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Abstract
Objective:To explore the correlation between magnetic resonance imaging (MRI) features of uterine fibroids (UFs) and therapeutic effects of high-intensity focused ultrasound ablation (HIFUA), and to provide evidence for UFs diagnosis with MRI in clinical practice.Methods:Forty-three UFs patients who were treated in our hospital from April 2012 to June 2014 were selected, including 72 UFs (48 multiple and 24 single UFs). Transverse, sagittal and coronal MRI scanning was performed one week before and after HIFUA to record UF number, location, type (intramural fibroid, submucosal fibroid and subserosal fibroid), mean diameter, hemoperfusion state, volume and ablation rate. The patients were followed up in the postoperative 1st, 2nd and 3rd months.Results:HIFUA exerted the best ablative effect on fibroids on the anterior uterine wall (F=26.763, P=0.036). Various types of fibroids were ablated significantly differently (F=3.406, P<0.05) by HIFUA that was most effective for ablating the subserosal ones. Having significantly different ablative effects on UFs with different radial line lengths (F=29.94, P<0.05), HIFUA ablated those with radial line lengths of 3-5 cm most effectively. For UFs with different T2WI signal intensities, HIFUA also functioned significantly differently (F=3.179, P=0. 03).Conclusion:HIFUA exerted significantly different ablative effects on UFs with various MRI features. Therefore, these features were well correlated with the therapeutic effects of HIFUA, allowing MRI as a promising diagnostic protocol.
Highlights
As the most common benign gynecological tumor, uterine fibroid (UF) is threatening 30% of the women of childbearing age.[1]
High-intensity focused ultrasound ablation (HIFUA) outcomes for different types of UFs: The volumes of different types of tumors were significantly decreased after HIFUA compared with those before (P
HIFUA outcomes for UFs with different radial line lengths: The volumes of UFs with different radial line lengths were all significantly reduced by HIFUA (P
Summary
As the most common benign gynecological tumor (over 50% of all cases), uterine fibroid (UF) is threatening 30% of the women of childbearing age.[1] UF burdens patients both psychologically and physiologically by shortening menstrual cycle, prolonging menstrual bleeding and even leading to infertility.[2] Traditionally, UFs are treated by hysterectomy which minimizes recurrence risk in the price of fertility deprivation,[3] so this method is not acceptable among young females. Minimally invasive or non-invasive surgeries (e.g. laparoscopic myomectomy, vaginal hysterectomy with cystectomy and uterine artery embolization) have been used to retain the uterus, they have not been widely applied due to high recurrence rate and treatment cost.[3] High-intensity focused ultrasound ablation (HIFUA), on the other hand, has been applied in clinical practice for over 10 years as a non-invasive method that retains the uterus without inducing obvious side effects. When the pathological data of patients are unavailable, the therapeutic effects of HIFUA are mainly evaluated by using ultrasonic imaging, enhanced computed tomography, magnetic resonance imaging (MRI) and positron emission tomography.[4]
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