Preview

Journal of radiology and nuclear medicine

Advanced search

EVALUATION OF FACTORS AFFECTING THE LONG-TERM RESULTS OF MAGNETIC RESONANCE IMAGING GUIDED FOCUSED ULTRASOUND ABLATION OF UTERINE FIBROIDS

https://doi.org/10.20862/0042-4676-2017-98-2-86-91

Abstract

Objective: to analyze the results of focused ultrasound ablation (MRgFUS) of uterine fibroids and to evaluate the factors affecting the long-term results of treatment.

Material and methods. Retrospective analysis of 67 FUS ablations (67 women, 94 fibroids) was performed. The observation period after FUS was up to 36 months. Characteristics of fibroids (standardized signal intensity (SSI) and signal heterogeneity in T2-WI, maximum diameter, volume, nonperfused volume (NPV), coefficients of volume and NPV dynamics (CDV, CDNPV), MR-type) were assessed by MRI. Standardization of the fibroid signal intensity was performed by using the signal intensity from iliac muscle. CDV, CDNPV were calculated as the ratio of fibroids volume and NPV at the time of control MRI to their initial values.

Results. Post treatment NPV ratio was 57.1 ± 22.5%. The maximal significant reduction of fibroids volume and NPV was detected by 12 months after FUS (52.1% and 85.8%). CDV and CDNPV showed significant (p<0.05) correlation with post treatment NPV ratio (r=-0.5 and r=0.37), fibroids volume (r=0.28 and r=0.49) and maximum diameter (r=0.26 and r=0.49). Fibroids with NPV ≥50% and volume <150 cm3 were characterized by the highest rate of volume reduction. Fibroids with NPV≥75% and volume >100 cm3 were characterized by the lowest rate of NPV reduction. The maximal reduction of volume during the observation period was detected in fibroids with NPV≥75% and volume <100 cm3, the minimal – in fibroids with NPV<25% and volume >150 cm3.

Conclusion. The dynamics of fibroids volume and NPV after MRgFUS depends on initial values of these characteristics. 

About the Authors

E. S. Zagvozdkin
Federal Center of Treatment and Rehabilitation, Ministry of Health of the RF
Russian Federation

Radiologist,

Ivan’kovskoe shosse, 3, Moscow, 125367



V. E. Sinitsyn
Federal Center of Treatment and Rehabilitation, Ministry of Health of the RF
Russian Federation

MD, PhD, DSc, Professor, Head of Diagnostic Radiology Center of FCTR,

Ivan’kovskoe shosse, 3, Moscow, 125367



E. A. Mershina
Federal Center of Treatment and Rehabilitation, Ministry of Health of the RF
Russian Federation

MD, PhD, Head of Radiology Department of FCTR,

Ivan’kovskoe shosse, 3, Moscow, 125367



References

1. Clark N.A., Mumford S.L., Segars J.H. Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr. Opin. Obstet. Gynecol. 2014; 26 (3): 151–61.

2. Gizzo S., Saccardi C., Patrelli T.S., Ancona E., Noventa M., Fagherazzi S. et al. Magnetic resonanceguided focused ultrasound myomectomy: safety, efficacy, subsequent fertility and quality-of-life improvements, a systematic review. Reprod. Sci. Thousand Oaks Calif. 2014; 21 (4): 465–76.

3. Chapman A., ter Haar G. Thermal ablation of uterine fibroids using MR-guided focused ultrasound – a truly non-invasive treatment modality. Eur. Radiol. 2007; 17(10): 2505–11.

4. Лядов К.В., Сидорова И.С., Курашвили Ю.Б., Степанов А.В. Дистанционная неинвазивная аблация тканей фокусированным ультразвуком под контролем магнитно-резонансной томографии в лечении миомы матки (руководство для врачей). М.: Лечебно-реабиалитационный центр Росздрава; 2008. [Lyadov K.V., Sidorova I.S., Kurashvili Yu.B., Stepanov A.V. Remote non-invasive focused ultrasound ablation under magnetic resonance imaging guidance in the treatment of uterine fibroids (a guide for physicians). Moscow: Federal Center of Treatment and Rehabilitation; 2008 (in Russ.).]

5. Hesley G.K., Gorny K.R., Woodrum D.A. MR-guided focused ultrasound for the treatment of uterine fibroids. Cardiovasc. Interv. Radiol. 2013; 36 (1): 5–13.

6. Stewart E.A., Rabinovici J., Tempany C.M., Inbar Y., Regan L., Gostout B. et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil. Steril. 2006; 85 (1): 22–9.

7. Stewart E.A., Gostout B., Rabinovici J., Kim H.S., Regan L., Tempany C.M. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet. Gynecol. 2007; 110 (2): 279–87.

8. Funaki K., Sawada K., Maeda F., Nagai S. Subjective effect of magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J. Obstet. Gynecol. Res. 2007; 33 (6): 834–9.

9. Funaki K., Fukunishi H., Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet. Gynecol. 2009; 34 (5): 584–9.

10. Fennessy F.M., Tempany C.M., McDannold N.J., So M.J., Hesley G., Gostout B. et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery – results of different treatment protocols. Radiology. 2007; 243 (3): 885–93.

11. Morita Y., Ito N., Hikida H., Takeuchi S., Nakamura K., Ohashi H. Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids – early experience. Eur. J. Obstet. Gynecol. Reprod. Biol. 2008; 139 (2): 199–203.

12. Лазуткина В.Ю., Чунаева Е.А., Азнауров В.Г., Синицын В.Е., Мершина Е.А. Отдаленные результаты лечения «темных» миом матки методом ФУЗ-аблации. Лучевая диагностика. 2013; 2: 28–31. [Lazutkina V.Yu., Chunaeva E.A., Aznaurov V.G., Sinitsyn V.E., Mershina E.A. Long-term results of the "dark" uterine fibroids treatment by FUS ablation. Luchevaya Diagnostika (Diagnostic Radiology, Russian journal). 2013; 2: 28–31 (in Russ.).]

13. LeBlang S.D., Hoctor K., Steinberg F.L. Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. Am. J. Roentgenol. 2010; 194 (1): 274–80.

14. Gorny K.R., Woodrum D.A., Brown D.L., Henrichsen T.L., Weaver A.L., Amrami K.K. et al. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J. Vasc. Interv. Radiol. 2011; 22 (6): 857–64.

15. Kim H.S., Baik J.H., Pham L.D., Jacobs M.A. MR-guided highintensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad. Radiol. 2011; 18 (8): 970–6.

16. Voogt M.J., van Stralen M., Ikink M.E., Deckers R., Vincken K.L., Bartels W.P. et al. Targeted vessel ablation for more efficient magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids. Cardiovasc. Intervent. Radiol. 2012; 35 (5): 1205–10.

17. Trumm C.G., Stahl R., Clevert D.A., Herzog P., Mindjuk I., Kornprobst S. et al. Magnetic resonance imagingguided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest. Radiol. 2013; 48 (6): 359–65.

18. Stewart E.A. Clinical practice. Uterine fibroids. N. Engl. J. Med. 2015; 372 (17): 1646–55.

19. Gorny K.R., Borah B.J., Brown D.L., Woodrum D.A., Stewart E.A., Hesley G.K. Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: review of 138 patients with an average follow-up of 2.8 years. J. Vasc. Interv. Radiol. 2014; 25 (10): 1506–12.

20. Саламадина Г.Е. Органосберегающее лечение миомы матки с использованием сфокусированного ультразвука. АГ-инфо. 2012; 2: 28–34. [Salamadina G.E. The organpreserving treatment of uterine fibroids by focused ultrasound. AG-info (Journal for Obstetricians and Gynecologists, Russian journal). 2012; 2: 28–34 (in Russ.).]


Review

For citations:


Zagvozdkin E.S., Sinitsyn V.E., Mershina E.A. EVALUATION OF FACTORS AFFECTING THE LONG-TERM RESULTS OF MAGNETIC RESONANCE IMAGING GUIDED FOCUSED ULTRASOUND ABLATION OF UTERINE FIBROIDS. Journal of radiology and nuclear medicine. 2017;98(2):86-91. (In Russ.) https://doi.org/10.20862/0042-4676-2017-98-2-86-91

Views: 9831


ISSN 0042-4676 (Print)
ISSN 2619-0478 (Online)