Obstet Gynecol Sci.  2017 Jan;60(1):92-99. 10.5468/ogs.2017.60.1.92.

Usefulness of modified BRB technique in treatment to ablate uterine fibroids with magnetic resonance image-guided high-intensity focused ultrasound

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

• KMID: 2383214
• DOI: http://doi.org/10.5468/ogs.2017.60.1.92

Abstract

OBJECTIVE
If bowels and other structures are in the pathway of high-intensity focused ultrasound (HIFU) beam during magnetic resonance image-guided HIFU (MRgFUS) therapy, filling to the bladder and the rectum and then emptying the bladder (i.e., the BRB technique) is used to avoid them. A modified BRB technique might be useful method to using a uterine elevator method or by inducing uterus downward traction to lower the position of the uterus.
METHODS
A total of 156 patients who had undergone MRgFUS surgery treatment for uterine fibroids from March 2015 to February 2016 were included in this retrospective study. Of the 156 patients, 40 were treated using a uterine elevator while 29 were treated using downward traction of uterus. HIFU was performed using Philips Achieva 1.5 Tesla MR and Sonalleve HIFU system.
RESULTS
MRgFUS surgery was feasible with modified BRB technique in 69 cases. Using uterine elevator method, the intensity of HIFU for group with antefletxio uteri was significantly lower than that for the group without antefletxio uteri (105.37±17.62 vs. 118.71±26.88 W). The group with downward traction of uterus induced was found to have significantly lower intensity of HIFU compared to the group without downward traction of uterus induced (110.26±22.60 vs. 130.51±27.81 W).
CONCLUSION
Modified BRB technique was useful in avoiding bowels and other structures located in HIFU beam pathway during MRgFUS treatment to ablate uterine fibroids.

Keyword

BRB; High-intensity focused ultrasound; Magnetic resonance image-guided high-intensity focused ultrasound; Uterine fibroids

MeSH Terms

Elevators and Escalators
Humans
Leiomyoma*
Methods
Rectum
Retrospective Studies
Traction
Ultrasonography*
Urinary Bladder
Uterus

Figure

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  Fig. 1 Modified BRB technique using with a uterine elevator. (A) Uterus was state of retroversion, bowel was located anterior of uterine fibroid, and uterine fibroid was located at the posterior state in the pelvis. (B) Uterine fibroid was located at anterior state than previous state after using uterine elevator. (C) Non-perfused volume was seen on contrast enhanced T1-weighted image after high-intensity focused ultrasound.

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  Fig. 2 Modified BRB technique inducing downward traction of the uterus. (A) Bowel was located anterior of uterine fibroid. It was located in the pathway of high intensity ultrasound beam. (B) The bowel was located upward than previous state after filling the bladder and downward traction of uterus. (C) Non-perfused volume was seen on contrast enhanced T1-weighted image after high-intensity focused ultrasound.

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  Fig. 3 Correlation between average sonication power, treatment time, and using uterine elevator. Spearman correlation coefficient were 0.224 between the average sonication power and using of uterine elevator, 0.106 between the treatment time and using of uterine elevator in magnetic resonance image-guided high-intensity focused ultrasound; relationship with the average sonication power was only statistically significant.

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  Fig. 4 Correlation between average sonication power, treatment time, and downward traction of uterus. Spearman correlation coefficient were 0.272 between the average sonication power and downward traction of uterus, 0.375 between the treatment time and downward traction of uterus in magnetic resonance image-guided high-intensity focused ultrasound; both were statistically significant.

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