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Diffusion-weighted magnetic resonance imaging using different b-value combinations for the evaluation of treatment results after volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids

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Abstract

Objectives

To assess the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-value combinations for treatment evaluation after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) of uterine fibroids.

Methods

Fifty-six patients with 67 uterine fibroids were treated with volumetric MR-HIFU. Pre-treatment and post-treatment images were obtained using contrast-enhanced T1-weighted MRI (CE-T1WI) and DWI using b = 0, 200, 400, 600, 800 s/mm2. ADC maps were generated using subsets of b-values to investigate the effects of tissue ablation on water diffusion and perfusion in fibroids treated with MR-HIFU. Four combinations of b-values were used: (1) all b-values; (2) b = 0, 200 s/mm2; (3) b = 400, 600, 800 s/mm2; and (4) b = 0, 800 s/mm2.

Results

Using the lowest b-values (0 and 200 s/mm2), the mean ADC value in the ablated tissue reduced significantly (p < 0.001) compared with baseline. Calculating the ADC value with the highest b-values (400, 600, 800 s/mm2), the ADC increased significantly (p < 0.001) post-treatment. ADC maps calculated with the lowest b-values resulted in the best visual agreement of non-perfused fibroid tissue detected on CE images. Other b-value combinations and normal myometrium showed no difference in ADC after MR-HIFU treatment.

Conclusions

A decrease in contrast agent uptake within the ablated region on CE-T1WI was correlated to a significantly decreased ADC when b = 0 and 200 s/mm2 were used.

Key Points

• DWI could be useful for treatment evaluation after MR-HIFU of uterine fibroids

• The ADC in fibroid tissue is influenced by the choice of b- values

• Low b-values seem the best choice to emphasise perfusion effects after MR-HIFU

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Acknowledgments

The scientific guarantor of this publication is Dr. ir. L.W. Bartels. The authors of this manuscript declare a relationship with the following company: Philips Healthcare (B.K.). The authors state that this work has not received any funding. Philips Healthcare provided financial support for the expenses of the first ten patients, including treatment and follow-up. No complex statistical methods were necessary for this paper.

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 reported previously by Voogt et al. [10] and Ikink et al. [33].

Methodology: retrospective, observational, multicentre study.

Author information

Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Marlijne E. Ikink, Marianne J. Voogt, Maurice A. A. J. van den Bosch & Robbert J. Nijenhuis

  2. High-intensity Focused Ultrasound (HIFU) Center, Samsung Medical Center, Seoul, South Korea

    Bilgin Keserci & Young-sun Kim

  3. Philips Healthcare, Advanced Science and Development, Seoul, South Korea

    Bilgin Keserci

  4. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sunkyunkwan University, Seoul, South Korea

    Young-sun Kim

  5. Department of Radiology and Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    Koen L. Vincken & Lambertus W. Bartels

Authors
  1. Marlijne E. Ikink
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  2. Marianne J. Voogt
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  3. Maurice A. A. J. van den Bosch
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  8. Lambertus W. Bartels
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Correspondence to Marlijne E. Ikink.

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Ikink, M.E., Voogt, M.J., van den Bosch, M.A.A.J. et al. Diffusion-weighted magnetic resonance imaging using different b-value combinations for the evaluation of treatment results after volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids. Eur Radiol 24, 2118–2127 (2014). https://doi.org/10.1007/s00330-014-3274-y

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  • DOI: https://doi.org/10.1007/s00330-014-3274-y

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