l’indigent et à quiconque me les demandera. Je
ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire.
Admis(e) dans l’intimité des personnes, je tairai les secrets qui me seront
confiés. Reçu(e) à l’intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs.
Je ferai tout pour soulager les souffrances. Je ne prolongerai pas
abusivement les agonies. Je ne provoquerai jamais la mort délibérément.
Je préserverai l’indépendance nécessaire à l’accomplissement de ma mission. Je n’entreprendrai rien qui dépasse mes compétences. Je les
entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés.
J’apporterai mon aide à mes confrères ainsi qu’à leurs familles dans l’adversité.
Que les hommes et mes confrères m’accordent leur estime si je suis fidèle
à mes promesses ; que je sois déshonoré(e) et méprisé(e) si j’y manque.
RESUMÉ
OBJECTIF:
L’objectif de cette étude était d’observer la majoration ou l’apparition
d’adénomyose en IRM chez les patientes traitées par Ulipristal Acétate (UPA) pour
myome(s) symptomatique(s).
MATERIEL ET METHODES:
Nous avons mené une étude prospective observationnelle avec comparaison
avant et après traitement. L’étude s’est déroulée de janvier 2014 à décembre
2017 dans deux hôpitaux universitaires.
La population étudiée était composée de femmes porteuses d’au moins un
myome symptomatique (ménorragie, douleur pelvienne, anémie,…) traitée par
UPA et ayant bénéficié de deux IRM (avant et après traitement).
Nous avons comparé l’évolution de l’adénomyose à un groupe témoin n’ayant pas
reçu d’UPA.
RESULTATS:
Sur 72 patientes (âgées de 25 à 49 ans) incluses dans l’étude, 27 ont montré une
majoration d’adénomyose en IRM: 12 patientes présentaient une majoration
d’adénomyose préexistante et 15 patientes ont montré une apparition de signes
d’adénomyose non visibles précédemment. Ces modifications concernaient
seulement le versant kystique de l’adénomyose, il n’y avait pas de modification de
l’épaisseur de la zone jonctionnelle.
Il n’y a eu aucune majoration spontanée des signes d’adénomyose en IRM dans le
groupe témoin.
CONCLUSION:
L’Ulipristal Acétate est responsable d’apparition et de majoration des signes