The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids

Keserci, Bilgin; Duc, Nguyen Minh

doi:10.1007/s00330-017-4885-x

Cited by 37 publications

(54 citation statements)

References 26 publications

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“…The perfusion analysis showed enhanced blood flow in the region of the myoma when compared to the surrounding myometrium. A high perfusion 13 rate has a strong cooling effect which has been shown to be a significant predictor of treatment outcome (Keserci and Duc, 2017). It has previously been reported that the perfusion of the uterine fibroids varies on average between 50-334 mL/100 g/min, which supports that the fibroid in this study had relatively high perfusion rate (Wei et al, 2018).…”

Section: Discussionsupporting

confidence: 78%

High-Intensity Focused Ultrasound Therapy in the Uterine Fibroid: A Clinical Case Study of Poor Heating Efficacy

Suomi

Viitala

Sainio

et al. 2019

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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A clinical case study of high-intensity focused ultrasound (HIFU) treatment in the uterine fibroid was conducted. During the therapy, poor heating efficacy was observed which could be attributed to several factors such as the local perfusion rate, patient-specific anatomy or changes in acoustic parameters of the ultrasound field. In order to determine the cause of the diminished heating, perfusion analyses and ultrasound simulations were conducted using the magnetic resonance imaging (MRI) data from the treatment. The perfusion analysis showed high local perfusion rate in the myoma (301.0 ± 25.6 mL/100 g/min) compared to the surrounding myometrium (233.8 ± 16.2 mL/100 g/min). The ultrasound simulations did not show large differences in the focal point shape or the acoustic pressure (2.07 ± 0.06 MPa) when tilting the transducer. However, a small shift (−2.2 ± 1.3 mm) in the axial location of the focal point was observed. The main causes for the dimin- * Corresponding ished heating were likely the high local perfusion and ultrasound attenuation due to the deep location of the myoma. c 2019 IEEE.

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Section: Discussionsupporting

confidence: 78%

High-Intensity Focused Ultrasound Therapy in the Uterine Fibroid: A Clinical Case Study of Poor Heating Efficacy

Suomi

Viitala

Sainio

et al. 2019

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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“…Recently, a new classification method based on MRI T1 perfusion-based time-SI curves for fibroid tissue compared with those for the myometrium in screening MRI was introduced by Keserci et al (20) for predicting the treatment outcome of HIFU ablation. The fibroids were classified into group A if the time-SI curve was lower than that for the myometrium (Fig.…”

Section: Main Pointsmentioning

confidence: 99%

“…Clinical studies (7,20,39,40,45) suggested that the cells to be treated must be located on the T2-weighted planning images, and the safety margin or distance from the border of the cells to be treated to critical organs such as the sacral bone should be taken into consideration (e.g., 4 cm), since heat accumulation in the bone can subsequently be transferred to the perineural fat and adjacent nerves. The adverse effects encountered in these studies were partly related to far-field heat absorption by distant bony structures (e.g., sciatic nerve symptoms).…”

Section: Distance Between Sacral Bone Surface and Uterine Fibroidsmentioning

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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“…MRI examination revealed that there were 15 uterine leiomyomas affected almost areas of anteflexed uterus considered as all type II uterine leiomyomas (the signal intensity of leiomyoma was greater than that of skeletal muscle and less than that of myometrium) (FIGURE 3A) [2]. The perfusion classification of uterine leiomyomas was regarded as type A uterine leiomyoma (the time signal intensity curve of uterine leiomyoma was less than that of myometrium) (FIGURE 3B) [3]. The patient was indicated single phase HIFU surgery under the guidance of magnetic resonance imaging by which clinician utilized 40 treatment cells (12 mm, n=12; 14 mm, n=18; 16 mm, n=10) and a mean power of 158 ± 26W.…”

Section: Resultsmentioning

confidence: 99%

“…Magnetic Resonance Imaging (MRI) guided High-intensity Focused Ultrasound (HIFU) which combines the anatomical and functional imaging of MR with the thermal ablation possibilities of HIFU, is an alternative treatment to hysterectomy for the treatment of uterine fibroids and preserves the uterus [2,3]. In this case report, we aimed to display one tough case of 15 leiomyomas and another tough case of huge leiomyoma ablated profitably by single phase HIFU along with the pros and cons of these findings.…”

Section: Introductionmentioning

confidence: 99%

MRI-guided High-intensity Focused Ultrasound As An Alternative Treatment Option For Multiple Leiomyomas And Huge Leiomyomas

Duc¹,

Huy²,

Hoa³

et al. 2018

Imaging-Medicine

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The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids

Cited by 37 publications

References 26 publications

High-Intensity Focused Ultrasound Therapy in the Uterine Fibroid: A Clinical Case Study of Poor Heating Efficacy

High-Intensity Focused Ultrasound Therapy in the Uterine Fibroid: A Clinical Case Study of Poor Heating Efficacy

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

MRI-guided High-intensity Focused Ultrasound As An Alternative Treatment Option For Multiple Leiomyomas And Huge Leiomyomas

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