Endometrial Ablation: Normal Imaging Appearance and Delayed Complications

Daub, Christopher A; Sepmeyer, Jacob A; Hathuc, Vivian; Sakala, Michelle D.; Caserta, Melanie P.; Clingan, M. Jennings; Hosseinzadeh, Keyanoosh

doi:10.2214/ajr.14.13960

Cited by 13 publications

(12 citation statements)

References 52 publications

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“…The use of ablation sites was a novel approach in this study to provide a system for localization of the HT targets as well as positive controls, both of which are absent from the previous studies. The hyper-intensive lesion shown in the contrast-enhanced MR were consistent with results from a prior publication [45], and matched the severe hemorrhage and fluid-filled cavities observed in the macroscopic and histological results. With that said, some studies found post-ablation targets to be seen as non-perfused areas in the MR images, as opposed to the hyper-intense regions seen here [46][47][48].…”

Section: Discussionsupporting

confidence: 90%

Feasibility and safety assessment of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine model

Zhu

Partanen

Talcott

et al. 2019

International Journal of Hyperthermia

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2019) Feasibility and safety assessment of magnetic resonance-guided highintensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine modelABSTRACT Purpose: To evaluate the feasibility and assess safety parameters of magnetic resonance-guided highintensity focused ultrasound (MRgHIFU)-mediated hyperthermia (HT; heating to 40-45 C) in various pelvic targets in a porcine model in vivo. Methods: Thirteen HT treatments were performed in six pigs with a commercial MRgHIFU system (Sonalleve V2, Profound Medical Inc., Mississauga, Canada) to muscle adjacent to the ventral/dorsal bladder wall and uterus to administer 42 C (±1 ) for 30 min (±5%) using an 18-mm target diameter and 100 W power. Feasibility was assessed using accuracy, uniformity, and MR-thermometry performance-based metrics. Safety parameters were assessed for tissues in the targets and beam-path by contrast-enhanced MRI, gross-pathology and histopathology. Results: Across all HT sessions, the mean difference between average temperature (T avg ) and the target temperature within the target region-of-interest (tROI, the cross-section of the heated volume at focal depth) was 0.51 ± 0.33 C. Within the tROI, the temperature standard deviation averaged 1.55 ± 0.31 C, the average 30-min T avg variation was 0.80 ± 0.17 C, and the maximum difference between T avg and the 10th-or 90th-percentile temperature averaged 2.01 ± 0.44 C. The average time to reach !41 C and cool to 40 C within the tROI at the beginning and end of treatment was 47.25 ± 27.47 s and 66.37 ± 62.68 s, respectively. Compared to unheated controls, no abnormally-perfused tissue or permanent damage was evident in the MR images, gross pathology or histological analysis. Conclusions: MRgHIFU-mediated HT is feasible and safety assessment is satisfactory for treating an array of clinically-mimicking pelvic geometries in a porcine model in vivo, implying the technique may have utility in treating pelvic targets in human patients. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 90%

Feasibility and safety assessment of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine model

Zhu

Partanen

Talcott

et al. 2019

International Journal of Hyperthermia

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“…Endometrial ablation procedures are performed for the treatment of menorrhagia in patients who present with abnormal uterine bleeding and have unsuccessful medical therapy (63). The main indication for endometrial ablation is premenopausal chronic ovulatory menorrhagia.…”

Section: Uterine and Ft Interventions Postablation Tubal Sterilizatiomentioning

confidence: 99%

Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for Radiologists

Revzin¹,

Moshiri²,

Katz³

et al. 2020

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“…Endometrial ablation is a procedure performed to destroy the endometrium in women with premenopausal menorrhagia who do not want to preserve fertility or undergo hysterectomy. Current methods include nonresectoscopic techniques using thermal, cryo-, radiofrequency, and microwave ablation, as well as older hysteroscopic techniques such as laser, rollerball, wire-loop, and vaporizing electrode ablation (23). These procedures cause scarring and adhesions from the healing-denuded myometrium, resulting in occlusion of the endometrial canal.…”

Section: Endometrial Ablationmentioning

confidence: 99%

“…Accumulation of blood in an obstructed canal can cause severe pain. The blood can fill the endometrial canal, localize to the cornua, or create a hematosalpinx in cases of prior tubal ligation (postablation tubal sterilization syndrome) (23).…”

Section: Endometrial Ablationmentioning

confidence: 99%

“…Preexisting adenomyosis can be a cause of postablation menorrhagia and dysmenorrhea. Endometrial glands deep within the myometrium may persist, as ablation techniques are limited to the basalis layer (23,24). A study by McCausland and McCausland (24) showed that adenomyosis can penetrate deeper into the myometrium or occur de novo after ablation, suggesting that ablation causes either surviving endometrium to invade the myometrium or existing ectopic endometrium to invade deeper into the myometrium.…”

Section: Endometrial Ablationmentioning

confidence: 99%

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Adenomyosis: A Sonographic Diagnosis

et al. 2018

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Adenomyosis is a common benign uterine condition and a frequent cause of pelvic pain in premenopausal women. Transvaginal US is now considered the primary imaging modality for the diagnosis of adenomyosis, and thus radiologists should be familiar with its sonographic appearance. US findings can be divided into three categories, which parallel the histology of adenomyosis: (a) ectopic endometrial glands and stroma, (b) muscular hyperplasia/hypertrophy, and (c) increased vascularity. Ectopic endometrial glands manifest as echogenic nodules and striations, radiating from the endometrium into the myometrium. When the glands contain fluid, myometrial cysts and fluid-filled striations may be visible at US. Muscular hyperplasia and hypertrophy cause focal or diffuse myometrial thickening and globular uterine enlargement, often with thin "venetian blind" shadows. The combination of these findings results in a heterogeneous myometrium, with blurring of the endometrial border. Adenomyosis increases uterine vascularity, depicted as a pattern of penetrating vessels at color Doppler US. Other US techniques that are helpful in the diagnosis of adenomyosis include obtaining cine clips and coronal reformatted images, both of which can survey the entire endometrial-myometrial border, and performing saline-infusion sonohysterography, during which ectopic glands frequently fill with either air or fluid. While most cases of adenomyosis develop spontaneously, there are specific inciting causes that include tamoxifen use, postendometrial ablation syndrome, and deep-infiltrating endometriosis. Mimics of adenomyosis include leiomyomas, uterine contractions, neoplasms, and vascular malformations. This article reviews the pathophysiology of adenomyosis and correlates it with the US findings, highlights specific causes of adenomyosis, and describes how to distinguish this common diagnosis from a variety of mimics. Online supplemental material is available for this article. RSNA, 2018.

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Endometrial Ablation: Normal Imaging Appearance and Delayed Complications

Abstract: Radiologists should recognize the normal imaging findings in patients who have undergone endometrial ablation, be aware of the causes of treatment failure, and accurately identify delayed complications associated with these procedures.

Cited by 13 publications

References 52 publications

Feasibility and safety assessment of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine model

Feasibility and safety assessment of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine model

Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for Radiologists

Adenomyosis: A Sonographic Diagnosis

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