Fibroid Volume Reduction Research Articles

Longitudinal Course of Fibroid Volume Reduction and Symptom Relief After Transcervical Radiofrequency Ablation

Longitudinal Course of Fibroid Volume Reduction and Symptom Relief After Transcervical Radiofrequency Ablation

Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis: A single center experience from the Republic of Korea

ObjectivesThis study aimed to assess the therapeutic outcomes of patients with uterine fibroid or adenomyosis treated by ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation at Incheon Christian Hospital, Korea. MethodsThis study included 618 patients, of which 272 suffered from uterine fibroid and 346 suffered from adenomyosis. Treatment was administrated using the Model Haifu JC Focused Ultrasound Tumor Therapeutic System (Chongqing Haifu Technology, Chongqing, China) under real-time ultrasound guidance. A follow-up was conducted on volume change as well as on symptom improvement using the Symptom Severity Score (SSS) and Uterine Fibroid Symptom and Quality of Life (UFS–QOL) after treatment. ResultThe uterine fibroid volume reduction rates (%) were 58.08%, 66.18%, and 77.59% at 3, 6, and 12months after treatment, respectively. The SSS reduction rates (%) were 55.58%, 52.76%, and 50.39% by 3, 6, and 12months, respectively. The UFS–QOL score increasing rates (%) were 42.66%, 43.50%, and 43.45% by 3, 6, and 12months, respectively. The uterine volume reduction rates (%) for adenomyosis were 43.99%, 47.01%, and 53.98% by 3, 6, and 12months, respectively. The SSS reduction rates (%) for adenomyosis were 55.61%, 52.38%, and 57.98% by 3, 6, and 12months, respectively. The UFS–QOL score increasing rates (%) for adenomyosis UFS–QOL score were 80.06%, 69.39%, and 85.07% by 3, 6, and 12months, respectively. ConclusionWe conclude that USgHIFU treatment for uterine fibroid and adenomyosis is an effective non-invasive therapy via the assessment of fibroid volume reduction, symptom improvement, UFS–QOL score increase, and acceptable level of side effects. Although preliminary experience of HIFU is encouraging, well-designed prospective trials and more clinical experiences are needed to ascertain the efficacy and safety of this new treatment.

Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles?

Purpose: The aim of this study was to assess the safety and effectiveness of contrast-enhanced ultrasound (CEUS) on ultrasound guided high intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. Methods: Thirty-three patients (37 fibroids) were randomly assigned to two groups: group A (17 patients, 20 fibroids) in which CEUS was used before, during and after HIFU treatment, and group B (16 patients, 17 fibroids) in which CEUS was not administered at all. Follow-up including contrast-enhanced magnetic resonance imaging (MRI) and a clinical questionnaire was performed, and technical success, ablation efficacy, volume reduction and complications were assessed. Results: Technical success was 100% in both groups. CEUS revealed residual enhancement in 40% of the patients in group A and the treatment was continued until the completion of ablation. MRI at 1 month after treatment revealed significant difference in the relative fibroid volume reduction rate between the two groups: 16.1% in group A versus 4.8%, in group B (p = 0.01). There was no statistically significant relative volume reduction rate for the results at 3, 6 and 12 months and no significant changes in the quality of life results or the complication rate. Conclusions: CEUS was safe and effective in enhancing US guidance during HIFU ablation of uterine fibroids. Moreover, the use of CEUS during HIFU sonication increased the ablation efficacy, leading to a more relevant fibroid volume reduction at 1 and 3 months. This gap disappeared after 6 months, when there were no differences between the two groups of patients at MRI. However, in our experience, USgHIFU represented a very effective method for the treatment of uterine fibroids, and the use of CEUS during HIFU procedure reduced the treatment time and treatment repetitions for incomplete fibroid ablation.

Post-Uterine Artery Embolization Pain and Clinical Outcomes for Symptomatic Myomas Using Gelfoam Pledgets Alone Versus Embospheres Plus Gelfoam Pledgets: A Comparative Pilot Study

BackgroundTo evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids. MethodWe conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700mg) plus Gelfoam under conscious sedation and local anaesthesia. This was followed by patient-controlled analgesia (PCA) using a morphine pump overnight.Post-procedural pain was assessed by the mean amount of self-administered morphine delivered by PCA pump (mL) from 0 to 19hours in each group. The mean volumes of the uterus and the dominant fibroid were calculated by ultrasound at baseline, three months, six months, and 12months. ResultsA total of 17 women participated in the study. Bilateral uterine artery occlusion was performed in eight women using Gelfoam alone, and in nine women using Embosphere+Gelfoam. One woman in the Embosphere+Gelfoam group developed a puncture-site hematoma requiring further intervention one week later. The mean (SD) amount of morphine self-administered by PCA pump at time 0, 1, and 2hours was 3.4mg (3.1), 2.9mg (2.2), and 2.4mg (3.3) in the Gelfoam-only group and 6.1mg (3.0), 9.6mg (7.1), and 5.3mg (4.4) in the Embosphere+Gelfoam group, respectively. After three hours, the amount of morphine used was equal in both groups. The mean (SD) total dose of morphine used was 29.5mg (18.6) in the Gelfoam group and 41.1mg (19.3) in the Embosphere+Gelfoam group (P=0.228). At 12months, the reduction in median total uterine volume and median dominant fibroid volume in each group was equal. ConclusionClinical outcomes were equivalent after uterine artery embolization using Gelfoam alone versus Gelfoam+Embospheres. Although the amount of immediate post-procedure pain may be less with Gelfoam alone, we could not demonstrate this objectively using morphine use as a measure of pain.

Quality Improvement Guidelines for Uterine Artery Embolization: An Evolution in Patient Selection

shown to experience symptomatic improvement, fibroid volume reduction, and fibroid infarction after embolization. It is just inappropriate to deny patients with adenomyosis or pedunculated subserosal fibroids the option to undergo a procedure associated with symptomatic improvement rates that far exceed the initial impressions formed by early case reports.

Role of Low-Dose Mifepristone for Managing Uterine Leiomyoma

Objective: The aim of this research was to assess the decrease in uterine volume and fibroid volume in patients with uterine leiomyoma who were receiving low-dose mifepristone for 3 months as well as evaluating relief in symptoms produced by this medication. Design: This was a prospective study carried out in a tertiary-care center. Materials and Methods: Fifty women (ages 30–50) with symptomatic uterine leiomyoma were given 10 mg of mifepristone per day for 3 months. The patients' decrease in menstrual and pressure symptoms and reduction in uterine and fibroid volume, measured by transvaginal sonography, were assessed at the end of 3 months of treatment and after 3 months of stopping treatment. Results: There was a significant reduction in the patients' uterine and fibroid volume at the end of 3 months. The mean reductions in uterine and fibroid volume after 1 month were up to 9.6% and 11.1%, respectively; after the second month, they were respectively, 18.3% and 21.4%; and after the third month, they were respectively, 27.8% and 32.1% (p<0.001). Three months after stopping treatment there was a slight increase in these parameters (p<0.001), but uterine and fibroid volume were still 26.25% and 27.24%, respectively, lower than baseline. There was significant reduction of menorrhagia, dysmenorrhea, and pressure symptoms of bladder frequency and pelvic pain at the end of 3 months (p<0.001), which increased slightly (p<0.05) after 6 months. According to the results of endometrial sampling, no patient had any complex hyperplasia or any atypical hyperplasia. The side-effects of the medication were minimal. Conclusions: Low-dose mifepristone had a shrinking effect on the patients' fibroid growths. It produced a definite reduction in the the patients' symptoms with few side-effects. (J GYNECOL SURG 30:70)

Pregnancy after transcervical radiofrequency ablation guided by intrauterine sonography: case report

Uterine fibroids are a prevalent disorder; with the exception of myomectomy, there are no treatments that are generally accepted as compatible with future fertility and fecundity. Radiofrequency ablation is a minimally invasive treatment modality for uterine fibroids that results in coagulative necrosis and fibroid volume reduction. There have been few reports of pregnancy after laparoscopic and transvaginal radiofrequency ablation of fibroids and no previous reports after a transcervical approach. We report the outcome of the first viable pregnancy after intrauterine sonography-guided radiofrequency ablation of a uterine fibroid.

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Introduction and objectiveUterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients.Material and methodsUterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test.ResultsBefore UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006).ConclusionsThe percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis

This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata. Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included. No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039). This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.

Cystic Degeneration of Fibroid following Mifepristone

ABSTRACT Uterine leiomyomas are common uterine tumors and often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. Several agents exist for the medical management of uterine fibroids through symptom control, reduction in fibroid volume, and reduction in menstrual blood loss. In our patient, Tab. mifepristone 25 mg was used for 9 months. In follow-up, size of fibroid tripled over 9 months. Patient started developing pressure symptoms. Surgery was difficult to perform because of cystic degeneration. Further long-term study is needed to exactly understand the long-term effect of these medicines. How to cite this article Jain N, Hakim M. Cystic Degeneration of Fibroid following Mifepristone. Int J Gynecol Endsc 2017;1(1):46-49.

Abstract No. 249 - Assessing the link between MRI imaging and short term outcome in uterine fibroid embolisation (UFE)

Purpose A poor correlation between reduction in fibroid size and uterine volume following UFE, and patient symptoms has been previously described using US imaging. The information provided by MRI imaging is significantly greater than US. The aim of this study is to identify whether there are features identifiable on either pre or post UFE MRI that are associated with patient outcome. Materials and Methods All patients at our institution have MRI pre and post UFE. Patient are also asked to complete a Quality of Life questionnaire at their booking clinic appointment. Patients are also assessed six months following UFE with MRI and repeat clinic asessment. At the clinic they are again requested to complete a Quality of life questionnaire. All patients who underwent UFE and had both pre and post MRI and had completed pre and post embolisation Quality of life questionnaires were included in the study. Various factors including pre-embolisation fibroid size, presence of adenomyomatosis, ovarian artery parasitization, post embolisation necrosis and post-embolisation changes in fibroid and uterine size were correlated with outcome factors. Results 172 patients were included in the study. Increasing size of the dominant fibroid and presence of adenomyomatosis were not found to be associated with a poorer outcome. The uterine volume reduced by 23% overall (SD 52%) and the dominant fibroid reduced in volume by 42% overall. The degree of necrosis in the dominant fibroid also showed significant increase (2.9). The Symptom severity score showed a marked improvement of -28 as did HRQL (26). However, despite overall improvement in all, no significant correlation with any of the imaging variables was demonstrated with the symptomatic scores. Conclusion The identification of ovarian parasitisation and adenomyosis pre-intervention were not associated with a poorer short-term post-embolisation outcome. Degree of fibroid necrosis, reduction in fibroid volume, and reduction in overall uterine size do not correlate with patient's symptomatic improvement post UFE. MRI may be of more use in assessing long term prognosis, and further investigation is needed.

MRI Assessment of Uterine Artery Patency and Fibroid Infarction Rates 6 Months after Uterine Artery Embolization with Nonspherical Polyvinyl Alcohol

We have observed significant rates of uterine artery patency after uterine artery embolization (UAE) with nonspherical polyvinyl alcohol (nsPVA) on 6 month follow-up MR scanning. The study aim was to quantitatively assess uterine artery patency after UAE with nsPVA and to assess the effect of continued uterine artery patency on outcomes. A single centre, retrospective study of 50 patients undergoing bilateral UAE for uterine leiomyomata was undertaken. Pelvic MRI was performed before and 6 months after UAE. All embolizations were performed with nsPVA. Outcome measures included uterine artery patency, uterine and dominant fibroid volume, dominant fibroid percentage infarction, presence of ovarian arterial collaterals, and symptom scores assessed by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). Magnetic resonance angiographic evidence of uterine artery recanalization was demonstrated in 90 % of the patients (64 % bilateral, 26 % unilateral) at 6 months. Eighty percent of all dominant fibroids demonstrated >90 % infarction. The mean percentage reduction in dominant fibroid volume was 35 %. No significant difference was identified between nonpatent, unilateral, and bilateral recanalization of the uterine arteries with regard to percentage dominant fibroid infarction or dominant fibroid volume reduction. The presence of bilaterally or unilaterally patent uterine arteries was not associated with inferior clinical outcomes (symptom score or UFS-QOL scores) at 6 months. The high rates of uterine artery patency challenge the current paradigm that nsPVA is a permanent embolic agent and that permanent uterine artery occlusion is necessary to optimally treat uterine fibroids. Despite high rates of uterine artery recanalization in this cohort, satisfactory fibroid infarction rates and UFS-QOL scores were achieved.

Reduction in Uterine and Fibroid Volumes in 135 Consecutive Subjects Following Laparoscopic and Ultrasound-Guided Radiofrequency Ablation of Fibroids: 12-Month Follow-Up

To assess outpatient radiofrequency volumetric thermal ablation (RFVTA) in women with symptomatic fibroids and moderate-to-severe menorrhagia, in terms of uterine and fibroid volume reduction (measured by contrast-enhanced MRI) and incidence of surgical re-intervention within 12 months posttreatment.

Ultrasound‐guided radiofrequency ablation of symptomatic uterine fibroids: short‐term evaluation of effect of treatment on quality of life and symptom severity

To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid. Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded. Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred. USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.

Ulipristal acetate: a guide to its use in uterine fibroids

Oral ulipristal acetate (Esmya™), a selective progesterone-receptor modulator, is an effective and well tolerated option for the pre-operative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age. It is associated with rapid control of excessive uterine bleeding and sustained reductions in uterine fibroid volume.

Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery

BackgroundThe efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery are uncertain.MethodsWe randomly assigned women with symptomatic fibroids, excessive uterine bleeding (a score of >100 on the pictorial blood-loss assessment chart [PBAC, an objective assessment of blood loss, in which monthly scores range from 0 to >500, with higher numbers indicating more bleeding]) and anemia (hemoglobin level of ≤10.2 g per deciliter) to receive treatment for up to 13 weeks with oral ulipristal acetate at a dose of 5 mg per day (96 women) or 10 mg per day (98 women) or to receive placebo (48 women). All patients received iron supplementation. The coprimary efficacy end points were control of uterine bleeding (PBAC score of <75) and reduction of fibroid volume at week 13, after which patients could undergo surgery.ResultsAt 13 weeks, uterine bleeding was controlled in 91% of the women receiving 5 mg of ulipristal acetate, 92% of those receiving 10 mg of ulipristal acetate, and 19% of those receiving placebo (P<0.001 for the comparison of each dose of ulipristal acetate with placebo). The rates of amenorrhea were 73%, 82%, and 6%, respectively, with amenorrhea occurring within 10 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were −21%, −12%, and +3% (P=0.002 for the comparison of 5 mg of ulipristal acetate with placebo, and P=0.006 for the comparison of 10 mg of ulipristal acetate with placebo). Ulipristal acetate induced benign histologic endometrial changes that had resolved by 6 months after the end of therapy. Serious adverse events occurred in one patient during treatment with 10 mg of ulipristal acetate (uterine hemorrhage) and in one patient during receipt of placebo (fibroid protruding through the cervix). Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently than with placebo.ConclusionsTreatment with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids. (Funded by PregLem; ClinicalTrials.gov number, NCT00755755.)

Treatment of uterine myoma with 5 or 10mg mifepristone daily during 6 months, post-treatment evolution over 12 months: double-blind randomised clinical trial

To evaluate the efficacy and safety of 5 and 10mg doses of mifepristone for 6 months for the treatment of uterine fibroids and to check those results at 1 year post-treatment. Randomised double-blind clinical study carried out at the "Eusebio Hernández" Hospital, Havana, Cuba. One hundred and seventy-six women with symptomatic uterine fibroids received one daily capsule of 10mg mifepristone orally or one daily capsule of 5mg mifepristone orally, over 6 months. Up to two endometrial biopsies were performed. Reduction in fibroid volume was used to evaluate efficacy. The 5 and 10mg dose had a similar efficacy in reducing the fibroid volume, 48.1% and 39.1%, p=0.07, and that of the uterus, 30.3% and 27.2%, p=0.63, respectively. Twelve months after treatment the majority of the subjects were asymptomatic with symptom prevalence similar to that at the end of treatment, except for hypermenorrhea and metrorrhagia, although the intensity of hypermenorrhea was much less, p<0.01. (1) Both doses obtain similar results in reducing fibroid size. (2) Administering 6 months' treatment achieves symptomatic improvement lasting 1 year in a high percentage of cases. (3) More studies need to be carried out with longer treatment and follow-up periods.

Efficacy of uterine artery embolisation for treatment of symptomatic fibroids and adenomyosis – An interim report on an Australian experience

Uterine artery embolisation (UAE) has been widely described internationally, however there is a paucity of data reported from Australia. To conduct a local audit on the efficacy and safety of UAE treating symptomatic fibroids and adenomyosis. Clinical data of 76 consecutive UAEs were reviewed. Degree of fibroid-related symptoms before embolisation and at follow-up visits were compared. Procedural and subsequent complications were recorded. Uterine and fibroid volumes were measured on MRI at baseline and six months post-UAE. Seventy-six UAEs were performed in 75 women. Fifty-nine women had follow-up duration of more than six months, and one woman was lost to follow-up. Clinical success was 93% overall (n = 59) and 96% for menorrhagia (n = 49). For dysmenorrhoea (n = 36), 89% of women had at least some improvement, 75% had significant improvement and 56% had resolution of pain. For urinary symptoms (n = 32), 97% of women had at least some improvement and 50% had resolution of all urinary symptoms. Adenomyosis was found in 17 (29%) women treated. The primary success rate was 96%, and secondary success rate (after repeat UAE) was 100%. MRI showed 50% uterine volume reduction and 60% dominant fibroid volume reduction. There were no significant procedural-related acute complications. There were three possible cases of endometritis, two managed conservatively and one required hysterectomy. This audit, based on local Australian experience, has confirmed that UAE is a safe and highly effective treatment for women with symptomatic fibroids and/or adenomyosis.

Reduction in the Vascular Bed Volume of Uterine Fibroids after Hormonal Treatment: Evaluation with Dynamic Double-Echo R2* Imaging

To demonstrate the reduction in vascular bed volume (VBV) of uterine fibroids after administration of gonadotropin-releasing hormone analogue (GnRHa) using magnetic resonance (MR) imaging including dynamic double-echo R₂* imaging (DDE-R₂*I) and to assess the value of DDE-R₂*I as a predictor of such reduction. Twenty-one women with uterine intramural fibroids underwent MR imaging including DDE-R₂*I before GnRHa treatment. DDE-R₂*I was acquired using a single-section, double-echo, fast spoiled gradient recalled acquisition in the steady state (SPGR) sequence. We calculated the area under the curve (AUC) of the signal intensity on R₂*I within a 3×3-cm²region of interest that served to represent the VBV. We repeated MR imaging after 2 administrations of GnRHa and repeated image analyses. We statistically analyzed correlations between (A) pre-treatment AUC (AUC(pre)) and AUC reduction and (B) AUC(pre) and volume reduction. The interval between the 2 MR studies ranged from 56 to 119 days (mean: 80.4 days). The average volume of the fibroids before GnRHa treatment was 647.8 mL compared with 463.4 mL after the therapy (decreased by an average of 28.5%; P<0.0001). Meanwhile, measured AUC was reduced by 55.3% (483.4 vs. 206.5; P<0.0001). AUC(pre) correlated with volume reduction (r=0.68), but not AUC reduction. We confirmed reduction in the VBV of fibroids using DDE-R₂*I. The measurement of AUC(pre) on DDE-R₂*I aids prediction of fibroid volume reduction but correlates poorly with the percentage of AUC reduction.

Targeted Vessel Ablation for More Efficient Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

PurposeTo report the first clinical experience with targeted vessel ablation during magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic uterine fibroids.MethodsPretreatment T1-weighted contrast-enhanced magnetic resonance angiography was used to create a detailed map of the uterine arteries and feeding branches to the fibroids. A three-dimensional overlay of the magnetic resonance angiography images was registered on 3D T2-weighted pretreatment imaging data. Treatment was focused primarily on locations where supplying vessels entered the fibroid. Patients were followed 6 months after treatment with a questionnaire to assess symptoms and quality of life (Uterine Fibroid Symptom and Quality of Life) and magnetic resonance imaging to quantify shrinkage of fibroid volumes.ResultsIn two patients, three fibroids were treated with targeted vessel ablation during MR-HIFU. The treatments resulted in almost total fibroid devascularization with nonperfused volume to total fibroid volume ratios of 84, 68, and 86%, respectively, of treated fibroids. The predicted ablated volumes during MR-HIFU in patients 1 and 2 were 45, 40, and 82 ml, respectively, while the nonperfused volumes determined immediately after treatment were 195, 92, and 190 ml respectively, which is 4.3 (patient 1) and 2.3 (patient 2) times higher than expected based on the thermal dose distribution. Fibroid-related symptoms reduced after treatment, and quality of life improved. Fibroid volume reduction ranged 31–59% at 6 months after treatment.ConclusionTargeted vessel ablation during MR-HIFU allowed nearly complete fibroid ablation in both patients. This technique may enhance the use of MR-HIFU for fibroid treatment in clinical practice.