The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids
To comparatively evaluate the role of magnetic resonance (MR) T1 perfusion-based time–signal intensity (SI) curves of fibroid tissue and the myometrium in classification of fibroids for predicting treatment outcomes of high-intensity focused ultrasound (HIFU) treatment.
The fibroids of 74 women who underwent MR-HIFU treatment were classified into group A (time–SI curve of fibroid lower than that of the myometrium) and group B (time–SI curve of fibroid equal to or higher than that of the myometrium). Non-perfused volume (NPV) ratios immediately after treatment and fibroid volume reduction ratios and symptom severity scores (SSS) at the 6-month follow-up were retrospectively assessed.
The immediate NPV ratios in groups A and B were 95.3 ± 6.3% (n = 62) and 63.8 ± 11% (n = 12), respectively. At the 6-month follow-up, the fibroid volume reduction ratios in groups A and B were 0.52 ± 0.14 (n = 50) and 0.07 ± 0.14 (n = 11), with the corresponding improvement in mean transformed SSS being 0.86 ± 0.14 and 0.19 ± 0.3, respectively. No serious adverse effects were reported.
Our novel classification method could play an important role in classifying fibroids for predicting the immediate outcomes of HIFU treatment.
• MRI is an important modality for outcome prediction in HIFU treatment
• Patient selection is a significant factor for achieving high NPV ratio
• NPV ratio is very strongly correlated with T1 perfusion-based classification
• T1 perfusion-based classification is a strong predictor of treatment outcome
KeywordsUterine fibroids Myometrium T1 perfusion Magnetic resonance imaging High-intensity focused ultrasound Therapeutic outcome
contrast-enhanced T1 weighted
dynamic contrast-enhanced magnetic resonance imaging
high-intensity focused ultrasound
magnetic resonance-guided high-intensity focused ultrasound
magnetic resonance imaging
region of interest
symptom severity score
T2-weighted turbo spin-echo
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Nguyen Minh Duc, Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
Conflict of interest
The authors of this manuscript declare a relationship with the following company: Bilgin Keserci is an employee of Philips.
The authors state that this work has not received any funding.
Statistics and biometry
Both authors have significant statistical expertise.
Institutional review board approval was obtained.
Written informed consent was obtained from all subjects (patients) in this study.
• cross-sectional study
• performed at one institution
- 15.InSightec Ltd. (2009) FDA approves label change for non-invasive fibroid treatment. http://www.insightec.com/us/news-events/press-releases/fda-approves-label-change-for-non-invasive-fibroid-treatment.