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01-07-2020 | Magnetic Resonance Imaging | Interventional

Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids

Authors: Inez M. Verpalen, Miranda van ‘t Veer-ten Kate, Erwin de Boer, Rolf D. van den Hoed, Joke M. Schutte, Jeroen R. Dijkstra, Arie Franx, Lambertus W. Bartels, Chrit T. W. Moonen, Martijn F. Boomsma

Published in: European Radiology | Issue 7/2020

Abstract

Objectives

The clinical applicability of magnetic resonance image−guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids is often limited due to inaccessible fibroids or bowel interference. The aim of this study was to implement a newly developed 3-step modified manipulation protocol and to evaluate its influence on the number of eligible women and treatment failure rate.

Methods

From June 2016 to June 2018, 165 women underwent a screening MRI examination, 67 women of whom were consecutively treated with MR-HIFU at our institution. Group 1 (n = 20) was treated with the BRB manipulation protocol which consisted of sequential applications of urinary bladder filling, rectal filling, and urinary bladder emptying. Group 2 (n = 47) was treated using the 3-step modified manipulation protocol which included (1) the BRB maneuver with adjusted rectal filling by adding psyllium fibers to the solution; (2) Trendelenburg position combined with bowel massage; (3) the manual uterine manipulation (MUM) method for uterine repositioning. A comparison was made between the two manipulation protocols to evaluate differences in safety, the eligibility percentage, and treatment failure rate due to unsuccessful manipulation.

Results

After implementing the 3-step modified manipulation protocol, our ineligibility rate due to bowel interference or inaccessible fibroids decreased from 18% (16/88) to 0% (0/77). Our treatment failure rate due to unsuccessful manipulation decreased from 20% (4/20) to 2% (1/47). There were no thermal complications to the bowel or uterus.

Conclusions

Implementation of the 3-step modified manipulation protocol during MR-HIFU therapy of uterine fibroids improved the eligibility percentage and reduced the treatment failure rate.

Trial registration

Registry number NL56182.075.16

Key Points

• A newly developed 3-step modified manipulation protocol was successfully implemented without the occurrence of thermal complication to the bowel or uterus.

• The 3-step modified manipulation protocol increased our eligibility percentage for MR-HIFU treatment of uterine fibroids.

• The 3-step modified manipulation protocol reduced our treatment failure rate for MR-HIFU treatment of uterine fibroids.

Available only for authorised users

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Title: Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids
Authors: Inez M. Verpalen
Miranda van ‘t Veer-ten Kate
Erwin de Boer
Rolf D. van den Hoed
Joke M. Schutte
Jeroen R. Dijkstra
Arie Franx
Lambertus W. Bartels
Chrit T. W. Moonen
Martijn F. Boomsma
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Ultrasound
Magnetic Resonance Imaging
Ultrasound
Published in: European Radiology / Issue 7/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-06780-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids

Abstract

Objectives

Methods

Results

Conclusions

Trial registration

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Trial registration

Key Points

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