Noninvasive Treatment of Uterine Fibroids: Early Mayo Clinic Experience With Magnetic Resonance Imaging-Guided Focused Ultrasound

Hesley, Gina K.; Felmlee, Joel P.; Gebhart, John B.; Dunagan, Kelly T.; Gorny, Krzysztof R.; Kesler, Jessica B.; Brandt, Kathleen R.; Glantz, Janel N.; Gostout, Bobbie S.

doi:10.4065/81.7.936

Cited by 73 publications

(53 citation statements)

References 18 publications

(17 reference statements)

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“…10,12,14,28 Briefly, patients were in the prone position for treatment, under conscious sedation, and were continuously monitored by a physician. The sedative agents, midazolam hydrochloride ͑Versed, Bedford Laboratories, Bedford, Ohio, USA͒ at a mean dose of 3.0 mg ͑range of 0.5-6.0 mg͒, and fentanyl citrate ͑Fentanyl; Baxter Healthcare, Deerfield, Illinois, USA͒ at a mean dose of 150 g ͑range of 25-300 g͒, were administered intravenously.…”

Section: Iib Mri-guided Focused Ultrasound Surgerymentioning

confidence: 99%

“…[10][11][12][13][14] Uterine fibroids are the most common indication for hysterectomy. 15 Although hysterectomy is one choice for the treatment of symptomatic fibroid, it can affect the patient's long-term health.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, MRg-HIFUS is now being used for the treatment of these benign lesions. [10][11][12][13][14] Although the potential uses for high frequency ultrasound 16 and focused ultrasound [17][18][19] in biomedicine have been known for a long time, the growing number of applications using focused ultrasound are primarily due to the integration of ultrasound with MRI technology to monitor the ablated tissue with a high degree of accuracy. [20][21][22][23] Moreover, MRg-HIFUS has been approved by the FDA as a noninvasive thermotherapy method for the treatment of uterine fibroids through evaluation in multicenter clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…[20][21][22][23] Moreover, MRg-HIFUS has been approved by the FDA as a noninvasive thermotherapy method for the treatment of uterine fibroids through evaluation in multicenter clinical trials. [10][11][12]14,24 In general, characterization and assessment of uterine fibroids are performed before treatment using both T 1 -and T 2 -weighted ͑T1WI, T2WI͒ 25,26 MR sequences, and after treatment with contrast-enhanced T 1 -weighted images ͑cT 1 WI͒. 10,11,14,24 Before treatment, cT1WI is used to determine the viability of the fibroid by the uptake of the contrast agent; if the fibroid enhances after injection, it is determined to be viable.…”

Section: Introductionmentioning

confidence: 99%

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Comparison between diffusion‐weighted imaging, ‐weighted, and postcontrast ‐weighted imaging after MR‐guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

2010

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Purpose:To investigate the comparison between diffusion-weighted imaging ͑DWI͒, T 2 -weighted imaging, ͑T 2 WI͒ and contrast T 1 -weighted imaging ͑cT 1 WI͒ in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery ͑MRg-HIFUS͒. Methods: Twenty one patients ͑45Ϯ 5 yrs͒ with clinical symptoms of uterine leiomyoma ͑fibroids͒ were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T 2 WI, and T 1 -weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT 1 WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the "eigenimage filter," using both cT 1 WI and DWI. Signal-to-noise ratios were determined for the T 2 WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated. Results: All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT 1 WI defined area. The mean pretreatment T 2 WI signal intensity ratios were T 2 WI/ muscle= 1.8Ϯ 0.7 and T 2 WI/ myometrium= 0.7Ϯ 0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT 1 WI and DWI segmented treatment volumes were found to be significantly correlated ͑r 2 = 0.94, p Ͻ 0.05͒ with the linear equation, ͑cT 1 WI͒ = 1.1͑DWI͒ − 0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots. Conclusions: Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT 1 WI-defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.

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Section: Iib Mri-guided Focused Ultrasound Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison between diffusion‐weighted imaging, ‐weighted, and postcontrast ‐weighted imaging after MR‐guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

2010

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“…Our institution has been performing MRgFUS ablation of uterine leiomyomas in patients with clinical indications for treatment since March 2005 [10][11][12][13]. A database of all treated patients has been kept for retrospective research purposes such as this one, with approval by the Mayo Clinic Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Safety of MR-guided focused ultrasound treatment of pedunculated subserosal uterine leiomyomas

Brown

Hesley

Gorny

et al. 2013

Journal of Therapeutic Ultrasound

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A 41-Year-Old Woman With Menorrhagia, Anemia, and Fibroids

Voorhis

2009

JAMA

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Uterine fibroids are common tumors that can cause heavy menstrual bleeding, pelvic pressure symptoms, and reproductive disorders. The incidence of fibroids peaks in the fifth decade of age and they are more common in African American women. Often, fibroids are asymptomatic and require no treatment. However, the case of Ms P, a 41-year-old woman with recurrent uterine fibroids, menorrhagia, anemia, and fatigue who wishes to retain fertility, illustrates the symptoms that require treatment. Evaluation usually begins with a pelvic examination and an ultrasound to determine both the size and location of the fibroids within the uterus. Standard treatment of symptomatic fibroids is surgical removal by myomectomy or hysterectomy, depending in part on the desire for future fertility; new treatment options include uterine artery embolization via interventional radiologic techniques as well as various medical interventions. Several new therapies show promise but are still experimental at this time. The evidence for treatment options for Ms P and symptomatic patients with fibroids in general is discussed.

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Noninvasive Treatment of Uterine Fibroids: Early Mayo Clinic Experience With Magnetic Resonance Imaging-Guided Focused Ultrasound

Cited by 73 publications

References 18 publications

Comparison between diffusion‐weighted imaging, ‐weighted, and postcontrast ‐weighted imaging after MR‐guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

Comparison between diffusion‐weighted imaging, ‐weighted, and postcontrast ‐weighted imaging after MR‐guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

Safety of MR-guided focused ultrasound treatment of pedunculated subserosal uterine leiomyomas

A 41-Year-Old Woman With Menorrhagia, Anemia, and Fibroids

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