Top

Published in:

01-11-2013 | Interventional

Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids

Authors: Marlijne E. Ikink, Marianne J. Voogt, Helena M. Verkooijen, Paul N. M. Lohle, Karlijn J. Schweitzer, Arie Franx, Willem P. Th. M. Mali, Lambertus W. Bartels, Maurice A. A. J. van den Bosch

Published in: European Radiology | Issue 11/2013

Abstract

Objective

To assess the mid-term efficacy of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) using a volumetric ablation technique for treating uterine fibroids.

Methods

Forty-six premenopausal women with 58 symptomatic uterine fibroids were prospectively included for MR-HIFU. After treatment, CE-MRI allowed measurement of the non-perfused volume (NPV) ratio, defined as the non-enhancing part of the fibroid divided by fibroid volume. Clinical symptoms and fibroid size on T2W-MRI were quantified at 3 and 6 months’ follow-up. The primary endpoint was a clinically relevant improvement in the transformed Symptom Severity Score (tSSS) of the Uterine Fibroid Symptom and Quality of Life questionnaire, defined as a 10-point reduction.

Results

Volumetric ablation resulted in a mean NPV ratio of 0.40 ± 0.22, with a mean NPV of 141 ± 135 cm³. Mean fibroid volume was 353 ± 269 cm³ at baseline, which decreased to 271 ± 225 cm³ at 6 months (P < 0.001), corresponding to a mean volume reduction of 29 % ± 20 %. Clinical follow-up showed that 54 % (25/46) of the patients reported a more than 10-point reduction in the tSSS. Mean tSSS improved from 50.9 ± 18.4 at baseline to 34.7 ± 20.2 after 6 months (P < 0.001).

Conclusion

Volumetric MR-HIFU is effective for patients with symptomatic uterine fibroids. At 6 months, significant symptom improvement was observed in 54 % of patients.

Key Points

• Volumetric MR-guided high-intensity focused ultrasound is a novel ablation technique for leiomyomatosis.

• We prospectively evaluated the outcome of volumetric MR-HIFU ablation for symptomatic fibroids.

• This study showed that volumetric MR-HIFU results in an effective treatment.

• A randomised controlled trial would set this technique in an appropriate context.

Borgfeldt C, Andolf E (2000) Transvaginal ultrasonographic findings in the uterus and the endometrium: low prevalence of leiomyoma in a random sample of women age 25–40 years. Acta Obstet Gynecol Scand 79:202–207PubMedCrossRef

Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36:433–445PubMed

Payson M, Leppert P, Segars J (2006) Epidemiology of myomas. Obstet Gynecol Clin North Am 33:1–11PubMedCrossRef

Walker CL, Stewart EA (2005) Uterine fibroids: the elephant in the room. Science 308:1589–1592PubMedCrossRef

Parker WH (2007) Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 87:725–736PubMedCrossRef

Stewart EA (2001) Uterine fibroids. Lancet 357:293–298PubMedCrossRef

Parker WH (2007) Uterine myomas: management. Fertil Steril 88:255–271PubMedCrossRef

Somigliana E, Vercellini P, Daguati R et al (2007) Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 13:465–476PubMedCrossRef

Carlson KJ, Nichols DH, Schiff I (1993) Indications for hysterectomy. N Engl J Med 328:856–860PubMedCrossRef

10.

Merrill RM (2008) Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 14:CR24–CR31PubMed

11.

Broder MS, Goodwin S, Chen G et al (2002) Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol 100:864–868PubMedCrossRef

12.

Edwards RD, Moss JG, Lumsden MA et al (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:360–370PubMedCrossRef

13.

Lohle PN, Voogt MJ, De VJ et al (2008) Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol 19:319–326PubMedCrossRef

14.

Lumsden MA (2002) Embolization versus myomectomy versus hysterectomy: which is best, when? Hum Reprod 17:253–259PubMedCrossRef

15.

Pinto I, Chimeno P, Romo A et al (2003) Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment—a prospective, randomized, and controlled clinical trial. Radiology 226:425–431PubMedCrossRef

16.

Pron G, Bennett J, Common A et al (2003) The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 79:120–127PubMedCrossRef

17.

Spies JB, Spector A, Roth AR et al (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100:873–880PubMedCrossRef

18.

Tempany CM, Stewart EA, McDannold N et al (2003) MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology 226:897–905PubMedCrossRef

19.

Ishihara Y, Calderon A, Watanabe H et al (1995) A precise and fast temperature mapping using water proton chemical shift. Magn Reson Med 34:814–823PubMedCrossRef

20.

McDannold N, Tempany CM, Fennessy FM et al (2006) Uterine leiomyomas: MR imaging-based thermometry and thermal dosimetry during focused ultrasound thermal ablation. Radiology 240:263–272PubMedCrossRef

21.

Fennessy FM, Tempany CM, McDannold NJ et al (2007) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–results of different treatment protocols. Radiology 243:885–893PubMedCrossRef

22.

LeBlang SD, Hoctor K, Steinberg FL (2010) Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 194:274–280PubMedCrossRef

23.

Stewart EA, Gostout B, Rabinovici J et al (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110:279–287PubMedCrossRef

24.

Hesley GK, Gorny KR, Henrichsen TL et al (2008) A clinical review of focused ultrasound ablation with magnetic resonance guidance: an option for treating uterine fibroids. Ultrasound Q 24:131–139PubMedCrossRef

25.

Kohler MO, Mougenot C, Quesson B et al (2009) Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry. Med Phys 36:3521–3535PubMedCrossRef

26.

Voogt MJ, Trillaud H, Kim YS et al (2012) Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol 22:411–417PubMedCrossRef

27.

Fennessy FM, Tempany CM (2005) MRI-guided focused ultrasound surgery of uterine leiomyomas. Acad Radiol 12:1158–1166PubMedCrossRef

28.

Funaki K, Fukunishi H, Funaki T et al (2007) Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol 196:184–186PubMedCrossRef

29.

Mougenot C, Quesson B, de Senneville BD et al (2009) Three-dimensional spatial and temporal temperature control with MR thermometry-guided focused ultrasound (MRgHIFU). Magn Reson Med 61:603–614PubMedCrossRef

30.

Rieke V, Butts PK (2008) MR thermometry. J Magn Reson Imaging 27:376–390PubMedCrossRef

31.

Spies JB, Coyne K, Guaou GN et al (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300PubMedCrossRef

32.

Hindley J, Gedroyc WM, Regan L et al (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 183:1713–1719PubMedCrossRef

33.

Stewart EA, Rabinovici J, Tempany CM et al (2006) Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85:22–29PubMedCrossRef

34.

Hovsepian DM, Siskin GP, Bonn J et al (2009) Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 20:S193–S199PubMedCrossRef

35.

Okada A, Morita Y, Fukunishi H et al (2009) Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: impact of the learning curve on patient outcome. Ultrasound Obstet Gynecol 34:579–583PubMedCrossRef

36.

van der Kooij SM, Hehenkamp WJ, Volkers NA et al (2010) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 203:105–113PubMed

37.

Brunereau L, Herbreteau D, Gallas S et al (2000) Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 patients. AJR Am J Roentgenol 175:1267–1272PubMedCrossRef

38.

Gupta JK, Sinha AS, Lumsden MA et al (2006) Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev :CD005073

39.

Arleo EK, Khilnani NM, Ng A et al (2007) Features influencing patient selection for fibroid treatment with magnetic resonance-guided focused ultrasound. J Vasc Interv Radiol 18:681–685PubMedCrossRef

40.

Zaher S, Gedroyc W, Lyons D et al (2010) A novel method to aid in the visualisation and treatment of uterine fibroids with MRgFUS in patients with abdominal scars. Eur J Radiol 76:269–273PubMedCrossRef

41.

Gorny KR, Chen S, Hangiandreou NJ et al (2009) Initial evaluation of acoustic reflectors for the preservation of sensitive abdominal skin areas during MRgFUS treatment. Phys Med Biol 54:N125–N133PubMedCrossRef

42.

Zhang L, Chen WZ, Liu YJ et al (2010) Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus. Eur J Radiol 73:396–403PubMedCrossRef

43.

Park MJ, Kim YS, Keserci B et al (2013) Volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids: treatment speed and factors influencing speed. Eur Radiol 23:943–950PubMedCrossRef

44.

Trumm CG, Stahl R, Clevert DA et al (2013) Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest Radiol 48:359–365

45.

Lenard ZM, McDannold NJ, Fennessy FM et al (2008) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–imaging predictors of success. Radiology 249:187–194PubMedCrossRef

46.

Mikami K, Murakami T, Okada A et al (2008) Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience. Radiat Med 26:198–205PubMedCrossRef

47.

Rabinovici J, Inbar Y, Revel A et al (2007) Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance-guided focused ultrasound surgery. Ultrasound Obstet Gynecol 30:771–777PubMedCrossRef

48.

Smart OC, Hindley JT, Regan L et al (2006) Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol 108:49–54PubMedCrossRef

49.

Funaki K, Fukunishi H, Sawada K (2009) Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 34:584–589PubMedCrossRef

50.

Smart OC, Hindley JT, Regan L et al (2006) Magnetic resonance guided focused ultrasound surgery of uterine fibroids–the tissue effects of GnRH agonist pre-treatment. Eur J Radiol 59:163–167PubMedCrossRef

51.

Kim YS, Kim JH, Rhim H et al (2012) Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology 263:600–609PubMedCrossRef

52.

Stewart EA, Nowak RA (1996) Leiomyoma-related bleeding: a classic hypothesis updated for the molecular era. Hum Reprod Update 2:295–306PubMedCrossRef

Title: Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids
Authors: Marlijne E. Ikink
Marianne J. Voogt
Helena M. Verkooijen
Paul N. M. Lohle
Karlijn J. Schweitzer
Arie Franx
Willem P. Th. M. Mali
Lambertus W. Bartels
Maurice A. A. J. van den Bosch
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2915-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 11/2013

Diffusion tensor imaging of the median nerve in recurrent carpal tunnel syndrome - initial experience

Dynamic contrast-enhanced MR imaging for differentiation between enchondroma and chondrosarcoma

Novel connecting tube for saline chaser in contrast-enhanced CT: the effect of spiral flow of saline on contrast enhancement

The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis

Non-ECG-gated unenhanced MRA of the carotids: Optimization and clinical feasibility

Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis