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

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Abstract

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 ± 6.9 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 < 0.001). 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 ± 8 months; range, 3–38). 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

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Abbreviations

NPV:

Nonperfused volume

UAE:

Uterine artery embolization

SSS:

Symptom severity score

References

  1. Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36:433–445

    PubMed  Google Scholar 

  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 188:100–107

    Article  PubMed  Google Scholar 

  3. Khan AT, Shehmar M, Gupta JK (2014) Uterine fibroids: current perspectives. Int J Womens Health 6:95–114

    Article  PubMed Central  PubMed  Google Scholar 

  4. Jun F, Yamin L, Xinli X et al (2012) Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature. Arch Gynecol Obstet 285:1407–1413

    Article  PubMed  Google Scholar 

  5. van der 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:e311–e318

    Google Scholar 

  6. Edwards RD, Moss JG, Lumsden MA et al (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:360–370

    Article  CAS  PubMed  Google Scholar 

  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 35:530–536

    Article  PubMed  Google Scholar 

  8. Pron G, Mocarski E, Bennett J et al (2003) Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario uterine fibroid embolization trial. J Vasc Interv Radiol 14:1243–1250

    Article  PubMed  Google Scholar 

  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 24:131–139

    Article  PubMed  Google Scholar 

  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 110:279–287

    Article  PubMed  Google Scholar 

  11. Hindley J, Gedroyc WM, Regan L et al (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 183:1713–1719

    Article  PubMed  Google Scholar 

  12. Fennessy FM, Tempany CM, McDannold NJ et al (2007) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–results of different treatment protocols. Radiology 243:885–893

    Article  PubMed  Google Scholar 

  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 146:92–95

    Article  PubMed  Google Scholar 

  14. LeBlang SD, Hoctor K, Steinberg FL (2010) Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 194:274–280

    Article  PubMed  Google Scholar 

  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 34:579–583

    Article  CAS  PubMed  Google Scholar 

  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 success. Hum Reprod 27:3425–3431

    Article  CAS  PubMed  Google Scholar 

  17. Lenard ZM, McDannold NJ, Fennessy FM et al (2008) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–imaging predictors of success. Radiology 249:187–194

    Article  PubMed Central  PubMed  Google Scholar 

  18. Trumm CG, Stahl R, Clevert DA et al (2013) Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest Radiol. doi:10.1097/RLI.0b013e3182806904

    PubMed  Google Scholar 

  19. Kim YS, Bae DS, Park MJ et al (2014) Techniques to expand patient selection for MRI-guided high-intensity focused ultrasound ablation of uterine fibroids. AJR Am J Roentgenol 202:443–451

    Article  PubMed  Google Scholar 

  20. Funaki K, Fukunishi H, Funaki T, Sawada K, Kaji Y, Maruo T (2007) Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol 196:e181–e186

    Article  Google Scholar 

  21. Zaher S, Gedroyc WM, Regan L (2009) Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids. Eur J Obstet Gynecol Reprod Biol 143:98–102

    Article  PubMed  Google Scholar 

  22. Rabinovici J, David M, Fukunishi H et al (2010) Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 93:199–209

    Article  PubMed  Google Scholar 

  23. Yoon SW, Lee C, Kim KA, Kim SH (2010) Contrast-enhanced dynamic MR Imaging of uterine fibroids as a potential predictor of patient eligibility for MR guided focused ultrasound (MRgFUS) treatment for symptomatic uterine fibroids. Obstet Gynecol Int 2010

  24. Stewart EA, Rabinovici J, Tempany CM et al (2006) Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85:22–29

    Article  PubMed  Google Scholar 

  25. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300

    Article  PubMed  Google Scholar 

  26. Pelage JP, Guaou NG, Jha RC, Ascher SM, Spies JB (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230:803–809

    Article  PubMed  Google Scholar 

  27. Administration USFaD (01.10.2014) Safety. http://www.fda.gov/safety/medwatch/howtoreport/ucm053087.htm

  28. Kim HS, Baik JH, Pham LD, Jacobs MA (2011) MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol 18:970–976

    Article  PubMed Central  PubMed  Google Scholar 

  29. Trumm CG, Matzko M (2010) MR-guided focused ultrasound surgery of uterine fibroids: initial clinical experience of a single European center. In: Abstracts of the 2010 European Congress of Radiology (ECR). European Society of Radiology, Vienna, p S249

  30. Toor SS, Jaberi A, Macdonald DB, McInnes MD, Schweitzer ME, Rasuli P (2012) Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas: a systematic review and meta-analysis. AJR Am J Roentgenol 199:1153–1163

    Article  PubMed  Google Scholar 

  31. Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC (2005) Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol 106:933–939

    Article  PubMed  Google Scholar 

  32. Nezhat FR, Roemisch M, Nezhat CH, Seidman DS, Nezhat CR (1998) Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 5:237–240

    Article  CAS  PubMed  Google Scholar 

  33. Hanafi M (2005) Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 105:877–881

    Article  PubMed  Google Scholar 

  34. Froeling V, Meckelburg K, Schreiter NF et al (2013) Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: long-term results. Eur J Radiol 82:2265–2269

    Article  CAS  PubMed  Google Scholar 

  35. Funaki K, Fukunishi H, Sawada K (2009) Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 34:584–589

    Article  CAS  PubMed  Google Scholar 

  36. Radeleff B, Eiers M, Bellemann N et al (2010) Expulsion of dominant submucosal fibroids after uterine artery embolization. Eur J Radiol 75:e57–e63

    Article  PubMed  Google Scholar 

  37. Redecha M Jr, Holoman K, Javorka V et al (2009) Myoma expulsion after uterine artery embolization. Arch Gynecol Obstet 280:1023–1024

    Article  PubMed  Google Scholar 

  38. Hehenkamp WJ, Volkers NA, Van Swijndregt AD, De Blok S, Reekers JA, Ankum WM (2004) Myoma expulsion after uterine artery embolization: complication or cure? Am J Obstet Gynecol 191:1713–1715

    Article  PubMed  Google Scholar 

  39. Kim KA, Yoon SW, Yoon BS, Park CT, Kim SH, Lee JT (2011) Spontaneous vaginal expulsion of uterine myoma after magnetic resonance-guided focused ultrasound surgery. J Minim Invasive Gynecol 18:131–134

    Article  PubMed  Google Scholar 

  40. Wamsteker K, Emanuel MH, de Kruif JH (1993) Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 82:736–740

    CAS  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is M.D. Matthias Matzko. The authors of this manuscript declare relationships with the following companies: M.D. Matthias Matzko was an invited speaker at scientific presentations at GE and Insightec. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Investigative Radiology by Trumm et al. 2013. Methodology: retrospective, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Helios-Amper Klinikum Dachau, Dachau, Helios-Amper Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany

    Irene Mindjuk, Peter Herzog & Matthias Matzko

  2. Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, München, Marchioninistr. 15, 81377, München, Germany

    Christoph G. Trumm & Robert Stahl

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  1. Irene Mindjuk
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  2. Christoph G. Trumm
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Correspondence to Irene Mindjuk.

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Mindjuk, I., Trumm, C.G., Herzog, P. et al. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur Radiol 25, 1317–1328 (2015). https://doi.org/10.1007/s00330-014-3538-6

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  • DOI: https://doi.org/10.1007/s00330-014-3538-6

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