MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre

Mindjuk, Irene; Trumm, C.; Herzog, Peter; Stahl, Robert; Matzko, M

doi:10.1007/s00330-014-3538-6

Cited by 98 publications

(76 citation statements)

References 39 publications

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“…In another study by Mindjuk et al (15), multivariate analysis revealed that although the nonperfused volume ratio of fibroids characterized by low SI in contrast-enhanced T1-weighted images was significantly high, T2 SI could not effectively predict the same. These two studies show that the T2 SI of a uterine fibroid cannot differentiate between vascularity and water from edema or degeneration (Figs.…”

Section: T1-perfusion Imagingmentioning

confidence: 99%

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Duc

Keserci

2018

Diagn Interv Radiol

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U terine fibroids, composed of smooth muscle cells and fibrous connective tissue derived from the myometrium, are common benign gynecological tumors that have a significant negative effect on the quality of life of a patient. Symptoms of uterine fibroids vary depending on their size and location, but the main symptoms are pelvic pain, menorrhagia or dysmenorrhea, increased frequency of urination, and reproductive dysfunction, including impaired fertility, pregnancy complications and loss (1, 2).The choice of treatment and its rate of success are dependent on the morphology and tissue characteristics of the uterine fibroids. Hysterectomy remains the definitive treatment for uterine fibroids, but this treatment option is unsuitable for women who wish to preserve their fertility. In the last decade, patient demands have spurred the development of a noninvasive therapeutic modality for symptomatic uterine fibroids called magnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) (3-11).The principle of HIFU treatment of uterine fibroids is that focused ultrasonic energy causes coagulative necrosis of the target. Since its first clinical use for treating symptomatic uterine fibroids, the use of HIFU has increased worldwide because of its excellent therapeutic efficacy in relieving fibroid-related symptoms, its ability to preserve the uterus, and its high level of safety (3-7). However, as shown in previous studies (8-11), MRI-guided HIFU ablation therapy cannot be used in all patients with symptomatic fibroids because of the tissue characteristics of the uterine fibroids such as the T1 and T2 MRI signal intensity (SI), and fibroid type defined by general uterine position, fibroid size, and fibroid number. In addition, technical limitations, including the presence of scar tissue, excessive abdominal subcutaneous fat, the distance between the skin and the fibroids, the distance between the sacral bone surface and the fibroids, and the bowel in the path of sonication, play a role in whether MRI-guided HIFU therapy is appropriate.In this article, we present a literature review of the influential clinical factors that might reduce the risk of an unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids. Tissue characteristics of uterine fibroids T2-weighted imagingT2 SI is the primary MRI classification parameter for determining patient suitability for MRI-guided HIFU. A patient is classified as type I when the SI of the uterine fibroid is lower than that of skeletal muscle, type II when the SI is lower than that of the myometrium but higher than that of skeletal muscle, or type III when the SI is higher than that of the myometrium (Fig. 1) (4). As shown by previous studies (4-13), uterine fibroids with different SIs on ABSTRACTMagnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) is an effective noninvasive treatment option for symptomatic uterine fibroids. However, tissue characteristics of uterine fibroids and technical limitations can limit the patie...

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Section: T1-perfusion Imagingmentioning

confidence: 99%

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Duc

Keserci

2018

Diagn Interv Radiol

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“…The aim of the operation was to remove the non-implanted part of the placenta; the deeply implanted part of the placenta was left in situ, to be absorbed slowly after the HIFU ablation. The average depth of the uterus was 10.36 AE 2.14 cm (range [8][9][10][11][12][13][14][15]. The median volume of any intraoperative blood loss was 20 ml (range 5-400); no blood transfusions were given.…”

Section: Hysteroscopic Operationmentioning

confidence: 99%

“…[9][10][11][12] Some reports on the treatment of PA by HIFU have been published recently, but the risk of haemorrhage and infection when using HIFU alone, is still high. In this study, we utilised USgHIFU combined with curettage guided by hysteroscopy to treat PA patients so that the chance of unexpected haemorrhage and infection from HIFU could be reduced.…”

Section: Introductionmentioning

confidence: 99%

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

Yin

Xue

et al. 2017

BJOG

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Objective The aim of this study was to evaluate the safety and efficacy of a combination of high-intensity focused ultrasound (HIFU) and hysteroscopic resection while treating placenta accreta (PA).Design A retrospective study.Setting A university teaching hospital in China.Methods This study included 25 patients diagnosed with PA who underwent HIFU followed by hysteroscopic resection in our hospital between January 2014 and December 2015. All patients had completed follow-up data. Treatment efficacy and safety were evaluated retrospectively.Main outcome measures Placenta accreta could be removed with hysteroscopic resection after HIFU.Results All patients received one session of HIFU ablation therapy. The median total HIFU treatment time was 18 minutes and the median exposure time was 600 seconds. During treatment, 23 lesions showed massive grey-scale changes and two lesions modest grey-scale change. Contrast-enhanced ultrasound showed signs of reduced perfusion in all lesions. During treatment, all patients tolerated the HIFU procedure well and completed the treatment. All patients complained of mild lower abdominal and sacrococcygeal pain, with a pain score ranging from 1 to 4 points. Seven patients complained of a 'hot' skin sensation. No serious complications were encountered during or after the procedure. All patients received hysteroscopic operations with a median of 2 days after HIFU treatment. The average depth of the uterus was 10.36 AE 2.14 cm. The median volume of intraoperative blood loss was 20 ml, and no blood transfusions were given. Sixteen patients underwent only one session of hysteroscopic resection and nine patients underwent a second session of hysteroscopic resection operation 11-61 days after the first operation. All patients preserved their uterus and tolerated the hysteroscopic operation well. Of the 25 patients, two had uterine perforation during the first operation. No other severe hysteroscopic complication was observed. The average hospital stay was 8.4 AE 1.6 days. After treatment the median duration of vaginal bleeding was 10 days. Twenty-one patients recovered normal menstruation 34 days after the operation. The other four patients continued breastfeeding and therefore exhibited abnormal menstruation.Conclusions HIFU treatment followed by hysteroscopic resection is safe and effective in treating patients with PA.Keywords Effectiveness, high-intensity focused ultrasound, hysteroscopy, placenta accreta, safety.Tweetable abstract For patients with placenta accreta, HIFU treatment before hysteroscopic resection could help reduce risk during the procedure of hysteroscopic resection.Please cite this paper as: Ye M, Yin Z, Xue M, Deng X. High-intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta. BJOG 2017; 124 (S3): 71-77.

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“…NPV ratio, which is highly correlated with clinical success, is significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T 1 weighted fat-saturated MR images and lower in fibroids with septations, with subserosal component and in skin-distant fibroids. 45 An adequate patient and strategy selection, combined with technical advances of the system, may lead to higher clinical success and low complication rate. This kind of experience suggests the need, in each field of MRgFUS application, of building clinical, imaging and technical selection criteria for patients' enrolment.…”

Section: Mrgfus Lessons Learned From Non-musculoskeletal Applicationsmentioning

confidence: 99%

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

Bazzocchi¹,

Napoli²,

Sacconi³

et al. 2016

BJR

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MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a "new" interventional technique and on its applications for MSK and allied sciences

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MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre

Cited by 98 publications

References 39 publications

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

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