Fibroid vascularisation assessed with three‐dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study

Nieuwenhuis, Lotte L.; Keizer, Alieke L.; Stoelinga, B.; Twisk, Jos W. R.; Hehenkamp, Wouter J.K.; Brölmann, Hans A.M.; Huirne, Judith A F

doi:10.1111/1471-0528.14608

Cited by 32 publications

(26 citation statements)

References 44 publications

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“…This may be because fibroids with significant enhancement are more vascular; blood flow in vascular fibroids could dissipate some heat and therefore the acoustic energy deposition in these fibroids is less than that of avascular uterine fibroids [9,10]. Recently, Nieuwenhuis et al found that the growth rate of fibroids was related to the proportion of blood vessels within the fibroid tissue [11]. Therefore, after HIFU, the residual tumor tissue in vascular fibroids (significant enhancement) is more likely to grow faster than that in avascular fibroid tumors (less enhancement).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence

Liu

et al. 2021

International Journal of Hyperthermia

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Objective: To assess the long-term outcomes and the factors affecting local recurrence of uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation. Materials and methods: 629 patients with a solitary uterine fibroid smaller than 10 cm in diameter treated with USgHIFU at our institutes between January 2011 and December 2016 were retrospectively analyzed. The patients were requested to take pre-HIFU and one day post-HIFU MRI. The patients were asked to return to the hospital every 3 months until January 2020, for imaging evaluation and to check on improvement in symptoms. Results: Five hundred and thirty-six patients completed follow-up according to our protocol. The median follow-up time was 69 (interquartile range: 48 to 89) months. Among them, local recurrence was detected in 110 patients. 18 (16.4%) patients required additional treatment between 12 and 24 months after USgHIFU treatment, 59 (53.6%) patients required additional treatment 24 months after USgHIFU. Therefore, in total, 77 patients required additional treatment, of which 32 received USgHIFU and 45 underwent myomectomy. The median non-perfused volume (NPV) ratio in patients with recurrence was 73%, compared to 89% among patients without recurrence. Multivariate analysis showed that NPV ratio, maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment. Conclusions: Achievement of NPV ratio higher than 70% has led to acceptable re-intervention rate during the follow-up period after USgHIFU. NPV ratio, maximum fibroid diameter, and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence

Liu

et al. 2021

International Journal of Hyperthermia

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“…The presence of fibroids close to the uterine cavity (type 3) interferes with endometrial blood flow. In a prospective study, Niewenhuis et al [ 31 ] showed that the increase in myoma volume was greater in highly vascularized myomas, strongly supporting the notion that blood supply modifications may affect blastocyst implantation, as suggested by Schild et al [ 32 ] and Kim et al [ 33 ].…”

Section: Infertilitymentioning

confidence: 74%

Conservative Management of Uterine Fibroid-Related Heavy Menstrual Bleeding and Infertility: Time for a Deeper Mechanistic Understanding and an Individualized Approach

Dolmans

Cacciottola

Donnez

2021

JCM

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(1) Background: Uterine fibroids are the most common form of benign uterine tumors, causing heavy menstrual bleeding (HMB), pelvic pain, infertility and pressure symptoms. Almost a third of women with uterine fibroids seek treatment. The objective of this review is to understand the mechanisms linking fibroids to these symptoms and evaluate different options for their management, particularly the place of gonadotropin-releasing hormone (GnRH) antagonist. (2) Methods: We gathered the most recent and relevant papers on the main fibroid-related symptoms and medical and surgical therapy for their treatment. Those reporting use of oral GnRH antagonists were investigated in detail. (3) Results: The mechanisms explaining myoma-related HMB and infertility were reviewed, as they are essential to a deeper mechanistic understanding and oriented approach. The choice of treatment depends on the number, size, and location of fibroids, and is guided by the patient’s age and desire to preserve her fertility. Economic impacts of myomas in terms of direct costs, lost workdays, and complications were found to be significant. Medical, surgical, and non-surgical strategies were analyzed in this context. Novel medical approaches with GnRH antagonist were explored and found to represent an effective new option. (4) Conclusion: The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. New options now exist, with GnRH antagonists proven to treat fibroid symptoms effectively, opening the door to novel strategies for the management of myomas.

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“…The vessels in the fibroid tissue lack the normal structure compared to the myometrial vessels and are more narrow in diameter [18]. Most fibroids are surrounded by a highly vascularized pseudocapsule which has its own gene expression profile and supplies the fibroid with peri-and intra-fibroid arteries [19]. Oxytocin mainly exerts its effects through the oxytocin receptor, which has a tissue-specific expression pattern.…”

Section: Discussionmentioning

confidence: 99%

Oxytocin selectively reduces blood flow in uterine fibroids without an effect on myometrial blood flow: a dynamic contrast enhanced MRI evaluation

Otonkoski

Sainio

Komar

et al. 2020

International Journal of Hyperthermia

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Introduction: Uterine fibroids are the most common benign neoplasms in women. The administration of intravenous oxytocin is known to increase the efficacy of a non-invasive thermal ablation method (MR-HIFU) for treating fibroids. However, it is not known whether this phenomenon is caused by the effect of the oxytocin on the myometrium or the fibroid itself. The objective of this study was to evaluate the influence of oxytocin on the blood flow of fibroids, myometrium and skeletal muscle using a quantitative perfusion MRI technique. Materials and methods: 17 premenopausal women with fibroids considered to be treated with MR-HIFU and 11 women with no fibroids were enrolled in the study. An extended MRI protocol of the pelvis was acquired for each subject. Later another MRI scan was performed with continuous intravenous infusion of oxytocin. The effect of oxytocin was analyzed from quantitative perfusion imaging. The study was registered in clinicaltrials.gov NCT03937401. Results: Oxytocin decreased the blood flow of each fibroid; the median blood flow of fibroid was 39.9 ml/100 g tissue/min without and 3.5 mL/100 g/min with oxytocin (p 0.0001). Oxytocin did not affect the blood flow of the myometrium in either group. Oxytocin increased the blood flow of the skeletal muscle in both groups (p ¼ 0.04). Conclusion: Oxytocin is effective in decreasing the blood flow in fibroids while having minor or no effect on the blood flow of normal myometrium. Routine use of oxytocin in HIFU therapy may make the therapy suitable to a larger group of women in a safe manner.

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Fibroid vascularisation assessed with three‐dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study

Abstract: Fibroid vascularisation correlates with absolute fibroid volume change and fibroid growth rate per year.

Cited by 32 publications

References 44 publications

Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence

Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence

Conservative Management of Uterine Fibroid-Related Heavy Menstrual Bleeding and Infertility: Time for a Deeper Mechanistic Understanding and an Individualized Approach

Oxytocin selectively reduces blood flow in uterine fibroids without an effect on myometrial blood flow: a dynamic contrast enhanced MRI evaluation

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