Abstract
Clinical data from 172 cases of uterine fibroids with different appearances on MRI-T2WI and accepted ultrasound guided high intensity focused ultrasound (USgHIFU) treatment were retrospectively analyzed. This study aimed to evaluate the clinical safety and efficacy of ablating different types of fibroids, classified by T2-weighted magnetic resonance imaging (MRI-T2WI). Based on MRI-T2WI signal intensities, uterine fibroids were classified as three types: hypointensive (52 cases), isointensive (64 cases) and hyperintensive (56 cases). Evaluation parameters including treatment time, ablation efficiency, percentage non-perfused volume, fibroid reduction rate, adverse reactions, symptom severity scores (SSS) and re-intervention rate were assessed from 3 months to 1 year. The percentage non-perfused volume and ablation efficiency of hyperintensive uterine fibroids were lower than those of isointensive and hypointensive uterine fibroids. All fibroids shrunk and the SSS continued to reduce at 3 and 6 months after treatment respectively. At 12-month postoperative assessments, hypointensive fibroids continued to shrink, while the isointensive fibroids enlarged but remained smaller than pre-treatment. The incident rate of postoperative Society of Interventional Radiology B-class (SIRB-class) adverse events showed no significant differences. The re-interventional rate of hyperintensive fibroids was higher than in isointensive and hypointensive groups. USgHIFU ablation of all types of fibroids were safe and effective.
Highlights
Uterine fibroids are common benign neoplasms among reproductive aged women, impairing their quality of life1
Studies using MRIgHIFU to ablate uterine fibroids6, 9, 10 showed that the percentage non-perfused volume which is defined as the percentage rate of the non-perfused volume comparing with fibroid volume after high-intensity focused ultrasound (HIFU) treatment on enhanced magnetic resonance imaging (MRI), immediately after ablation was approximately 10% to 50%, and rarely over 70%
This retrospective study may help to make an indirect comparison between the safety and efficacy of US guided HIFU (USgHIFU) and MRI guided HIFU ablation of uterine fibroids
Summary
Uterine fibroids are common benign neoplasms among reproductive aged women, impairing their quality of life. 10–20% of women with uterine fibroids exhibit symptoms, such as menorrhagia, heavy bleeding, infertility, pain, frequent urination and constipation Surgical interventions such as laparoscopic or hysteroscopic myomectomy or hysterectomy are the most common methods of treatment. While clear and accurate monitoring images and intraoperative temperature measurements can be obtained by MRI-guided HIFU (MRIgHIFU), it is expensive, requires complicated operations, and exhibits poor real-time performance. Studies have shown that the percentage non-perfused volume and the decrease rate of MRI-T2WI hyperintensive fibroids are lower than those of isointensive and hypointensive fibroids. Studies have shown that the percentage non-perfused volume and the decrease rate of MRI-T2WI hyperintensive fibroids are lower than those of isointensive and hypointensive fibroids10 This difference may lead to discrepancies in clinical effectiveness among patients with fibroids of different signals
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