Gonadotrophin-Releasing Hormone and Magnetic-Resonance–Guided Ultrasound Surgery for Uterine Leiomyomata

Abstract

II-3.

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

“…This finding is in line with the results of Hindley et al (3), which were a 13.5% fibroid volume reduction and a 27.3 point reduction in SSS at 6-month follow-up. Somewhat larger changes were reported in another study (16): Fibroid volume decreased by 21% at 6-month and by 37% at 12-month follow-up, while symptom severity was reduced by 45% at 6-month and 48% at 12-month follow-up. In this latter study, however, patients received a gonadotropin-releasing-hormone-agonist before sonication, which may have facilitated leiomyoma volume reduction by creating a temporary hypoestrogenic state.…”

MR-guided focused ultrasound for the treatment of adenomyosis: current insights

“…Current candidates for use as adjuncts include oxytocin infusion during the procedure as previously discussed, or preprocedure preparation with a course of gonadotropin-releasing hormone agonists, as has been shown to be effective in enhancing the effect of MRgFUS for leiomyomata. 48,49 UAE has been used with some success in the treatment of leiomyomata, and more recently has been used for the treatment of adenomyosis. Current UK National Institute for Health and Care Excellence guidance advises that UAE may be offered in the treatment of adenomyosis.…”

Ultrasound guided high-intensity focused ultrasound combined with gonadotropin releasing hormone analogue (GnRHa) ablating uterine leiomyoma with homogeneous hyperintensity on T2 weighted MR imaging

“…Smart et al 10,11 have carried out research on the efficacy of HIFU combined with GnRHa for ablating uterine leiomyomas .10 cm in diameter. Compared with simple HIFU treatment, preliminary results from that study showed the use of a 3-month course of GnRHa therapy before HIFU improved the thermoablative treatment effect.…”

“…There was an average reduction in target leiomyoma volume of 21% and 37% at 6 months and 12 months. However, distinguished from Smart et al 10,11 study, this research focused on the uterine leiomyomas with homogeneous hyperintensity on T 2 weighted MRI-those with a diameter of 4-7 cm. A usual finding was the presence of degeneration inside fibroids .10 cm in diameter, and the research showed these leiomyomas manifested heterogeneous hyperintensity on T 2 weighted MRI and could be easily ablated by USgHIFU because they contained sparing cellularity and more fibres.…”