Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Abstract

This study aimed to establish the feasibility of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for devascularization of uterine fibroids. Ultrasound color Doppler flow imaging (CDFI) and B-mode imaging were used to target fibroid vascularity. The vessels were covered and ablated by high-intensity focused ultrasound spots. In this study, 42 fibroids with a volume of 66.98 § 4.00 cm 3 were treated. No blood flow was detected by post-treatment CDFI in 40 fibroids. The 6-mo non-perfusion volume rate was 75.23% § 34.77% (n = 40). The mean shrinkage in fibroid volume was 38.20% and 43.89%, respectively, at 1 and 6 mo after treatment (p < 0.001). The uterine fibroid symptom and quality of life scores were reduced by 9.43% at 1 mo and 26.66% at 6-mo after treatment (p < 0.001). No serious adverse event was observed. This study demonstrates the feasibility of USgHIFU-induced fibroid devascularization, and more studies are required for the evaluation of safety and efficacy.

A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation

“…Color Doppler ultrasound discriminates between vascularized and nonvascularized tissue and has shown utility in evaluating the nonperfused volume following ablation [ 18 , 107 ]. In preclinical models, both power Doppler and color Doppler registered a significant decrease in blood flow [ 16 ] following HIFU thermal ablation even in the absence of contrast agent.…”

“…However, spatial resolution is reduced compared to other modalities. Tracers such as 18 F-fluorodeoxyglucose ( 18 F-FDG) can provide both metabolic and morphological data. As a metabolic marker, 18 F-FDG PET imaging immediately postablation does not always present with an inflammation-based hyperintense rim around the ablated zone [109] as in other (e.g., CT and MRI) modalities.…”

“…Tracers such as 18 F-fluorodeoxyglucose ( 18 F-FDG) can provide both metabolic and morphological data. As a metabolic marker, 18 F-FDG PET imaging immediately postablation does not always present with an inflammation-based hyperintense rim around the ablated zone [109] as in other (e.g., CT and MRI) modalities. In liver tumors, a hyperintense rim surrounding the treated region on 18 F-FDG PET may be indicative of remaining viable tumor as opposed to reflexive hyperemia.…”

“…As a metabolic marker, 18 F-FDG PET imaging immediately postablation does not always present with an inflammation-based hyperintense rim around the ablated zone [109] as in other (e.g., CT and MRI) modalities. In liver tumors, a hyperintense rim surrounding the treated region on 18 F-FDG PET may be indicative of remaining viable tumor as opposed to reflexive hyperemia. Furthermore, a hyperintense rim on 18 F-FDG PET may develop days to weeks later, but this is due to increased glucose metabolism as tissue regenerates.…”

“…In liver tumors, a hyperintense rim surrounding the treated region on 18 F-FDG PET may be indicative of remaining viable tumor as opposed to reflexive hyperemia. Furthermore, a hyperintense rim on 18 F-FDG PET may develop days to weeks later, but this is due to increased glucose metabolism as tissue regenerates.…”