Subjective effect of magnetic resonance‐guided focused ultrasound surgery for uterine fibroids

Funaki, Kaoru; Sawada, Katsuhiro; Maeda, Fumio; Nagai, Syuji

doi:10.1111/j.1447-0756.2007.00665.x

Cited by 56 publications

(39 citation statements)

References 16 publications

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“…However, type 3 (high T2 SI) fibroids are characterized by a significantly lower NPV ratio, 16 a higher necessary level of mean acoustic power, 23 and a higher reintervention rate. 29,30 In our patient cohort, we observed a markedly increased mean NPV ratio compared with previously reported results, 11,20,25,29 with a high safety profile. Baseline characteristics that had been considered as limiting factors of MRgFUS treatments, such as large number of fibroids, fibroids with high T2w SI or heterogeneous fibroids, as well as bowels lying in the ultrasound beam pathway, had no statistically significant impact on the NPV results achieved.…”

Section: Discussionsupporting

confidence: 64%

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

Trumm¹,

Stahl²,

Clevert³

et al. 2013

Investigative Radiology

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Objectives: The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)Yguided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. Materials and Methods: This is a retrospective analysis of 115 women (mean age, 42 years; range, 27Y54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean T SD total volume and number of treated fibroids (per patient) were 89 T 94 cm 3 and 2.2 T 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Results: Magnetic resonance imagingYguided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% T 15% (range, 38%-100%). Mean applied energy level was 5400 T 1200 J, and mean number of sonications was 74 T 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. Conclusions: With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

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Section: Discussionsupporting

confidence: 64%

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

Trumm¹,

Stahl²,

Clevert³

et al. 2013

Investigative Radiology

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“…High signal intensity within a fibroid relative to the uterine wall on T2W imaging may indicate a hypervascular fibroid [16,17]. Such fibroids can be further evaluated with contrast-enhanced imaging to determine if the high signal intensity is due to increased vascularity or other causes.…”

Section: Fibroid Vascularitymentioning

confidence: 96%

Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI

et al. 2008

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Uterine leiomyomas (fibroids), the most common benign tumor in women of childbearing age, can cause symptoms including dysmenorrhea, menorrhagia, urinary symptoms, pain and infertility. Hysterectomy is a common approach to treating uterine fibroids, and less invasive surgical approaches such as myomectomy and uterine artery embolization also have been shown to alleviate symptoms. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is the only totally non-invasive surgical approved method for treating uterine fibroids. In clinical trials, MRgFUS resulted in significant relief of uterine fibroid symptoms. The safe and effective use of MRgFUS is affected by fibroid type and location, position relative to adjacent anatomical structures and the presence of co-existent pelvic disease. Additionally, successful outcomes with MRgFUS have been correlated with the volume of fibroids ablated during the procedure. Thus, selection of patients in whom sufficient fibroid volumes can be treated safely using the MRgFUS system is critical for successful outcomes. The MR images in this pictorial essay provide examples of uterine fibroids for which MRgFUS should be considered and is designed to facilitate the selection of patients for whom MRgFUS is most likely to provide sustained symptom relief.

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“…In addition, it has been found that the response to each individual sonication is greater posttreatment with GnRHa, with a 50 % larger area of targeted tissue destruction per unit of energy applied [21]. We therefore also consider pretreatment of patients with highly cellular fibroids (hyperintense SI on T2 WI) with a GnRHa, as it has been reported that MRgFUS of T2 hyperintense fibroids results in lower non-perfused volumes compared to iso-or hypointense fibroids [22]. GnRHa's potentiate the thermal effects of MRgFUS [23], and may have an important role in treating fibroids which otherwise have been found to respond poorly to MRgFUS [24].…”

Section: Patient Selection For Treatmentmentioning

confidence: 99%

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

Fennessy

Tempany

2013

Curr Radiol Rep

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Magnetic resonance-guided high focused ultrasound surgery (MRgFUS) is a non-invasive treatment option for uterine fibroids. In addition to offering excellent anatomical depiction of the uterine fibroids and uterus, magnetic resonance imaging offers functional imaging and thermal guidance for safe delivery of the focused ultrasound beam. Once appropriately selected for treatment, this out patient treatment option is well tolerated by patients and results in sustained symptom relief. More recent advances in this technology allows for quicker treatment times, allowing for greater nonperfused volumes to be attainable within the allotted scanner time. Also, upon review of fibroid and patient characteristics, the optimal candidates for successful MRgFUS are becoming more established.

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Subjective effect of magnetic resonance‐guided focused ultrasound surgery for uterine fibroids

Abstract: MRgFUS is an effective and safe method for treating symptomatic uterine fibroids, especially for type 1 and type 2 fibroids. Type 3 fibroids, however, are difficult to treat using the current MRgFUS system.

Cited by 56 publications

References 16 publications

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

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

Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

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