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Role of contrast-enhanced ultrasonography in MR-guided focused ultrasound ablation on uterus fibroids: lesion selection and assessment of ablative effects

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine whether contrast-enhanced ultrasonography (CEUS) can be used for selecting lesions and assessing the ablative effects of MRgFUS ablation on uterus fibroids, compared with MR imaging.

Methods

This retrospective study was approved by the institutional review board of our hospital. From April 2018 to November 2019, a total of 44 symptomatic fibroids in 38 patients who underwent MRgFUS ablation were included. The association between pre-ablation characteristics on CEUS/MR imaging and the non-perfusion volume (NPV) after ablation was analyzed using multivariable linear regression analysis. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve values was compared between the CEUS and MR imaging regression models. NPV after ablation was compared between CEUS and enhanced MR imaging.

Results

On CEUS, entangled branch vessels, fast-in, and fast-out patterns were significantly associated with NPV, with an AUC of 0.95 (95% CI; 0.88, 1.00). On MR imaging, hyper-intensity on T2-weighted images (T2WI), hyper-intense ring-like signal on T2WI images, and hyper-enhancement on contrast-enhanced T1WI images were correlated with NPV, with an AUC of 0.86 (95% CI; 0.70, 1.00). After ablation, no differences in NPV were noted between contrast-enhanced T1WI (84.13 ± 75.42 cm3) and CEUS (80.22 ± 76.49 cm3).

Conclusions

Some pre-ablation characteristics of uterine fibroids on CEUS were associated with NPV after MRgFUS. CEUS may contribute to the evaluation of ablative outcomes and patient selection, similar to MR imaging.

Key Points

• Contrast-enhanced ultrasonography (CEUS) is effective for selecting the appropriate uterine fibroids before MR-guided focused ultrasound (MRgFUS) ablation and evaluating non-perfusion volumes (NPV) after ablation, as a potential alternative to MR imaging.

• Before ablation, entangled branch vessels, fast-in, and fast-out patterns on CEUS were significantly associated with NPV after MRgFUS.

• No significant differences in NPV were detected between contrast-enhanced T1WI and CEUS after ablation.

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Abbreviations

AUC:

Area under the curve

CEUS:

Contrast-enhanced ultrasonography

MRgFUS:

Magnetic resonance-guided focused ultrasound

NPV:

Non-perfusion volumes

ROC:

The receiver operating characteristic curve

T1WI:

T1-weighted images

T2WI:

T2-weighted images

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Funding

This work was partially supported by the National Natural Science Fund by the National Science Foundation of China (No. 81671691).

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    Authors and Affiliations

    1. Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

      Wen Luo, Pei-di Zhang, Xiao Yang, Hai-jing Liu, Lei Ding, Li-na Pang, Xiao-dong Zhou & Li-wen Liu

    2. Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

      Jian-min Zheng, Ying Liu, Xing Tang & Min-wen Zheng

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    1. Wen Luo
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    Correspondence to Wen Luo or Min-wen Zheng.

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    Guarantor

    The scientific guarantor of this publication is Wen Luo.

    Conflict of interest

    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.

    Statistics and biometry

    We consulted an expert in statistics (Ling Wang, Department of Statistics, Fourth Military Medical University, Xi’ an, China) for the preparation of this manuscript. She was not one of the authors of this study.

    Informed consent

    Due to the retrospective nature of this study, informed consent was waived for the current study.

    Ethical approval

    This study was conducted in accordance with the declaration of Helsinki. This study was conducted with approval from the ethics committee of Xijing Hospital.

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    Wen Luo and Pei-di Zhang are the co-first authors.

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    Luo, W., Zhang, Pd., Yang, X. et al. Role of contrast-enhanced ultrasonography in MR-guided focused ultrasound ablation on uterus fibroids: lesion selection and assessment of ablative effects. Eur Radiol 32, 2110–2119 (2022). https://doi.org/10.1007/s00330-021-08294-x

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