Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery

Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids

“…The growing experience with MRgFUS treatment along with the implementation of the less restrictive modified FDA commercial treatment guidelines facilitated improved clinical results while maintaining a high safety profile of the technique. 19,25,26 In their cohort of 80 patients, applying more relaxed treatment guidelines, LeBlang et al 25 achieved a mean NPV ratio of 55%. For all groups of fibroids, independent of size, it was possible to obtain an NPV ratio of at least 50%, whereas larger NPV ratios of more than 60% were predominantly seen after treatment of smaller fibroid volumes (ie, G100 cm 3 ).…”

“…Morita et al 26 retrospectively analyzed 83 patients to determine the safety of treating closer to the serosal surface and thereby increasing the treatment volume. Measuring the distance between the treatment spots and the serosa, they found that 79% and 37% of the sonications were located less than 15 and 10 mm from the serosal surface, respectively.…”

“…As Morita et al 26 stressed, the distance between the sonication spot and the serosa should be determined on a case-by-case basis (eg, in case of fibroids close to the serosal surface) by careful assessment of neighboring sensitive structures such as bowel in the pretreatment MR images. In our experience, potential damage can be circumvented by using small or tilted spots and by paying special attention to the spot location using the real-time temperature maps and the anatomical images to verify that no patient movement has occurred.…”

Intraprocedure contrast enhanced ultrasound: The value in assessing the effect of ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids

“…MRI is often used to evaluate the treatment efficacy of HIFU for uterine fibroids. Many studies have shown that enhanced MRI could offer the most accurate results of the size of uterine fibroids and the non-perfused volume (NPV) [12][13][14]. Recently, some studies have shown that the fractional ablation of uterine fibroid, which was defined as the percentage rate of the NPV comparing with overall fibroid volume, calculated by MRI after HIFU treatment, was the most important factor influencing the long-term clinical results of HIFU ablation [15,16].…”

Résultats préliminaires de la destruction des fibromes utérins par ultrasons focalisés contrôlée par résonance magnétique

“…Il faut dé truire plus pour obtenir une efficacité plus durable. Une sé lection des patientes est indispensable et constitue la clé de la prise en charge des fibromes par ultrasons focalisé s ou par embolisation ; entre 15 et 20 % des fibromes sont accessibles à la technique par ultrasons si l'on veut obtenir une dé vascularisation suffisante pour un taux de succè s convenable à moyen-long terme [35]. Cette nouvelle technique qui, malgré un retard français, arrive à maturité à l'é tranger (plusieurs centaines de machines installé es dans le monde, avec ou sans contrôle IRM) sera une alternative aux traitements existants et devra être comparé e en efficacité aux techniques validé es mais plus agressives comme l'embolisation des artè res uté rines qui est à ce jour le gold standard du traitement conservateur non chirurgical (autant d'embolisations pour fibrome sont ré alisé es dans notre service que d'hysté rectomies ou de myomectomies non hysté roscopiques).…”