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

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• 作者：Irene Mindjuk ; Christoph G. Trumm ; Peter Herzog ; Robert Stahl…
• 关键词：High ; intensity focused ultrasound ablation ; Leiomyoma ; Ablation ; MRI ; MR guided interventional procedures
• 刊名：European Radiology
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：25
• 期：5
• 页码：1317-1328
• 全文大小：2,542 KB
• 参考文献：1. Buttram, VC, Reiter, RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36: pp. 433-445
  2. Baird, DD, Dunson, DB, Hill, MC, Cousins, D, Schectman, JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188: pp. 100-107 CrossRef
  3. Khan, AT, Shehmar, M, Gupta, JK (2014) Uterine fibroids: current perspectives. Int J Womens Health 6: pp. 95-114 CrossRef
  4. Jun, F, Yamin, L, Xinli, X (2012) Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature. Arch Gynecol Obstet 285: pp. 1407-1413 CrossRef
  5. Kooij, SM, Bipat, S, Hehenkamp, WJ, Ankum, WM, Reekers, JA (2011) Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol 205: pp. e311-e318
  6. Edwards, RD, Moss, JG, Lumsden, MA (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356: pp. 360-370 CrossRef
  7. Manyonda, IT, Bratby, M, Horst, JS, Banu, N, Gorti, M, Belli, AM (2012) Uterine artery embolization versus myomectomy: impact on quality of life–results of the FUME (fibroids of the uterus: myomectomy versus embolization) trial. Cardiovasc Intervent Radiol 35: pp. 530-536 CrossRef
  8. Pron, G, Mocarski, E, Bennett, J (2003) Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario uterine fibroid embolization trial. J Vasc Interv Radiol 14: pp. 1243-1250 CrossRef
  9. Hesley, GK, Gorny, KR, Henrichsen, TL, Woodrum, DA, Brown, DL (2008) A clinical review of focused ultrasound ablation with magnetic resonance guidance: an option for treating uterine fibroids. Ultrasound Q 24: pp. 131-139 CrossRef
  10. Stewart, EA, Gostout, B, Rabinovici, J, Kim, HS, Regan, L, Tempany, CM (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110: pp. 279-287 CrossRef
  11. Hindley, J, Gedroyc, WM, Regan, L (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 183: pp. 1713-1719 CrossRef
  12. Fennessy, FM, Tempany, CM, McDannold, NJ (2007) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–results of different treatment protocols. Radiology 243: pp. 885-893 CrossRef
  13. Morita, Y, Takeuchi, S, Hikida, H, Ohashi, H, Ito, N (2009) Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery. Eur J Obstet Gynecol Reprod Biol 146: pp. 92-95 CrossRef
  14. LeBlang, SD, Hoctor, K, Steinberg, FL (2010) Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 194: pp. 274-280 CrossRef
  15. Okada, A, Morita, Y, Fukunishi, H, Takeichi, K, Murakami, T (2009) Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: impact of the learning curve on patient outcome. Ultrasound Obstet Gynecol 34: pp. 579-583 CrossRef
  16. Machtinger, R, Inbar, Y, Cohen-Eylon, S, Admon, D, Alagem-Mizrachi, A, Rabinovici, J (2012) MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment succes
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Diagnostic Radiology
  Interventional Radiology
  Neuroradiology
  Ultrasound
  Internal Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1084

文摘

Objectives To assess the technical and clinical results of MRgFUS treatment and factors affecting clinical treatment success. Materials and methods A total of 252 women (mean age, 42.1?±-.9?years) with uterine fibroids underwent MRgFUS. All patients underwent MRI before treatment. Results were evaluated with respect to post-treatment nonperfused volume (NPV), symptom severity score (SSS), reintervention rate, pregnancy and safety data. Results NPV ratio was significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T1-weighted fat saturated MR images and in fibroids distant from the spine (>3?cm). NPV ratio was lower in fibroids with septations, with subserosal component and in skin-distant fibroids (p--.001). NPV ratio was highly correlated with clinical success: NPV of more than 80?% resulted in clinical success in more than 80?% of patients. Reintervention rate was 12.7?% (mean follow-up time, 19.4?±-?months; range, 3-8). Expulsion of fibroids (21?%) was significantly correlated with a high clinical success rate. No severe adverse events were reported. Conclusions Adequate patient selection and correct treatment techniques, based on the learning curve of this technology, combined with technical advances of the system, lead to higher clinical success rates with low complications rate, comparable to other uterine-sparing treatment options. Key Points -MRgFUS appears to be a valid alternative to other uterus-preserving therapies -Patient selection is a significant factor in achieving high NPV ratios -MRI screening parameters correlate with the amount of fibroid ablation in MRgFUS -NPV results of more than 80?% correlate with higher clinical success rates