P01.03: What maximum measure of fibroid is treatable at the first MRgFUS procedure?

Abstract

MR-guided focused ultrasound surgery (MRgFUS) is a minimally invasive method for thermal ablation of uterine fibroids. Patients with fibroids of a major axis of 3–12 cm on T2 weighted MRI are considered candidates for the first treatment session with MRgFUS. We investigated whether fibroids of a major axis of over 12.5 cm could be treated successfully. Five patients with fibroids of a major axis over 12.7 cm were treated with the first treatment session of MRgFUS (ExAblate 2000; InSightec). The primary goal was to attain ablative necrosis without severe adverse events. On the display of the FUS workstation, the region of treatment (ROT) was outlined on the coronal plane, as previously described, and the number of spots for sonication emerged thereon. After treatment, the nonperfused volume (NPV) of ablative necrosis was evaluated through contrast enhanced T1-weighted MRI. Fibroid volume before treatment was 677–1,000 cm3; the fibroid major axis, 12.7-15.0 cm; the number of spots sonicated, 131–141; the NPV ratio, 40.2-95.7%; and treatment time, 3:28–3:53 hours. The patient symptoms of heavy menstrual bleeding or pelvic pressure ameliorated one month after the treatment. The outcome was similar to that of fibroids with a major axis under 12 cm. Two patients complaining of a fever over 38 degrees C recovered within 2 days through antibiotics; One of them was in no mood to work for a week due to pain. Another patient with a fibroid of a major axis of 14.3 cm (volume 1,000 cm3) declined treatment in the last stages of 141 sonications because of severe fatigue and lumbar pain; enhanced MR images could not be taken. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.