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4 cm3 before UFE and 41.4 cm3 after UAE, which resulted in a 40.1% volume reduction (P Akt targets Spies and colleagues,[26] and Walker and Pelage,[27] who reported ranges between 35% and 55%. Severe symptoms and presence of large and numerous fibroids among the participants of this study are consistent with what have been observed in other studies on African and African-American populations notably by Kjerulff et al.[8] Spies and colleagues[26] originally validated their symptom score questionnaire in a patient population with uterine fibroids in comparison with a healthy control group. The baseline symptom severity scores and short-term follow-up in their patient population correspond to those observed in this study. Similar observations have also been made in a study by Scheurig et al. No clear association between baseline UV and DFV, and percentage UV and DFV EPZ-6438 in vitro reduction after UFE emerged from the results of previously reported large case series.[26,28] Likewise, in this study, no association was found between the number of fibroids, the localization of the dominant leiomyoma at baseline MRI, and the UV/DFV reduction after UFE. In addition, no significant correlation between improvement in symptoms and imaging findings was identified. However, strong enhancement at baseline correlated to a better outcome. In the study by Reena et al., it was observed Montelukast Sodium that clinical and imaging response to UFE was lower in older patients and those with larger fibroids/UV at presentation. Our study was not powered to detect these differences. Future studies may, therefore, look into these parameters. A study in South Africa aimed at assessing the effect of large uterus on the outcome of UFE did not, however, reveal significant differences between those with UVs below and above 780 cm3. This is likely related to embolic particle distribution per unit volume of the fibroid. This may also explain why the response to UFE in our study is similar to that in the west, even though our participants had, on average, large and numerous fibroids. Other factors such as diet and living conditions, which were not assessed in this study, could also play a role. Future studies may, therefore, take into consideration the number of embolic particles per fibroid volume, environmental factors, and lifestyle of the participants. Significant reduction in the uterine and dominant fibroid after UFE is due to sluggish or no blood flow in the uterine arteries, which are the vessels that typically supply large feeding branches to the fibroids. The enhancement of fibroids is related to blood flow. Fibroids with good blood flow, therefore, enhance strongly and vice versa. This explains why fibroids which were strongly enhancing at baseline had better response after UFE.