European Radiology

, Volume 27, Issue 12, pp 5299–5308 | Cite as

The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids

Magnetic Resonance



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.

Key Points

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


Uterine fibroids Myometrium T1 perfusion Magnetic resonance imaging High-intensity focused ultrasound Therapeutic outcome 



adverse effect


contrast-enhanced T1 weighted


dynamic contrast-enhanced magnetic resonance imaging


eco-planar imaging


high-intensity focused ultrasound


magnetic resonance-guided high-intensity focused ultrasound


magnetic resonance imaging


non-perfused volume


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.

Ethical approval

Institutional review board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• cross-sectional study

• performed at one institution


  1. 1.
    Stewart EA (2001) Uterine fibroids. Lancet 357:293–298CrossRefPubMedGoogle Scholar
  2. 2.
    Zowall H, Cairns JA, Brewer C et al (2008) Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG 115:653–662CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Pritts EA, Parker WH, Olive DL (2009) Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 91:1215–1223CrossRefPubMedGoogle Scholar
  4. 4.
    Funaki K, Fukunishi H, Funaki T et al (2007) Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and SI of preexisting T2 weighted magnetic resonance images. Am J Obstet Gynecol 196:184.e181–184.e186CrossRefGoogle Scholar
  5. 5.
    Stewart EA, Gostout B, Rabinovici J et al (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110:279–287CrossRefPubMedGoogle 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 249:187–194CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    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
  8. 8.
    Kim HS, Baik JH, Pham LD et al (2011) MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol 18:970–976CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dobrotwir A, Pun E (2012) Clinical 24 month experience of the first MRgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol 56:409–416CrossRefPubMedGoogle Scholar
  10. 10.
    Machtinger R, Inbar Y, Cohen-Eylon S et al (2012) MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success. Hum Reprod 27:3425–3431CrossRefPubMedGoogle Scholar
  11. 11.
    Trumm CG, Stahl R, Clevert D-A et al (2013) Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Investig Radiol 48:359–365CrossRefGoogle Scholar
  12. 12.
    Yoon SW, Lee C, Kim KA et al (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. doi: 10.1155/2010/834275 Google Scholar
  13. 13.
    Mindjuk I, Trumm CG, Herzog P et al (2015) MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur Radiol 25:1317–1328CrossRefPubMedGoogle Scholar
  14. 14.
    Gizzo S, Saccardi C, Patrelli TS et al (2014) Magnetic resonance-guided focused ultrasound myomectomy: safety, efficacy, subsequent fertility and quality-of-life improvements, a systematic review. Reprod Sci 21:465–476CrossRefPubMedGoogle Scholar
  15. 15.
    InSightec Ltd. (2009) FDA approves label change for non-invasive fibroid treatment.
  16. 16.
    Köhler MO, Mougenot C, Quesson B et al (2009) Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry. Med Phys 36:3521–3535CrossRefGoogle Scholar
  17. 17.
    Spies JB, Coyne K, Guaou Guaou N et al (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300PubMedGoogle Scholar
  18. 18.
    Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMedGoogle Scholar
  19. 19.
    Lin CN, Liao YS, Chen WC et al (2016) Use of myometrium as an internal reference for endometrial and cervical cancer on multiphase contrast enhanced MRI. PLoS One 11, e0157820CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ikink ME, Voogt MJ, Verkooijen HM et al (2013) Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids. Eur Radiol 23:3054–3061CrossRefPubMedGoogle Scholar
  21. 21.
    Zhao WP, Chen JY, Chen WZ (2015) Effect of biological characteristics of different types of uterine fibroids, as assessed with T2- weighted magnetic resonance imaging, on ultrasound-guided high-intensity focused ultrasound ablation. Ultrasound Med Biol 41:423–431CrossRefPubMedGoogle Scholar
  22. 22.
    Pennes HH (1948) Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 1:93–122PubMedGoogle Scholar
  23. 23.
    Park MJ, Kim YS, Rhim HC et al (2014) Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused US therapy. J Vasc Interv Radiol 25:231–239CrossRefPubMedGoogle Scholar
  24. 24.
    Chen R, Keserci B, Bi H et al (2016) The safety and effectiveness of volumetric magnetic resonance-guided high intensity focused ultrasound treatment of symptomatic uterine fibroids: Early clinical experience in China. J Ther Ultrasound 4:27CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hindley J, Gedroyc WM, Regan L et al (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 183:1713–1719CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.MR Therapy Division, PhilipsJung-guSouth Korea
  2. 2.Department of RadiologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam

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