European Radiology

, Volume 25, Issue 12, pp 3455–3458 | Cite as

Scaled signal intensity of uterine fibroids based on T2-weighted MR images: a potential objective method to determine the suitability for magnetic resonance-guided focused ultrasound surgery of uterine fibroids

  • Hyun Park
  • Sang-Wook YoonEmail author
  • Amit Sokolov



Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a non-invasive method to treat uterine fibroids. To help determine the patient suitability for MRgFUS, we propose a new objective measure: the scaled signal intensity (SSI) of uterine fibroids in T2 weighted MR images (T2WI).


Forty three uterine fibroids in 40 premenopausal women were included in this retrospective study. SSI of each fibroid was measured from the screening T2WI by standardizing its mean signal intensity to a 0–100 scale, using reference intensities of rectus abdominis muscle (0) and subcutaneous fat (100). Correlation between the SSI and the non-perfused volume (NPV) ratio (a measure for treatment success) was calculated.


Pre-treatment SSI showed a significant inverse-correlation with post treatment NPV ratio (p < 0.05). When dichotomizing NPV ratio at 45 %, the optimal cut off value of the SSI was found to be 16.0.


A fibroid with SSI value 16.0 or less can be expected to have optimal responses. The SSI of uterine fibroids in T2WI can be suggested as an objective parameter to help in patient selection for MRgFUS.

Key Points

• Signal intensity of fibroid in MR images predicts treatment response to MRgFUS.

• Signal intensity is standardized into scaled form using adjacent tissues as references.

• Fibroids with SSI less than 16.0 are expected to have optimal responses.


Uterine fibroid Magnetic resonance imaging Scaled signal intensity Focused ultrasound Ablation 



The authors thank Cha Bok Chung and Eun Joo Baek for their help in managing the patients during MRgFUS treatment. We also thank Suk Hee Kim and Seon Ha Yun for their help in preparing the manuscript.

The scientific guarantor of this publication is Professor Sang-Wook Yoon. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. 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 waived by the Institutional Review Board. Methodology: retrospective, observational study, performed at one institution.


  1. 1.
    McDannold N, Tempany CM, Fennessy FM et al (2006) Uterine leiomyomas: MR imaging-based thermometry and thermal dosimetry during focused ultrasound thermal ablation. Radiology 240:263–272PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    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 110:279–287CrossRefPubMedGoogle Scholar
  3. 3.
    LeBlang SD, Hoctor K, Steinberg FL (2010) Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 194:274–280CrossRefPubMedGoogle Scholar
  4. 4.
    Yoon SW, Kim KA, Whang YY, Lee C, Cha SH, Lee SY et al (2008) Magnetic resonance imaging-guided focused ultrasound surgery for uterine fibroids: Initial experience in Korea. Korean J Obstet and Gynecol 51:5Google Scholar
  5. 5.
    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 Obstetrics Gynecol 196:184 e1-6CrossRefGoogle Scholar
  6. 6.
    Lenard ZM, McDannold NJ, Fennessy FM et al (2008) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–imaging predictors of success. Radiology 249:187–194PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    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 27:3425–3431CrossRefPubMedGoogle Scholar
  8. 8.
    Yoon SW, Lee C, Cha SH et al (2008) Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI. Eur Radiol 18:2997–3006CrossRefPubMedGoogle Scholar
  9. 9.
    Fennessy FM, Tempany CM, McDannold NJ et al (2007) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–results of different treatment protocols. Radiology 243:885–893CrossRefPubMedGoogle Scholar
  10. 10.
    Oguchi O, Mori A, Kobayashi Y, Horiuchi A, Nikaido T, Fujii S (1995) Prediction of histopathologic features and proliferative activity of uterine leiomyoma by magnetic resonance imaging prior to GnRH analogue therapy: correlation between T2-weighted images and effect of GnRH analogue. J Obstet Gynaecol 21:107–117CrossRefGoogle Scholar
  11. 11.
    Cura M, Cura A, Bugnone A (2006) Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol 47:1105–1114CrossRefPubMedGoogle Scholar
  12. 12.
    Swe TT, Onitsuka H, Kawamoto K, Ueyama T, Tsuruchi N, Masuda K (1992) Uterine leiomyoma: correlation between signal intensity on magnetic resonance imaging and pathologic characteristics. Radiat Med 10:235–242PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  1. 1.Comprehensive Gynecologic Cancer Center, CHA Bundang Medical CenterCHA UniversityGyunggi-doRepublic of Korea
  2. 2.Department of Diagnostic Radiology, CHA Bundang Medical CenterCHA UniversitySungnam-siRepublic of Korea
  3. 3.InSightec Ltd.HaifaIsrael

Personalised recommendations