Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Geraci, Laura; Napoli, Alessandro; Catalano, Carlo; Midiri, Massimo; Gagliardo, Cesare

doi:10.1155/2017/2520989

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…30,35 At the beginning, MRgFUS was used to treat both benign and malignant neoplasms. 24,27,49 Currently, this procedure is being used for new clinical and experimental scenarios. 3,14,15,35 In functional neurosurgery, transcranial MRgFUS (tcMRgFUS) is definitely emerging as a noninvasive, nonprosthetic, guided, and repeatable technique for treating mostly idiopathic tremor-dominant Parkinson's disease (PD), essential tremor (ET), and neuropathic pain.…”

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confidence: 99%

Preliminary experience with a transcranial magnetic resonance–guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease

Iacopino

Gagliardo²,

Giugno

et al. 2018

Neurosurgical Focus

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OBJECTIVETranscranial magnetic resonance–guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson’s disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world’s first tcMRgFUS system integrated with a 1.5-T MRI unit.METHODSThe authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure.RESULTSDuring the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects.CONCLUSIONSAlthough this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors’ knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.

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confidence: 99%

Preliminary experience with a transcranial magnetic resonance–guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease

Iacopino

Gagliardo²,

Giugno

et al. 2018

Neurosurgical Focus

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“…From an efficacy and safety perspective, there emerged the good profile of minimally invasive technologies, in terms of better symptoms control, as well as lower occurrence rate of severe adverse events, with important benefits also in terms of quality of life [ 7 , 35 ]. These advantages may result in economic benefits from both a payer’s and a societal perspective.…”

Section: Discussionmentioning

confidence: 99%

Innovative and conventional “conservative” technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment

et al. 2022

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Background To evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard “conservative” procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE). Methods A Health Technology Assessment was conducted, assuming the payer’s perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients’ clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids’ experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy). Results Literature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients’ perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients’ productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of − 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs. Conclusions Results suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.

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“…In these differentiations MRI may predict the status of contrast enhancing lesions and give results very similar to positron emission tomography with regards to differentiation between tumor recurrence and radiation necrosis [ 38 ]. However, the targeted UF non-perfused volume is not directly correlated with the amount of non-viable tumor tissue [ 39 ]. One of the possible upgrades of the treatment protocols of MRI imaging for HIFU procedure is the use of uterotonic agents that could restrict the blood flow into the lesion.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids—Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs

Łoziński¹,

Ciebiera

Łuczyńska

et al. 2021

Diagnostics

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Objective: The assessment of the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) when qualifying patients with uterine fibroids (UFs) for magnetic resonance-guided high-intensity ultrasound (MR-HIFU). Material and methods: This retrospective, single center study included 283 women who underwent DCE-MRI and were treated with MR-HIFU. The patients were divided according to non-perfused volume (NPV) as well as by the type of curve for patients with a washout curve in the DCE-MRI study and patients without a washout curve. The studied women were assessed in three groups according to the type of uterotonics administered. Group A (57 patients) received one dose of misoprostol/diclofenac transvaginally and group B (71 patients) received oxytocin intravenously prior to the MR-HIFU procedure. The remaining 155 women (group C) were treated with the traditional non-drug enhanced MR-HIFU procedure. Results: The average NPV value was higher in no washout group, and depended on the uterotonics used. Conclusions: We demonstrated a correlation between dynamic contrast enhancement curve types and the therapeutic efficacy of MR-HIFU. Our results suggest that DCE-MRI has the potential to assess treatment outcomes among patients with UFs, and patients with UFs that present with a washout curve may benefit from the use of uterotonic drugs. More studies are required to draw final conclusions.

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Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Cited by 5 publications

References 32 publications

Preliminary experience with a transcranial magnetic resonance–guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease

Preliminary experience with a transcranial magnetic resonance–guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease

Innovative and conventional “conservative” technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids—Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs

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