J Menopausal Med.  2016 Aug;22(2):94-107. 10.6118/jmm.2016.22.2.94.

Clinical Consideration of Treatment to Ablate Uterine Fibroids with Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound (MRgFUS): Sonalleve

• Jeong JH
• Hong GP
• Kim YR
• Ha JE
• Lee KS

• KMID: 2365465
• DOI: http://doi.org/10.6118/jmm.2016.22.2.94

Abstract

OBJECTIVES
Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS.
METHODS
This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio.
RESULTS
When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly.
CONCLUSIONS
In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.

Keyword

High-intensity focused ultrasound ablation; Leiomyoma; Myoma; Oxytocin

MeSH Terms

Delivery of Health Care
High-Intensity Focused Ultrasound Ablation
Humans
Leiomyoma*
Magnetic Resonance Imaging
Myoma
Oxytocin
Sonication
Ultrasonography*
Oxytocin

Figure

• 

  Fig. 1 Coronal (A) and sagittal (B) magnetic resonance (MR) thermometry images show temperature overlay and the magnetic resonance (MR); white lines, white arrow) during volumetric MR imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) ablation with a 16 mm treatment cell. X-shaped two white triangles are their presumed sonication pathway. Yellow box indicate the 30-240 EM area, the possible thermal damage (yellow arrow). MR thermometry show the temperature of abdominal skin (C) & tissues adjacent to sacrum (D).

• 

  Fig. 2 (A) T2-, (B) T1-weighted magnetic resonance (MR) image before high intensity focused ultrasound (HIFU), (C) Contrast enhanced T1-weighted MR image after HIFU show excellent non-perfused volume (NPV) and NPV ratio. Arow indicate the multiple fibroid of uterus.

• 

  Fig. 3 Correlation between average sonication power, average treatment time, and using with uterotonics.* *Spearman correlation coefficient were 0.320 between the average sonication power and using or not using with uterotonics, -0.344 between treatment time and using or not using with uterotonics.

• 

  Fig. 4 Correlation between non-perfused volume (NPV) ratio, average sonication power and Funaki type of uterine fibroids after magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS). *The average sonication power was classified by 1: <100, 2 :100-130, 3 :130-160, 4: >160. Pearson correlation coefficient and Spearman correlation coefficient were 0.311 and 0.300 between the average sonication power and Funaki type of uterine fibroid, -0.344 and -0.320 between the NPV ratio and Funaki type of uterine fibroid in MRgFUS;both were statistically significant.

• 

  Fig. 5 (A) T2-weighted magnetic resonance (MR) image before high intensity focused ultrasound (HIFU), red triangle indicated the beam pathway, (B) Contrast enhanced T1-weighted MR image after HIFU show excellent non-perfused volume when using with multiple sonication beam pathway in the multiple fibroids, multipe fibroids on the same beam pathway was ablated simultaneously during one sonication.

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