Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) treatment is reported to be unsuitable for subjects with bright myoma – higher signal intensity than that of the myometrium on T2-weighted MRI – but suitable for those with dark myoma – lower signal intensity than that of the myometrium on T2-weighted MRI. This study re-evaluates outcomes of bright myoma. Of 19 women (age 31–43) with bright myoma treated with MRgFUS between 2004 and 2005 and followed up over 9 years, 18 were successfully contacted and their data were collected from patient records, MR images, mail and/or telephone. MRgFUS treatment of uterine myoma with ExAblate 2000 has been described previously. The preoperative volume of myoma on T2-weighted MRI and the post-MRgFUS non-perfused volume (NPV) on contrast-enhanced images were calculated from the sum of MRI slices. All subjects were asked whether they had undergone alternative treatment (surgery or uterine artery embolisation (UAE)) after MRgFUS. Post-surgical materials of myoma, when available, were used for histological study. The MRgFUS preoperative volume of myoma was between 63.7 and 874 cc, the NPV between 5.3 and 100% (2 subjects >80% and 7 subjects <30%). Ten women underwent alternative treatment: myomectomy (n = 3), hysterectomy (n = 4) and UAE (n = 3) between 8 months and 7 years after MRgFUS. Unless the periphery of the myoma was completely ablated by MRgFUS, the myoma lesion re-grew rapidly. Complaints included severe pain (n = 14) during MRgFUS treatment and nausea and vomiting (n = 4) immediately after treatment. Postoperative histology of specimens at follow-up revealed cellular leiomyomas in 4 of 5 cases. The outcome for MRgFUS-treated bright myoma determined by NPV% and alternative treatment was mostly poor; however, some favorable subjects with good outcomes and long-term uterine preservation were observed. Further re-evaluation of MRgFUS treatment for suitable candidates with bright myoma is needed.
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