Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids-Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs.

Tomasz Łoziński,Elżbieta Łuczyńska,Justyna Filipowska,Michał Ciebiera,Artur Czekierdowski

doi:10.3390/diagnostics11040715

Abstract

Objective: The assessment of the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) when qualifying patients with uterine fibroids (UFs) for magnetic resonance-guided high-intensity ultrasound (MR-HIFU). Material and methods: This retrospective, single center study included 283 women who underwent DCE-MRI and were treated with MR-HIFU. The patients were divided according to non-perfused volume (NPV) as well as by the type of curve for patients with a washout curve in the DCE-MRI study and patients without a washout curve. The studied women were assessed in three groups according to the type of uterotonics administered. Group A (57 patients) received one dose of misoprostol/diclofenac transvaginally and group B (71 patients) received oxytocin intravenously prior to the MR-HIFU procedure. The remaining 155 women (group C) were treated with the traditional non-drug enhanced MR-HIFU procedure. Results: The average NPV value was higher in no washout group, and depended on the uterotonics used. Conclusions: We demonstrated a correlation between dynamic contrast enhancement curve types and the therapeutic efficacy of MR-HIFU. Our results suggest that DCE-MRI has the potential to assess treatment outcomes among patients with UFs, and patients with UFs that present with a washout curve may benefit from the use of uterotonic drugs. More studies are required to draw final conclusions.

Highlights

Uterine fibroids (UFs) are commonly found in women during their reproductive age
Between April 2015 and February 2020, we identified 688 patients with symptomatic uterine fibroids (UFs) who were potentially eligible for MR-high-intensity-focused ultrasound (HIFU) therapy
Based on all the presented data we suggest that the volume changes of ablated UFs, used power and maximum optimal temperature are related in some manner to the type of enhancement curve types found on dynamic contrast-enhanced magnetic resonance imaging (DCE-magnetic resonance imaging (MRI)) and that MRI has the potential to measure hemodynamic changes after MR-HIFU procedure

Summary

Introduction

Uterine fibroids (UFs) are commonly found in women during their reproductive age. affecting a high percentage of the female population, the vast majority of these tumors are asymptomatic and do not require an intervention [1,2]. Minimally invasive treatment of UFs including magnetic resonanceguided focused ultrasound (MRgFUS) and, later, its more advanced option magnetic resonance-guided high-intensity ultrasound (MR-HIFU) have been introduced [11,12] This is a non-invasive thermal ablation technique which uses magnetic resonance imaging (MRI) guidance and a focused ultrasound beam applied externally to destroy benign and malignant tumors located in the human body [13]. The successful application of HIFU was described in patients with various malignancies, such as prostate and liver cancers, bone tumors or in selected benign masses, such as UFs [14] This treatment modality proved to be safe and effective. The second aim was to find out if the parameters would become more accurate and allow exclusion of cases of Funaki types I and II that do not respond well to ultrasound treatment

Eligibility Criteria

Interventions

Treatment Procedure

Statistical Analysis

Results

Conclusions