Korean J Radiol.  2018 Aug;19(4):724-732. 10.3348/kjr.2018.19.4.724.

Efficacy, Efficiency, and Safety of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Ablation of Uterine Fibroids: Comparison with Ultrasound-Guided Method

• Wang Y
• Wang ZB
• Xu YH

• KMID: 2413701
• DOI: http://doi.org/10.3348/kjr.2018.19.4.724

Abstract

OBJECTIVE
The purpose of this study was to compare efficacy, sonication energy efficiency, treatment time and safety of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) and those of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for ablation of uterine fibroids.
MATERIALS AND METHODS
This study included 43 patients with 44 symptomatic uterine fibroids treated with MRgHIFU and 51 patients with 68 symptomatic uterine fibroids treated with USgHIFU. After therapy, contrast-enhanced MRI was conducted and complete ablation was defined as 100% non-perfused volume (NPV) of fibroids. Patients with completely ablated fibroids were selected for the comparison of the treatment data and sonication parameters between MRgHIFU and USgHIFU treated groups.
RESULTS
Thirteen completely ablated fibroids in 10 patients (23.3%, 10/43) were achieved with MRgHIFU and 28 completely ablated fibroids in 22 patients (43.1%, 22/51) were achieved with USgHIFU. In completely ablated fibroids, the energy-efficiency factor (EEF) was 5.1 ± 3.0 J/mm3 and 4.7 ± 2.5 J/mm3 in the MRgHIFU and USgHIFU, respectively (p = 0.165). There was a negative linear correlation between EEF and the NPV of fibroids for MRgHIFU (p = 0.016) and USgHIFU (p = 0.001). The mean treatment time was 174.5 ± 42.2 minutes and 114.4 ± 39.2 minutes in the MRgHIFU and USgHIFU procedures, respectively (p = 0.021). There were no severe adverse events and major complications after treatment.
CONCLUSION
MRgHIFU and USgHIFU are safe and effective with the equivalent energy efficiency for complete ablation of fibroids. USgHIFU has shorter treatment time than MRgHIFU.

Keyword

Uterine fibroids; High-intensity focused ultrasound ablation; MR imaging; Ultrasound

MeSH Terms

High-Intensity Focused Ultrasound Ablation
Humans
Leiomyoma*
Magnetic Resonance Imaging
Methods*
Sonication
Ultrasonography*

Figure

• 

  Fig. 1 Scatterplot showed EEF distribution was correlated with volume of fibroids completely ablated by MRgHIFU (◆) and USgHIFU (○).EEF = energy-efficiency factor, MRgHIFU = magnetic resonance-guided high-intensity focused ultrasound, USgHIFU = ultrasound-guided high-intensity focused ultrasound

• 

  Fig. 2 Patient with symptomatic uterine fibroids treated by MRgHIFU.Representative images are shown for three different time points. A. Uterine fibroid in 37-year-old woman was hypo-intense on pretreatment T2WI. B. Sagittal contrast-enhanced T1WI showed homogeneous enhancement before MRgHIFU. C. Sagittal contrast-enhanced T1WI showed 100% NPV in fibroid immediately after sonication. D. Fibroid volume shrinkage (65% of baseline) with sustained non-perfused area at 6-month follow-up. NPV = non-perfused volume, T1WI = T1-weighted imaging, T2WI = T2-weighted imaging

• 

  Fig. 3 Patient with symptomatic uterine fibroids treated by USgHIFU.Representative images are shown for three different time points. A. Uterine fibroid in 36-year-old woman was hypo-intense on pretreatment T2WI. B. Sagittal contrast-enhanced T1WI showed homogeneous enhancement before USgHIFU. C. Sagittal contrast-enhanced T1WI showed 100% NPV in fibroid immediately after treatment. D. Fibroid volume shrinkage (64.5% of baseline) with sustained non-perfused area at 6-month follow-up.

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