Leiomyoma Shrinkage After MRI-Guided Focused Ultrasound Treatment: Report of 80 Patients

LeBlang, Suzanne; Hoctor, Katherine; Steinberg, Fred

doi:10.2214/ajr.09.2842

Cited by 132 publications

(103 citation statements)

References 28 publications

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“…Both interventional methods have a very short recovery time compared to surgery. The achieved reduction of the myoma volume of 45.8 % after 6 months is in agreement with previous studies with reduction rates of 13.5 -46 % [17,23,24]. Different reasons for the increase in volume reduction beyond the NPV are being dis- cussed.…”

Section: Discussionsupporting

confidence: 91%

MR-Guided HIFU Treatment of Symptomatic Uterine Fibroids Using Novel Feedback-Regulated Volumetric Ablation: Effectiveness and Clinical Practice

Ruhnke

Eckey

Bohlmann

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate a novel feedback-regulated volumetric sonication method in MR-guided HIFU treatment of symptomatic uterine fibroids. Materials and Methods: 27 fibroids with an average volume of 124.9???139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5?T MR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16?mm were used and compared concerning sonication success, diameter of?induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). Results: In total, 205 TC and 227 FC were applied. The NPV ratio was 23???15?% (2???55). The TC were slightly smaller than intended (?3.9???52?%; range, ?100???81), while the FC were 20.1???25.3?% bigger (p?=?0.02). Feedback mechanism is less diversifying in diameter (p?

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Section: Discussionsupporting

confidence: 91%

MR-Guided HIFU Treatment of Symptomatic Uterine Fibroids Using Novel Feedback-Regulated Volumetric Ablation: Effectiveness and Clinical Practice

Ruhnke

Eckey

Bohlmann

et al. 2013

Fortschr Röntgenstr

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“…Reaching high NPVs is the mainstay predictor of therapeutical success in the MR-HIFU treatment of UFs. [21][22][23][24] Another nonthermal tissue damaging effect of HIFU is caused by acoustic cavitation. This mechanical process occurs at high acoustic intensities and leads to the vaporization of tissue water and the formation of rapidly expanding microbubbles, which subsequently collapse with the release of shock waves and high-speed liquid jets, leading to tearing forces, which are followed by direct tissue damage.…”

Section: Hifu -Application Methods and Physical Mechanisms Of Tissue mentioning

confidence: 99%

“…[25][26][27][28] Thus, according to the recent US Food and Drug Administration safety criteria, safety margins of 1.5 cm between the treated UF volume and the adjacent peritoneal serosa have to be considered. 24 …”

Section: Hifu -Application Methods and Physical Mechanisms Of Tissue mentioning

confidence: 99%

“…The so-called NPV ratio, determined as the NPV/UF volume, is the most reliable predicting factor for UF volume shrinkage. 11,15,[21][22][23][24] Using conventional MR-HIFU ablation technique without temperature mapping, very high NPV ratios up to 50% and in some cases .90% are reported. 22,[37][38][39] Here, it has to be critically mentioned that those very high NPV ratios might be due to the lower safety criteria leaving the patients at an increased risk of post-MR-HIFU complications.…”

Section: Therapeutic Outcomementioning

confidence: 99%

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MR-guided high-intensity focused ultrasound treatment of uterine fibroids

Wiggermann¹,

Beldoch²,

Hoellen³

et al. 2016

RRFU

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Uterine fibroids are benign, encapsulated uterine tumors, representing the most common reason for hysterectomy in premenopausal women. High-intensity focused ultrasound (HIFU; also known as focused ultrasound surgery) is a noninvasive technique leading to tissue heating in a centered focus, inducing a thermal tissue necrosis. Magnetic resonance-guided HIFU (MR-HIFU; also know as MR-guided focused ultrasound surgery) allows to allocate the uterine fibroids as well as to evaluate whether these are accessible for HIFU treatment. Further advantages are MR-based real-time temperature mapping and immediate evaluation of postprocedure therapeutic success by MR imaging. These advantages minimize the patient risk and make the treatment more effective. MR-HIFU is a uterus conserving, low pain-to-painless, and noninvasive treatment option. Here, we review its medical and economic advance to surgical procedures due to the low complication rates combined with proven symptom relief and the enhancement of the quality of life.

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“…Previous studies (2,5,6) demonstrated that these results may have been due to the reduced non-perfused volume (NPV) observed immediately after HIFU. The extent of the NPV inside the uterine fibroids has been observed using enhanced magnetic resonance imaging (MRI) following treatment, as an indication of treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images

Zhao

Chen

2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the efficacy of dynamic contrast-enhanced magnetic resonance imaging (MRI) in predicting the outcome of using ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of uterine fibroids with T2 hyperintensity under MRI. A total of 131 uterine fibroids from 131 patients that appeared hyperintense under T2-weighted MRI were analyzed. The uterine fibroids were subjectively categorized into slight, irregular or regular enhancement groups, according to pretreatment dynamic contrast-enhanced MRI in the arterial phase within 60 sec after the injection of gadolinium. The non-perfused volume (NPV), which is indicative of successful ablation, was represented as the non-perfused area inside the uterine fibroids on enhanced MRI scans following treatment. Additionally, the treatment duration, treatment efficiency, sonication duration, energy efficiency ratio and any adverse events were recorded. The results indicated that the average NPV ratio for all the treated fibroids was 68.5%, while the average NPV ratios for fibroids with slight, irregular or regular enhancement were 84.7, 70.6 and 57.1%, respectively. Fibroids with regular enhancement were associated with the lowest NPV ratio and the lowest treatment efficiency, but exhibited the highest energy effect ratio and an elevated risk of severe adverse effects. The results of the present study indicate that hyperintense uterine fibroids with slight and irregular enhancement in the arterial phase of dynamic contrast-enhanced MRI are suitable for USgHIFU treatment. By contrast, uterine fibroids with regular enhancement were associated with the lowest treatment efficacy and safety.

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Leiomyoma Shrinkage After MRI-Guided Focused Ultrasound Treatment: Report of 80 Patients

Cited by 132 publications

References 28 publications

MR-Guided HIFU Treatment of Symptomatic Uterine Fibroids Using Novel Feedback-Regulated Volumetric Ablation: Effectiveness and Clinical Practice

MR-Guided HIFU Treatment of Symptomatic Uterine Fibroids Using Novel Feedback-Regulated Volumetric Ablation: Effectiveness and Clinical Practice

MR-guided high-intensity focused ultrasound treatment of uterine fibroids

Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images

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