Abstract
PurposeTo evaluate the effect of bowel interposition on assessing procedure feasibility, and the usefulness and limiting conditions of bowel displacement techniques in magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of uterine fibroids.Materials and MethodsInstitutional review board approved this study. A total of 375 screening MR exams and 206 MR-HIFU ablations for symptomatic uterine fibroids performed between August 2010 and March 2015 were retrospectively analyzed. The effect of bowel interposition on procedure feasibility was assessed by comparing pass rates in periods before and after adopting a unique bowel displacement technique (bladder filling, rectal filling and subsequent bladder emptying; BRB maneuver). Risk factors for BRB failure were evaluated using logistic regression analysis.ResultsOverall pass rates of pre- and post-BRB periods were 59.0% (98/166) and 71.7% (150/209), and in bowel-interposed cases they were 14.6% (7/48) and 76.4% (55/72), respectively. BRB maneuver was technically successful in 81.7% (49/60). Through-the-bladder sonication was effective in eight of eleven BRB failure cases, thus MR-HIFU could be initiated in 95.0% (57/60). A small uterus on treatment day was the only significant risk factor for BRB failure (B = 0.111, P = 0.017).ConclusionThe BRB maneuver greatly reduces the fraction of patients deemed ineligible for MR-HIFU ablation of uterine fibroids due to interposed bowels, although care is needed when the uterus is small.
Highlights
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation has been increasingly adopted worldwide as a non-surgical therapy for symptomatic uterine fibroids, due to its satisfactory therapeutic efficacy in controlling symptoms and its high level of safety [1,2,3,4]
Through-the-bladder sonication was effective in eight of eleven BRB failure cases, MR-HIFU could be initiated in 95.0% (57/60)
The BRB maneuver greatly reduces the fraction of patients deemed ineligible for MR-HIFU ablation of uterine fibroids due to interposed bowels, care is needed when the uterus is small
Summary
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation has been increasingly adopted worldwide as a non-surgical therapy for symptomatic uterine fibroids, due to its satisfactory therapeutic efficacy in controlling symptoms and its high level of safety [1,2,3,4]. MR-HIFU ablation therapy cannot be used for all patients due to a number of limiting factors, and 14–74% of referred patients were reportedly eligible for this procedure [5,6,7]. One of these limiting factors is bowel interposition between the abdominal wall and the uterus, blocking the sonication path. Bowel interposition during HIFU ablation carries a potential risk of bowel perforation and peritonitis due to near-field heating, which might be potentiated by bowel gas, and could damage the bowel wall [8]. For a safe procedure, it is extremely important to take the interposed bowel loops out of the beam path before initiating HIFU sonication
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