J Menopausal Med.  2016 Dec;22(3):139-145. 10.6118/jmm.2016.22.3.139.

Expulsion of Fibroids to the Endometrial Cavity after Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound Surgery (MRgFUS) Treatment of Intramural Uterine Fibroids

• Jeong JH
• Hong GP
• Kim YR
• Hong DG
• Ha JE
• Yeom JI
• Kim EJ
• Kim HI
• Lee KS

• KMID: 2378233
• DOI: http://doi.org/10.6118/jmm.2016.22.3.139

Abstract

OBJECTIVES
This report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy.
METHODS
Of the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system.
RESULTS
The volume of fibroids ranged from 26.0 cm³ to 199.5 cm³, averaging 95.6 cm³. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy.
CONCLUSIONS
In some cases, after an intramural uterine fibroid is treated with MRgFUS, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution.

Keyword

High-intensity focused ultrasound ablation; Hysteroscopy; Leiomyoma; Uterine myomectomy

MeSH Terms

Delivery of Health Care
Gynecology
High-Intensity Focused Ultrasound Ablation
Humans
Hysteroscopy
Leiomyoma*
Magnetic Resonance Imaging
Obstetrics
Ultrasonography*
Uterine Myomectomy

Figure

• 

  Fig. 1 T2-weighted images I the coronal (A) and sagittal (B) plane taken during magnetic resonance imaging-guided high intensity focused ultrasound surgery (MRgFUS) treatment. The cells are round in the transverse plane (A) and have an ellipsoid shape in their longitudinal direction (B). This system is possible to show the thermometry and monitor all the intraabdominal organ regardless depth. The crossed white lines show the pathway of the ultrasound beam. White and orange lines shown in demark the border of the region show certain (white) thermal damage or potential (orange) thermal damage.

• 

  Fig. 2 Intramural type of myoma before magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) was changed to submucosal type after MRgFUS treatment on the MRI finding, (A) Intramural myoma before MRgFUS treatment, (B) Immediate intramural myoma after MRgFUS treatment, (C) Myoma protruding to endometrial cavity in the 3 month later after MRgFUS treatment.

• 

  Fig. 3 (A-F) The various cases with myoma protruding to the endometrial cavity after magnetic resonance imaging-guided high intensity focused ultrasound surgery (MRgFUS) treatment in hysteroscopic finding, not before.

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