What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers

Bitton, Rachel; Fast, Angela M.; Vu, Kim‐Nhien; Lum, Deirdre; Chen, Bertha; Hesley, Gina K.; Raman, Steven S.; Matsumoto, Alan H.; Price, Thomas M.; Tempany, Clare M.; Dhawan, Neha; Dolen, Eric G.; Kohi, Maureen P.; Fennessey, Fiona M; Ghanouni, Pejman

doi:10.1007/s00330-023-09984-4

Cited by 12 publications

(3 citation statements)

References 38 publications

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“…Park et al ( 27 ) reported that an immediate NPVR of at least 80% was safe in USgHIFU ablation of uterine fibroids, which could achieve a greater tumor volume shrinkage compared with lower NPVR. While Mindjuk et al ( 28 ) found that the NPVR results of more than 80% were correlated with higher clinical success rates, Bitton et al ( 29 ) considered >80% of the NPVR as the image biomarker for the largest improvement in symptoms after HIFU treatment. Therefore, the NPVR 80% was chosen as the criterion for separating l_NPVR from h_NPVR in our study ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…The T2 signal was related to the variation of cell density, collagen fiber content, blood supply types and water content of the tumors ( 31 , 39 ), however its intensity could not accurately reflect the complex texture of uterine fibroids. A single qualitative classification based on T2 signal intensity could not accurately evaluate the heterogeneous conditions, although it is still considered as primary imaging biomarker to predict the efficacy of HIFU ablation in treatment of uterine fibroids ( 29 ). The key issue should be addressed to precisely select the patients suitable to HIFU ablation of the uterine fibroids before treatment for clinically curative response.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a radiomics model based on T2-weighted imaging for predicting the efficacy of high intensity focused ultrasound ablation in uterine fibroids

Cheng,

Yang,

Wang

et al. 2024

Quant Imaging Med Surg

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Background The heterogeneity of uterine fibroids in magnetic resonance imaging (MRI) is complex for a subjective visual evaluation, therefore it is difficult for an accurate prediction of the efficacy of high intensity focused ultrasound (HIFU) ablation in fibroids before the treatment. The purpose of this study was to set up a radiomics model based on MRI T2-weighted imaging (T2WI) for predicting the efficacy of HIFU ablation in uterine fibroids, and it would be used in preoperative screening of the fibroids for achieving high non-perfused volume ratio (NPVR). Methods A total of 178 patients with uterine fibroids were consecutively enrolled and treated with ultrasound-guided HIFU under conscious sedation between February 2017 and December 2021. Among them, 96 patients with 108 uterine fibroids with high ablation efficacy (NPVR ≥80%, h_NPVR) and 82 patients with 92 fibroids with lower ablation efficacy (NPVR <80%, l_NPVR) were retrospectively analyzed. The transverse T2WI images of fibroids were selected, and the fibroids were delineated slice by slice using ITK-SNAP software. The radiomics analysis was performed to find the imaging biomarker for the construction of a predicting model for the evaluation of the ablation efficacy, including the feature extraction, feature selection and model construction. The prediction model was built by logistic regression and assessed by receiver operating characteristic (ROC) curve, and the prediction efficiency of the two models was compared by Delong test. The ratio of the training set to the testing set was 8:2. Results The logistic regression model showed that the mean area under the curve (AUC) of the training set was 0.817 [95% confidence interval (CI): 0.755–0.882], and the testing set was 0.805 (95% CI: 0.670–0.941), respectively, which indicated a strong classification ability. The Delong test showed that there was no significant difference in the area under the ROC curve between the training set and testing set (P>0.05). Conclusions The radiomics model based on T2WI is feasible and effective for predicting the efficacy of HIFU ablation in treatment of uterine fibroids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development and validation of a radiomics model based on T2-weighted imaging for predicting the efficacy of high intensity focused ultrasound ablation in uterine fibroids

Cheng,

Yang,

Wang

et al. 2024

Quant Imaging Med Surg

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“…Prompt evaluation of the ablation rate during MRgFUS is vital; it facilitates early identification of under-ablated areas and informs decisions for supplementary treatments to optimize outcomes. A higher ablation ratio—calculated as the ratio of abated volume to total fibroid volume—is linked to enduring clinical benefits 4 , 5 . The most common approach for ablated tissue detection post-ablation employs T1-weighted MR imaging with gadolinium-based contrast agents 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted imaging as a potential non-gadolinium alternative for immediate assessing the hyperacute outcome of MRgFUS ablation for uterine fibroids

Huang,

Zhou,

et al. 2024

Sci Rep

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The aim of this study was to investigate the value of diffusion-weighted imaging (DWI) as a potential non-gadolinium alternative for promptly assessing the hyperacute outcome of magnetic resonance-guided focused ultrasound (MRgFUS) treatment for uterine fibroids. In this retrospective study we included 65 uterine fibroids from 44 women, who underwent axial DWI (b-value: 800 s/mm2) and contrast-enhanced (CE) MR within 15 min post-ablation. Two blinded observers independently reviewed the DWI findings of ablated necrotic lesions and measured their volumes on DWI and CE images. The post-ablation DWI images revealed clear depiction of ablative necrotic lesions in all fibroids, which were classified into two types: the bull’s eye sign (type 1) and the bright patch sign (type 2). The inter-observer intraclass correlation coefficient for classifying DWI signal types was 0.804 (p < 0.001). Volumetric analysis of ablated necrosis using DWI and CE T1-weighted imaging showed no significant variance, nor did the non-perfused volume ratios (all p > 0.05). Bland–Altman analysis revealed a mean difference of 2.38% and 1.71% in non-perfused volume ratios between DWI and CE, with 95% limits of agreement from − 19.06 to 23.82% and − 18.40 to 21.82%, respectively. The findings of this study support the potential of DWI as a viable non-gadolinium alternative for evaluating the hyperacute outcomes of MRgFUS ablation in uterine fibroids.

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Experimental Evaluation of an Ultrasound‐Guided High‐Intensity‐Focused Ultrasound Probe for Sonication of Artery

Huang,

Zhou,

Pan

et al. 2024

J of Ultrasound Medicine

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ObjectivesThis study aimed to develop an ultrasound‐guided high‐intensity‐focused ultrasound (USgHIFU) probe for arterial sonication and to evaluate vascular contraction.MethodsThe USgHIFU probe comprised two confocal spherical transducers for sonication and a US color Doppler flow imaging probe for guidance. A vessel‐mimicking phantom was sonicated in two directions. In the vascular radial direction, an isolated rabbit aorta embedded in ex vivo pork liver was sonicated at different acoustic powers (245 and 519 W), flow rates (25, 30, and 50 mL/minute), and sonication energies (519, 980, and 1038 J). Changes in the postsonication vessels were evaluated using US imaging, microscopic observation, and histopathological analysis.ResultsBeam focusing along the vascular radial direction caused significant deformation of both tube walls (n = 4), whereas focusing along the axial direction only affected the contraction of the anterior wall (n = 4). The contraction index (Dc) of the vessel sonicated at 245 W and 980 J was 56.2 ± 9.7% (n = 12) with 25 mL/minute. The Dc of the vessel sonicated at 519 W and 1038 J was 56.5 ± 7.8% (n = 17). The Dc of the vessel sonicated at 519 J total energy was 18.3 ± 5.1% (n = 12).ConclusionThe developed USgHIFU probe induced greater vascular contractions by covering a larger area of the vessel wall in the radial direction. Sonication energy affects vascular contraction through temperature elevation of the vessel wall. When the acoustic power was high, an increase in acoustic power, even with comparable sonication energy, did not result in greater vessel contraction.

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What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers

Cited by 12 publications

References 38 publications

Development and validation of a radiomics model based on T2-weighted imaging for predicting the efficacy of high intensity focused ultrasound ablation in uterine fibroids

Development and validation of a radiomics model based on T2-weighted imaging for predicting the efficacy of high intensity focused ultrasound ablation in uterine fibroids

Diffusion-weighted imaging as a potential non-gadolinium alternative for immediate assessing the hyperacute outcome of MRgFUS ablation for uterine fibroids

Experimental Evaluation of an Ultrasound‐Guided High‐Intensity‐Focused Ultrasound Probe for Sonication of Artery

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