Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience

Mikami, Koji; Murakami, Takamichi; Okada, Atsuya; Osuga, Keigo; Tomoda, Kaname; Nakamura, Hajime

doi:10.1007/s11604-007-0215-6

Cited by 55 publications

(47 citation statements)

References 24 publications

(43 reference statements)

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“…Zhao et al (12) further found that hyperintensity on T2-weighted images of a fibroid indicates the presence of angiogenesis, richness of aqueous tissue, and cell components with less fibrous tissue, whereas hypointensity or isointensity on T2-weighted images of a fibroid indicates that angiogenesis is less common and the fibrous content is richer than that of fibroids with hyperintensity on T2-weighted images. Mikami et al (13) reported that the uterine fibroids in the failed treatment group demonstrated heterogeneous and high SI on T2-weighted images relative to that of the myometrium, whereas the uterine fibroids in the successful treatment group demonstrated low SI relative to that of the myometrium.…”

Section: T2-weighted Imagingmentioning

confidence: 99%

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Duc

Keserci

2018

Diagn Interv Radiol

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U terine fibroids, composed of smooth muscle cells and fibrous connective tissue derived from the myometrium, are common benign gynecological tumors that have a significant negative effect on the quality of life of a patient. Symptoms of uterine fibroids vary depending on their size and location, but the main symptoms are pelvic pain, menorrhagia or dysmenorrhea, increased frequency of urination, and reproductive dysfunction, including impaired fertility, pregnancy complications and loss (1, 2).The choice of treatment and its rate of success are dependent on the morphology and tissue characteristics of the uterine fibroids. Hysterectomy remains the definitive treatment for uterine fibroids, but this treatment option is unsuitable for women who wish to preserve their fertility. In the last decade, patient demands have spurred the development of a noninvasive therapeutic modality for symptomatic uterine fibroids called magnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) (3-11).The principle of HIFU treatment of uterine fibroids is that focused ultrasonic energy causes coagulative necrosis of the target. Since its first clinical use for treating symptomatic uterine fibroids, the use of HIFU has increased worldwide because of its excellent therapeutic efficacy in relieving fibroid-related symptoms, its ability to preserve the uterus, and its high level of safety (3-7). However, as shown in previous studies (8-11), MRI-guided HIFU ablation therapy cannot be used in all patients with symptomatic fibroids because of the tissue characteristics of the uterine fibroids such as the T1 and T2 MRI signal intensity (SI), and fibroid type defined by general uterine position, fibroid size, and fibroid number. In addition, technical limitations, including the presence of scar tissue, excessive abdominal subcutaneous fat, the distance between the skin and the fibroids, the distance between the sacral bone surface and the fibroids, and the bowel in the path of sonication, play a role in whether MRI-guided HIFU therapy is appropriate.In this article, we present a literature review of the influential clinical factors that might reduce the risk of an unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids. Tissue characteristics of uterine fibroids T2-weighted imagingT2 SI is the primary MRI classification parameter for determining patient suitability for MRI-guided HIFU. A patient is classified as type I when the SI of the uterine fibroid is lower than that of skeletal muscle, type II when the SI is lower than that of the myometrium but higher than that of skeletal muscle, or type III when the SI is higher than that of the myometrium (Fig. 1) (4). As shown by previous studies (4-13), uterine fibroids with different SIs on ABSTRACTMagnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) is an effective noninvasive treatment option for symptomatic uterine fibroids. However, tissue characteristics of uterine fibroids and technical limitations can limit the patie...

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Section: T2-weighted Imagingmentioning

confidence: 99%

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Duc

Keserci

2018

Diagn Interv Radiol

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“…Uterine fibroid symptoms were reduced to 53% and the degree of menstrual pain was reduced to 50% as reported by Yoon et al [70–72]. Bulk-related and menstrual symptoms diminished in 51% of patients after 6 months of HIFU treatment [73]. …”

Section: Resultsmentioning

confidence: 72%

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

et al. 2014

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SummaryBackgroundHigh-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature.Material/MethodsAn inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013.ResultsIn current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects.ConclusionsUterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.

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“…Symptoms are reduced by more than 50% in terms of pain, [102][103][104] bulk-related and menstrual symptoms, comparable with the results of conventional surgery. 105 After HIFU, the ablated fibroid volume is decreased, and is related to the non-perfused volume of the tumour immediately after treatment. 44,106,107 Nonetheless, HIFU cannot propagate through air-filled viscera such as bowel.…”

Section: Fibroidsmentioning

confidence: 99%

Clinical applications of high-intensity focused ultrasound

et al. 2016

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Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience

Abstract: MRIgFUS ablation is a safe, effective treatment for nonobese patients with symptomatic fibroids that show low signal intensity on T2-weighted images. Ablation of more than 50% of the fibroid volume may be needed with a short-term follow-up.

Cited by 55 publications

References 24 publications

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

Clinical applications of high-intensity focused ultrasound

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