MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation

Zhang, Yajiao; Xiao, Zhibo; Sheng, Bo; Li, Jia; Zheng, Yineng; Lv, Fajin; Chen, Jin-Yun

doi:10.1080/02656736.2019.1701100

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…No adverse events of class D, E, or F occurred in this study. And the incidence of this study was similar to previous studies ( 6 , 10 , 39 ). The incidence of postoperative lower abdominal pain, sacrococcygeal pain, and lower limb pain/numbness was higher in the group with pelvic injury than in the group without injury, which was considered to be due to the fact that more energy was required for fibroid ablation in the injury group, and the corresponding soft tissues and nerves were irradiated at an increased dose and at an increased treatment intensity, thus likely causing an increased incidence of corresponding adverse events.…”

Section: Discussionsupporting

confidence: 91%

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study

Liu,

Lv,

Liu

et al. 2024

Quant Imaging Med Surg

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Background The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI). Methods A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury. Results Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191–2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567–3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204–2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283–3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093–4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury. Conclusions Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.

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Section: Discussionsupporting

confidence: 91%

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study

Liu,

Lv,

Liu

et al. 2024

Quant Imaging Med Surg

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“…However, in our study, there were no such adverse effects lending further evidence to the safety of the procedure. Care may be required in HIFU treatment of uterine fibroids located on the posterior uterine wall or in retroverted uteri, close to the surface of the sacral bone adjacent to lumbosacral nerves, to prevent sciatic nerve damage or sacral injury [37,38]. Occurring in approximately 4-14% of patients, such transient irritation is one of the most frequently reported side effects, along with vaginal discharge (6%) [19,27,37,38], which was reported in 10% of our patients.…”

Section: Discussionmentioning

confidence: 79%

“…Care may be required in HIFU treatment of uterine fibroids located on the posterior uterine wall or in retroverted uteri, close to the surface of the sacral bone adjacent to lumbosacral nerves, to prevent sciatic nerve damage or sacral injury [37,38]. Occurring in approximately 4-14% of patients, such transient irritation is one of the most frequently reported side effects, along with vaginal discharge (6%) [19,27,37,38], which was reported in 10% of our patients. Serious side effects like skin burns (up to 2%) or even small bowel perforations (0.1%) are possible but have been only rarely reported [7,39].…”

Section: Discussionmentioning

confidence: 79%

Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study

Marinova

Ghaei

Recker

et al. 2021

International Journal of Hyperthermia

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Introduction: To evaluate treatment response of uterine fibroids after ultrasound guided high-intensity focused ultrasound (USgHIFU) with a special focus on fibroid size and characterization based on Funaki classification scheme, as well as clinical response to treatment of leading fibroid-associated symptoms. Materials and methods: Uterine fibroids treated by USgHIFU were assigned to Funaki type 1-3 based on T2-w-MRI. Differences in size, non-perfused volume ratio (NPVR) and volume reduction over time were determined using T1-/T2-w MRI sequences and contrast-enhanced sonography. Treatment effects on three leading fibroid-associated symptoms were also evaluated. Measurements were compared by mixed model, Bland-Altman's plot and Spearman's correlation. Results: In this prospective single-center study, 35 patients with 44 symptomatic uterine fibroids were treated by USgHIFU (n ¼ 22, n ¼ 12 and n ¼ 10 assigned to Funaki type 1, 2 and 3, respectively). NPVRs of Funaki type 1 and 2 fibroids were significantly higher compared to type 3 (p ¼ .0023). A significant fibroid shrinkage was observed independent of Funaki type compared to baseline: 38.8 ± 26.9%, 46.7 ± 30.3% and 54.5 ± 29.3% at 3, 6 and 12 months, respectively (each p < .05). Moreover, patients experienced a significant improvement of fibroid-associated hypermenorrhea (3.9 ± 1.3 vs. 2.3 ± 1.3), pressure in the pelvic area (3.5 ± 1.3 vs. 2.1 ± 0.9) and frequent urination (2.8 ± 1.5 vs. 1.9 ± 0.8) one year post-procedure (each p < .05), regardless of fibroid Funaki type. Conclusion: Following USgHIFU, a significant shrinkage of uterine fibroids and improvement of leading fibroid-associated symptoms were demonstrated regardless of the Funaki type.

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“…The average NPVR was 71.5 ± 18.4%, which is slightly lower than the results of other studies on HIFU therapy for undefined fibroids adjacent to the sacrococcygeal region. 16 , 19 …”

Section: Discussionmentioning

confidence: 99%

Sacral injury and influencing factors after ultrasonic ablation of uterine fibroids ≤30 mm from the sacrum

Zheng¹,

Chen²,

Xiao³

et al. 2023

Diagn Interv Radiol

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To study sacral injuries and influencing factors after ultrasonic ablation of uterine fibroids no more than 30 mm from the sacrum. METHODSA total of 406 patients with uterine fibroids who underwent percutaneous ultrasound ablation were analyzed retrospectively. All patients underwent contrast-enhanced magnetic resonance imaging (MRI) scans before and after high-intensity focused ultrasound. The abnormal signal intensity (low signal intensity on T1WI and high signal intensity on T2WI) on the postoperative MRIs was indicative of a sacral injury. The patients were divided into a sacrum injury group and a sacrum non-injury group. The relationship between fibroid characteristics, ultrasound ablation parameters, and injury was analyzed using univariate and multivariate analyses. RESULTSThere were 139 cases of sacral injury (34.24%). When the distance from the fibroid's dorsal side to the sacrum was 0-10 mm, the risk assessment showed that the danger of sacral injury increased by 1.85 times and 3.03 times compared with that at a distance of 11-20 or 21-30 mm. Furthermore, the risk of sacral injury increased by 1.89 times and 3.23 times when the therapeutic dose (TD) of a fibroid was >500 KJ compared with that of a fibroid with TD= 250-500 KJ and <250 KJ. CONCLUSIONA distance of 10 mm or less and a TD of >500 KJ were significantly correlated with sacral injury. The distance from the fibroid's dorsal side to the sacrum and the TD were the main causes of injury to the sacrum. A distance of 10 mm or less and a TD of >500 KJ carried higher injury risks, while a distance of 21-30 mm and a TD of <250 KJ were the most appropriate circumstances to reduce the risk of sacral injury.

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MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation

Abstract: 2020) MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation,

Cited by 7 publications

References 20 publications

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study

Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study

Sacral injury and influencing factors after ultrasonic ablation of uterine fibroids ≤30 mm from the sacrum

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