The purpose of this study was to determine if contrast material-enhanced magnetic resonance (MR) imaging could be used to stratify patients who have undergone failed primary uterine artery embolization (UAE) for repeated embolization. One hundred one consecutive patients who underwent UAE at a single center were followed prospectively and assessed for the presence of persistent contrast enhancement of leiomyomas on follow-up MR imaging. Among 11 of the 111 patients with primary clinical failure (10%), MR imaging showed persistent enhancement in eight. Of the eight cases of failure with continued tumor enhancement on MR imaging, six were treated with repeated embolization. All six patients showed complete symptomatic relief at 12-month follow-up. In women who have been treated with failed primary UAE, continued enhancement of leiomyomas on MR imaging can be used to identify candidates for successful repeated UAE.