Characteristic features of blood circulation and angiogenesis in patients of reproductive age with uterine myoma, adenomyosis and intrauterine septum: functional MRI-based assessment of expression levels of angiogenesis markers in the endometrium


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Abstract

Objective. To evaluate characteristic features of blood circulation and angiogenesis in patients of reproductive age with uterine myoma, nodular adenomyosis and intrauterine septum using functional MRI-based assessment of the level of expression of angiogenesis markers in the endometrium. Materials and methods. 862 patients with benign uterine diseases and infertility were examined and surgically treated before the IVFprogram. Among them 200patients were with nodular adenomyosis, 510 patients - with uterine fibroids, 152 patients - with intrauterine septum. Infertility was treated in accordance with the IVF protocol. Histological and immunohistochemical (IHC) analysis of endometrial biopsy samples during the "implantation window" in cycles before surgical treatment and before IVF was performed in 30 patients in the main groups and in 10 patients with tubal-peritoneal infertility factor without endometrial and myometrial pathology. Magnetic resonance imaging (MRI) was performed using magnetic induction f ield of 3T and gadolinium contrast agent. Results. IHC analysis of endometrial biopsy samples showed statistically significant differences in the expression of angiogenesis markers in the endometrium (vascular endothelial growth factor A (VEGF-A), atrix metalloproteinases (MMP-2.9), avP3-integrin) in patients before and after surgical treatment and in the control group. In patients with intrauterine septum, blood flow in intrauterine septum decreased by more than 30%, which was comparable to a high level of pregnancy losses in this group (84%) and expression level of receptivity markers in the endometrium, in particular, - angiogenesis. Functional MRI was used to assess blood flow in the myometrium, myoma nodes and adenomyosis, and to determine the structure and mapping of myoma nodes and adenomyosis. Conclusion. In patients with adenomyosis, uterine fibroids, and intrauterine septum, there was a lower expression of angiogenesis markers (VEGF, MMP 2,9, and avfi3-integrin) in the endometrium before surgery compared to the expression of these markers after surgery and to the control group (without endometrial and myometrial pathology). The method of functional contrast-enhanced MRI allows to assess the blood flow in different myometrial loci and intrauterine septum, reliably to assess the blood flow in different myometrial pathologies, including uterine myoma, adenomyosis, to determine the structure and mapping of myoma nodes and adenomyosis.

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About the authors

Irena F. Kozachenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: i_kozachenko@oparina4.ru
Ph.D., leading researcher of the Gynecological Department

Zograb N. Makiyan

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: z_makiyan@oparina4.ru
Dr. Med. Sci., leading researcher of the Gynecological Department

Nafisa M. Fayzullina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: n_faizullina@oparina4.ru
PhD, senior researcher of the Pathology Department

Vladimir G. Bychenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_bychenko@oparina4.ru
PhD, Head of the Department of Radiation Diagnostics

Aleksandr I. Shchegolev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ashegolev@oparina4.ru
Dr. Med. Sci., Professor, Head of 2nd Pathology Department

Leila V. Adamyan

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: aleila@inbox.ru
Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Head of the Gynecological Department, Deputy Scientific Director

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