<b>MRI Guidance of Focused Ultrasound Therapy of Uterine Fibroids:</b> Early Results

Hindley, Jonathan T.; Gedroyc, Wladyslaw; Regan, Lesley; Stewart, Elizabeth A.; Tempany, Clare M.; Hynnen, Kullervo; Macdanold, Nathan; Inbar, Yael; Itzchak, Y; Rabinovici, Jaron; Kim, Kevin; Geschwind, Jean François H.; Hesley, Gina K.; Gostout, Brian; Ehrenstein, T.; Hengst, Sylvia; Sklair‐Levy, Miri; Shushan, Asher; Jólesz, Ferenc A.

doi:10.2214/ajr.183.6.01831713

Cited by 376 publications

(287 citation statements)

References 29 publications

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“…After screening, 135 patients were determined to meet all eligibility criteria and were treated with MR-guided focused ultrasound surgery at Brigham and Women's Hospital. The eligibility criteria for enrollment in the trial of MR-guided focused ultrasound surgery have been previously described (1)(2)(3)(4)(5). Patients with calcified fibroids were excluded.…”

Section: Patientsmentioning

confidence: 99%

“…Pretreatment patient preparation, treatment planning, and sonication have been described in detail in previous publications (1)(2)(3)(4)(5)(6)(7). For planning on the day of treatment, standard T2-weighted fast spin-echo images were acquired while the patient was in the prone position on the MR-guided focused ultrasound surgery table.…”

Section: Treatmentmentioning

confidence: 99%

“…Originally the maximum treatment volume was 100 cm 3 and was limited to 33% of the total fibroid volume, the total "in-bore" treatment time was limited to 3 hours, and a second treatment was not allowed. These guidelines were then relaxed by the Food and Drug Administration: The maximum treatment volume was changed to 150 cm 3 and limited to 50% of the total fibroid volume, maximum treatment time remained 3 hours, and a second treatment was allowed.…”

Section: Treatmentmentioning

confidence: 99%

“…However, in previous clinical trials and also in our study, the sonicated volume of the fibroid was limited by treatment guidelines defined on the basis of consultation with the Food and Drug Administration (5). Originally, the maximum treatment volume of a fibroid was 100 cm 3 and was limited to 33% of the total fibroid volume, the total in-bore time was limited to 3 hours, and a second treatment was not allowed. These guidelines have since been relaxed by the Food and Drug Administration, but the majority of our patients were treated under the more restrictive guidelines.…”

Section: Genitourinary Imaging: Uterine Leiomyomas: Mr-guided Focusedmentioning

confidence: 99%

“…Treatments performed according to initial guidelines led to significant improvement in symptoms despite small volumes of tissue ablated and have been shown to be sustained 12 and 24 months after treatment in many patients (5,7). MR-guided focused ultrasound surgery has also been shown to be effective at fibroid volume reduction at 6-month follow-up (3).…”

mentioning

confidence: 99%

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Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Lénárd¹,

McDannold²,

Fennessy³

et al. 2008

Radiology

155

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Purpose:To retrospectively assess the magnetic resonance (MR) imaging predictors of success at reducing uterine leiomyoma volume and achieving patient symptom relief 12 months after MR imaging-guided focused ultrasound surgery. Materials and Methods:This single-center retrospective analysis of 71 symptomatic fibroids in 66 women was approved by the institutional review board and was HIPAA-compliant. Patients were treated with MR imaging-guided focused ultrasound surgery. The volume of treated fibroid and nonperfused volume (NPV) were calculated with software, while symptom outcome was assessed with a symptom severity score (SSS). Fibroids were classified as hyperintense or hypointense relative to skeletal muscle on pretreatment T2-weighted MR images. Results:Baseline volume of treated fibroids was 255.5 cm 3 Ϯ 201.7 (standard deviation), and baseline SSS was 61.5 Ϯ 14.9. Both pretreatment fibroid signal intensity (SI) and posttreatment NPV predicted 12-month volume reduction independently: Fibroids with an NPV of at least 20% or with low SI both showed significantly larger volume reduction (17.0% Ϯ 13.0 and 17.2% Ϯ 20.1, respectively) than fibroids with an NPV less than 20% or with high SI (10.7% Ϯ 18.2 and no significant change, respectively). Patients whose fibroids demonstrated an NPV of at least 20% also experienced a larger decrease in SSS than did patients with fibroids with an NPV less than 20% (50.1% Ϯ 19.8 vs 32.6% Ϯ 29.9). Conclusion:Fibroids with low SI on pretreatment T2-weighted MR images were more likely to shrink than were ones with high SI. The larger the NPV immediately after treatment, the greater the volume reduction and symptom relief were. These findings may help both in selecting appropriate patients for MR-guided focused ultrasound surgery and in predicting patient outcome.

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