Techniques to Expand Patient Selection for MRI-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

Kim, Youngsun; Bae, Duk-Soo; Park, Min Jung; Viitala, Antti; Keserci, Bilgin; Rhim, Hyunchul; Lim, Hyo Keun

doi:10.2214/ajr.13.10753

Cited by 28 publications

(31 citation statements)

References 40 publications

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“…Uterine fibroid patients with transverse scars might be managed by angling the transducer to increase the protected area; the beam-shaping feature, which reduces the intensity of the ultrasound field in the selected region by shutting off some sonication elements; the urinary bladder-filling technique to avoid the scar; or a combination of these approaches (8,10,23,35,36). However, longitudinal scars are more problematic because they are usually at the midline where the ultrasonic energy has to penetrate other intermediate tissue layers.…”

Section: Technical Limitations Presence Of Scar Tissuementioning

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: Technical Limitations Presence Of Scar Tissuementioning

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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“…Even though there might be partial improvement of such resistive properties by the use of gonadotropin-releasing hormone agonist, 6,7 it is not currently possible to satisfactorily correct those resistive or attenuating factors; therefore, fibroids with such "negativity" that cannot be corrected should be excluded from the treatment. This strategy may prevent wasteful procedures from occurring and thus make more fibroid patients benefit from this therapeutic modality and, eventually, curtail medical expenses.…”

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confidence: 99%

Screening Magnetic Resonance Imaging–Based Prediction Model for Assessing Immediate Therapeutic Response to Magnetic Resonance Imaging–Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

Kim

Lim

Park

et al. 2016

Investigative Radiology

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“…The passage of the focused ultrasound beam through bowel in the treatment of uterine fibroids is contraindicated due to concerns regarding this organ's absorption of energy. Various methods have been used to move loops of bowel from the beam path including filling the bladder with normal saline, or by rectal filling using either a rectal balloon filled with normal saline or inserting rectal ultrasound gel [61]. One group has described applying pressure to the central abdominal wall in order to displace bowel via the use of a convex gel pad [62].…”

Section: High Intensity Focused Ultrasound Treatment Of Uterine Fibroidsmentioning

confidence: 99%

Thermal ablative treatment of uterine fibroids

Quinn

Gedroyc

2015

International Journal of Hyperthermia

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In addition to surgical methods of treating uterine fibroids, numerous non-invasive treatments have been developed. Many of these involve the use of hyperthermia, the heating of tissue by a variety of methods. These include the use of lasers, radiofrequency, microwave energy and high intensity focused ultrasound, guided by both ultrasound and magnetic resonance imaging. In this review we examine the technology behind these treatment modalities and review the current evidence for their use.

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Techniques to Expand Patient Selection for MRI-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

Abstract: In this article, we discuss techniques that contribute to widening patient selection for MRI-guided HIFU therapy of uterine fibroids.

Cited by 28 publications

References 40 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

Screening Magnetic Resonance Imaging–Based Prediction Model for Assessing Immediate Therapeutic Response to Magnetic Resonance Imaging–Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

Thermal ablative treatment of uterine fibroids

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