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Wang L, Liu Y, Lin J, Pan Y, Liu Y, Lv F. The Predictive Effect of Quantitative Analysis of Signal Intensity Heterogeneity on T2-Weighted MR Images for High-intensity Focused Ultrasound Treatment of Uterine Fibroids. Acad Radiol 2024:S1076-6332(24)00232-0. [PMID: 38704283 DOI: 10.1016/j.acra.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate whether the quantitative index of signal intensity (SI) heterogeneity on T2-weighted (T2W) magnetic resonance images can predict the difficulty and efficacy of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids. MATERIALS AND METHODS The standard deviation (SD) of T2W image (T2WI) SI was used to quantify SI heterogeneity. The correlation between SD and the non-perfused volume ratio (NPVR) in 575 patients undergoing HIFU treatment was retrospectively analyzed, and the efficacy of SD in predicting NPVR was discussed. Three classifications were made based on the SD, and the ablation difficulty and ablation effect of different grades were compared. A total of 65 cases from another center were used as an external validation set to verify the classification performance of SD. RESULTS The SD of SI was negatively correlated with NPVR (r = -0.460, p < 0.001). The predictive efficiency of SD for the ablation effect was higher than that of the scaled signal intensity (0.767 vs. 0.701, p = 0.006). Univariate and multivariate logistic regression analyses showed that SD was an independent predictor of ablation effect. Based on SD, the three classifications were divided into SD I: SD < 101.0, SD II: 101.0 ≤ SD < 138.7, and SD III: SD≥ 138.7. The treatment time, sonication time, treatment intensity, and total energy of SD I were lower than those of SD II and III (p < 0.05). CONCLUSION The heterogeneity of T2WI SI of uterine fibroids is negatively correlated with NPVR. The SD of SI can be used to predict the ablation difficulty and ablation effect of HIFU.
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Affiliation(s)
- Lu Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.)
| | - Yang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China (Y.L., F.L.)
| | - Jinfeng Lin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.)
| | - Yuanrui Pan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.)
| | - Yang Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.)
| | - Fajin Lv
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing 400016, China (L.W., J.L., Y.P., Y.L., F.L.); Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China (Y.L., F.L.).
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Bitton RR, Fast A, Vu KN, Lum DA, Chen B, Hesley GK, Raman SS, Matsumoto AH, Price TM, Tempany C, Dhawan N, Dolen E, Kohi M, Fennessey FM, Ghanouni P. What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers. Eur Radiol 2023; 33:7360-7370. [PMID: 37553488 DOI: 10.1007/s00330-023-09984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. MATERIALS AND METHODS In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36 months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes. RESULTS Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30-79 (p = 0.03) and ≥ 80% (p = 0.01). CONCLUSION Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother. CLINICAL RELEVANCE STATEMENT Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid. TRIAL REGISTRATION Clinical trial ID: NCT01285960. KEY POINTS • Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment.
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Affiliation(s)
- Rachel R Bitton
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA.
| | - Angela Fast
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
| | - Kim-Nhien Vu
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
| | - Deirdre A Lum
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Gina K Hesley
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Steven S Raman
- Interventional Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Alan H Matsumoto
- Interventional Radiology, University of Virginia, Charlottesville, VA, USA
| | - Thomas M Price
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Maureen Kohi
- Vascular and Interventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Fiona M Fennessey
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
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Tanaka ME, Keefe N, Caridi T, Kohi M, Salazar G. Interventional Radiology in Obstetrics and Gynecology: Updates in Women's Health. Radiographics 2023; 43:e220039. [PMID: 36729949 DOI: 10.1148/rg.220039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Interventional radiology has had an expanding role in women's health over the past few decades, with recent accelerated growth and development. Interventional radiology is fundamental in the treatment of multiple conditions that affect women, including pelvic venous disease, uterine fibroids, and adenomyosis, and in postpartum management. Patient workup, classification, and treatment techniques have continued to evolve as interventional radiology has become more prevalent in the treatment of patients affected by these conditions. The authors provide a review of the pathophysiology of, patient workup for, and treatment of pelvic venous disease and uterine artery embolization for various disease processes. The authors also highlight updates from the past 5-10 years in diagnosis, classification, and treatment strategies. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mari E Tanaka
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Nicole Keefe
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Theresa Caridi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Maureen Kohi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Gloria Salazar
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
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Kociuba J, Łoziński T, Zgliczyńska M, Byrczak M, Vitale SG, Skrzypczak M, Zaręba K, Ciebiera M. Adverse events and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids - a systematic review and future perspectives. Int J Hyperthermia 2023; 40:2174274. [PMID: 36775655 DOI: 10.1080/02656736.2023.2174274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVES The aim of this review was to analyze and summarize the most common adverse events (AEs) and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids (UFs) and to establish the risk factors of their occurrence. METHODS We searched for original research studies evaluating MRgFUS therapy in UFs with outcomes containing AEs and/or complications in different databases (PubMed/MEDLINE, SCOPUS, COCHRANE) until March 2022. Reviews, editorials, opinions or letters, case studies, conference papers and abstracts were excluded from the analysis. The systematic literature search identified 446 articles, 43 of which were analyzed. RESULTS According to available evidence, the overall incidence of serious complications in MRgFUS therapy is relatively low. No AEs/complications were reported in 11 out of 43 analyzed studies. The mean occurrence of all AEs in the analyzed material was 24.67%. The most commonly described AEs included pain, skin burns, urinary tract infections and sciatic neuropraxia. Major AEs, such as skin ulcerations or deep vein thrombosis, occurred in 0.41% of cases in the analyzed material. CONCLUSION MRgFUS seems to be safe in UF therapy. The occurrence of AEs, especially major ones, is relatively low in comparison with other methods. The new devices and more experience of their users seem to reduce AE rate. The lack of unification in AE reporting and missing data are the main issues in this area. More prospective, randomized studies with unified reporting and long follow-up are needed to determine the safety in a long-term perspective.
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Affiliation(s)
- Jakub Kociuba
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Łoziński
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszow, Poland.,Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Magdalena Zgliczyńska
- Department of Obstetrics, Perinatology and Neonatology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Byrczak
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Maciej Skrzypczak
- Second Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Kornelia Zaręba
- Obstetrics and Gynecology Department, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
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Yuan Y, Xu W, Shen H, Lin Z, Xu F, Shi Q, Zhan P, Liu M, Shu J, Chen J, Xing HR. Long-term outcomes of ultrasound guided high intensity focused ultrasound ablation for patients with uterine fibroids classified by T2WI: a multicenter retrospective study. Int J Hyperthermia 2023; 40:2212887. [PMID: 37202174 DOI: 10.1080/02656736.2023.2212887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids classified by T2-weighted magnetic resonance imaging (T2WI-MRI). MATERIALS AND METHODS The data of 1427 premenopausal women with symptomatic uterine fibroids who underwent USgHIFU at four teaching hospitals in China were analyzed retrospectively. The uterine fibroids were classified based on their T2WI-MRI signal intensities relative to that of skeletal muscle, myometrium and endometrium as: hypointense, isointense, heterogeneous hyperintense fibroids (HHF), slightly HHF (sHHF) and markedly HHF (mHHF), respectively. The rates of symptom relief and reintervention post-USgHIFU ablation were compared between the classified groups. RESULTS A total of 1303 patients were followed up for 44 (40, 49) months. The symptom relief rate of the hypointense and isointense fibroids was 83.3% and 79.5%, respectively, which were significantly higher (p < .05) compared to that of HHF, sHHF and mHHF (58.3%, 44.2% and 60.4%), respectively. sHHF had the lowest symptom relief rate (p < .05). The cumulative reintervention rate for hypointense, isointense, HHF, sHHF and mHHF types were 8.8%, 10.8%, 21.4%, 39.9% and 19.8%, respectively. The reintervention rate of hypointense/isointense fibroids was significantly lower than that of HHF/mHHF/sHHF (p < .01), while sHHF had the highest re-intervention rate (p < .01). Thus, reintervention rate is inversely correlated to the rate of symptom relief. CONCLUSIONS USgHIFU ablation is effective for hypointense, isointense, HHF and mHHF with acceptable long-term follow-up outcomes. However, sHHF is associated with a higher reintervention rate.
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Affiliation(s)
- Yuan Yuan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Huangpin Shen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Zhenjiang Lin
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical University, Nanchong, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ping Zhan
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Mali Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - H Rosie Xing
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Yuan B, Qin X, Xi J. The Comparison of Life Quality between Ultrasound-Guided High-Intensity Focused Ultrasound and Laparoscopic Myomectomy for the Treatment of Uterine Fibroids. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9604915. [PMID: 36035293 PMCID: PMC9410940 DOI: 10.1155/2022/9604915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/18/2023]
Abstract
Objective This study is aimed at comparing the uterine fibroids patients' postoperative living quality between ultrasound-guided high-intensity focused ultrasound (HIFU) and laparoscopic myomectomy. Materials and Methods A total of 164 patients were included with uterine fibroids who underwent laparoscopic myomectomy and HIFU in Cangzhou Central Hospital from September 2020 to November 2021. This study divided these objects into HIFU group and laparoscopic group, and both groups were followed up 6 months after surgery. After obtaining the results, Uterine Fibroid Symptom and health-related Quality Of Life questionnaire (UFS-QOL) and 36-Item Short Form Health Survey (SF-36) were performed before and after treatment to assess patient outcome. Results After treatments, the living quality in both groups was significantly improved compared with that before surgery, which had statistical significant (P < 0.05). After treatment, the scores of the two scales in HIFU group were significantly better than those in the laparoscopic group (P < 0.05). Conclusion In comparison with laparoscopic myomectomy, ultrasound-guided high-intensity focused ultrasound could improve the life quality of patients more effectively than traditional laparoscopic myomectomy and was helpful to the recovery and prognosis of uterine fibroids after treatment. The outcomes will provide a reference for clinicians to select a more appropriate treatment for uterine fibroids.
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Affiliation(s)
- Bilin Yuan
- Hebei Medical University, Shijiazhuang 050051, China
| | - Xinyi Qin
- Hebei Medical University, Shijiazhuang 050051, China
| | - Jie Xi
- Department of Gynecology, Cangzhou Central Hospital, Cangzhou 061000, China
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Jiang L, Yu JW, Yang MJ, Zhong Q, Chen JY. Ultrasound-guided HIFU for uterine fibroids of hyperintense on T2-weighted MR imaging with or without GnRH-analogue-pretreated: A propensity score matched cohort study. Front Surg 2022; 9:975839. [PMID: 35990089 PMCID: PMC9386137 DOI: 10.3389/fsurg.2022.975839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the therapeutic effect of high-intensity focused ultrasound (HIFU) ablation and HIFU pretreated with gonadotropin-releasing hormone analogue (GnRH-a) in the treatment of hyperintense uterine fibroids on T2-weighted magnetic resonance imaging (T2WI) by using propensity score matching. Materials and methods 339 women with 368 hyperintense uterine fibroids on T2WI who underwent single-session HIFU ablation were enrolled, including 283 patients with 303 fibroids in the single-session HIFU (sHIFU) group and 56 patients with 65 fibroids in the HIFU pretreated with GnRH-a (Gn-HIFU) group. The signal intensity (SI) value and standard deviation (SD) value were measured based on T2WI, and the fibroids were further subdivided into heterogeneous hyperintense fibroids, slightly homogeneous hyperintense fibroids and markedly homogeneous hyperintense fibroids as 3 subgroups (HHF, sHHF and mHHF group respectively). Treatment time, sonication time, dose, non-perfused volume (NPV), NPV per sonication time, non-perfused volume ratio (NPVR), energy effect ratio (EEF) and adverse events were recorded. Results Out of 339 patients, the median NPVR was 75.2% (interquartile range,31.5%). After propensity score matching, the matched cohort included 91 (64.5%) patients in the sHIFU group and 48 (34.5%) patients in the Gn-HIFU group. The NPVR of sHHF in the Gn-HIFU group had significantly smaller than that in the sHIFU group (60.2% versus 74.9%, p = 0.005), and the NPVR of HHF in the Gn-HIFU group was higher than those in the sHIFU group (87.4% versus 72.9%, p = 0.002). Conclusions Compared with HIFU alone, the therapeutic efficacy of the heterogeneous hyperintense fibroids may be enhanced by GnRH-a pretreated with HIFU, however it is important to rule out the slightly homogeneous hyperintense fibroids.
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Affiliation(s)
- Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jing-Wen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mei-Jie Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Qiao Zhong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Jin-Yun Chen
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Ng VWY, Cheung VYT. Successful Control of Heavy Menstrual Bleeding Using High-Intensity Focused Ultrasound Ablation of Fibroid Uterus in a Woman With Eisenmenger Syndrome. Cureus 2022; 14:e27165. [PMID: 36017286 PMCID: PMC9393315 DOI: 10.7759/cureus.27165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 12/01/2022] Open
Abstract
Uterine fibroid causes heavy menstrual bleeding and can be difficult to manage particularly in patients with complicated medical history. We present a woman with Eisenmenger syndrome, who presented with heavy menses due to fibroid uterus. She was advised against having hormonal therapy or major surgery under general anesthesia. We successfully controlled her heavy menses and avoided surgery using high-intensity focused ultrasound ablation of her fibroid.
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Arip M, Yap VL, Rajagopal M, Selvaraja M, Dharmendra K, Chinnapan S. Evidence-Based Management of Uterine Fibroids With Botanical Drugs-A Review. Front Pharmacol 2022; 13:878407. [PMID: 35800452 PMCID: PMC9256340 DOI: 10.3389/fphar.2022.878407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Uterine fibroids (UFs) are a common benign gynecological tumor that affect the majority of women over their lifetime. Several pharmacological agents are available to reduce the size of fibroids and ameliorate the symptoms of UF. However, these drugs are expensive and are usually associated with profound side effects. Thus, botanical drugs are gaining attention in this era due to their cost effectiveness with a comparable and more potent therapeutic efficacy while demonstrating lesser adverse effects. The objective of this review is to summarize the available information on the mechanism of various botanical drugs and polyherbal formulations with anti-uterine fibroid activity. A systematic search was performed on botanical drugs with anti-uterine fibroid activity using several search engines, which include PubMed, Google Scholar, and Science Direct. Based on the literatures identified, a total of five botanical drugs and three polyherbal formulations were included and discussed in this review, which yields useful information regarding the mechanism of different botanical drugs and polyherbal formulations in exerting anti-uterine fibroid activity for its potential use as an alternative treatment choice for uterine fibroids.
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Affiliation(s)
- Masita Arip
- Allergy and Immunology Research Centre, Institute for Medical Research, Ministry of Health Malaysia, National Institute of Health Complex, Setia Alam, Malaysia
| | - Vi Lien Yap
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Malaysia
- *Correspondence: Vi Lien Yap, ; Malarvili Selvaraja, ; Mogana Rajagopal,
| | - Mogana Rajagopal
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Malaysia
- *Correspondence: Vi Lien Yap, ; Malarvili Selvaraja, ; Mogana Rajagopal,
| | - Malarvili Selvaraja
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Malaysia
- *Correspondence: Vi Lien Yap, ; Malarvili Selvaraja, ; Mogana Rajagopal,
| | - K Dharmendra
- Narayan Institute of Pharmacy, Gopal Narayan Singh University, Jamuhar, India
| | - Sasikala Chinnapan
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Malaysia
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Ferrario L, Garagiola E, Gerardi C, Bellavia G, Colombo S, Ticca C, Rossetti C, Ciboldi M, Meroni M, Vanzulli A, Rampoldi A, Bignardi T, Arrigoni F, Porazzi E, Foglia E. Innovative and conventional "conservative" technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment. HEALTH ECONOMICS REVIEW 2022; 12:21. [PMID: 35303183 PMCID: PMC8932203 DOI: 10.1186/s13561-022-00367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard "conservative" procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE). METHODS A Health Technology Assessment was conducted, assuming the payer's perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients' clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids' experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy). RESULTS Literature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients' perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients' productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of - 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs. CONCLUSIONS Results suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.
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Affiliation(s)
- L Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy.
| | - E Garagiola
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
| | - C Gerardi
- IRCCS- Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - G Bellavia
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S Colombo
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Ticca
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Rossetti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Ciboldi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Meroni
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Vanzulli
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Rampoldi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - T Bignardi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - E Porazzi
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
| | - E Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
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Mlodawska OW, Saini P, Parker JB, Wei JJ, Bulun SE, Simon MA, Chakravarti D. Epigenomic and enhancer dysregulation in uterine leiomyomas. Hum Reprod Update 2022; 28:518-547. [PMID: 35199155 PMCID: PMC9247409 DOI: 10.1093/humupd/dmac008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine leiomyomas, also known as uterine fibroids or myomas, are the most common benign gynecological tumors and are found in women of reproductive and postmenopausal age. There is an exceptionally high prevalence of this tumor in women by the age of 50 years. Black women are particularly affected, with an increased incidence, earlier age of onset, larger and faster growing fibroids and greater severity of symptoms as compared to White women. Although advances in identifying genetic and environmental factors to delineate these fibroids have already been made, only recently has the role of epigenomics in the pathogenesis of this disease been considered. OBJECTIVE AND RATIONALE Over recent years, studies have identified multiple epigenomic aberrations that may contribute to leiomyoma development and growth. This review will focus on the most recent discoveries in three categories of epigenomic changes found in uterine fibroids, namely aberrant DNA methylation, histone tail modifications and histone variant exchange, and their translation into altered target gene architecture and transcriptional outcome. The findings demonstrating how the altered 3D shape of the enhancer can regulate gene expression from millions of base pairs away will be discussed. Additionally, translational implications of these discoveries and potential roadblocks in leiomyoma treatment will be addressed. SEARCH METHODS A comprehensive PubMed search was performed to identify published articles containing keywords relevant to the focus of the review, such as: uterine leiomyoma, uterine fibroids, epigenetic alterations, epigenomics, stem cells, chromatin modifications, extracellular matrix [ECM] organization, DNA methylation, enhancer, histone post-translational modifications and dysregulated gene expression. Articles until September 2021 were explored and evaluated to identify relevant updates in the field. Most of the articles focused on in the discussion were published between 2015 and 2021, although some key discoveries made before 2015 were included for background information and foundational purposes. We apologize to the authors whose work was not included because of space restrictions or inadvertent omission. OUTCOMES Chemical alterations to the DNA structure and of nucleosomal histones, without changing the underlying DNA sequence, have now been implicated in the phenotypic manifestation of uterine leiomyomas. Genome-wide DNA methylation analysis has revealed subsets of either suppressed or overexpressed genes accompanied by aberrant promoter methylation. Furthermore, differential promoter access resulting from altered 3D chromatin structure and histone modifications plays a role in regulating transcription of key genes thought to be involved in leiomyoma etiology. The dysregulated genes function in tumor suppression, apoptosis, angiogenesis, ECM formation, a variety of cancer-related signaling pathways and stem cell differentiation. Aberrant DNA methylation or histone modification is also observed in altering enhancer architecture, which leads to changes in enhancer-promoter contact strength, producing novel explanations for the overexpression of high mobility group AT-hook 2 and gene dysregulation found in mediator complex subunit 12 mutant fibroids. While many molecular mechanisms and epigenomic features have been investigated, the basis for the racial disparity observed among those in the Black population remains unclear. WIDER IMPLICATIONS A comprehensive understanding of the exact pathogenesis of uterine leiomyoma is lacking and requires attention as it can provide clues for prevention and viable non-surgical treatment. These findings will widen our knowledge of the role epigenomics plays in the mechanisms related to uterine leiomyoma development and highlight novel approaches for the prevention and identification of epigenome targets for long-term non-invasive treatment options of this significantly common disease.
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Affiliation(s)
| | | | - J Brandon Parker
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jian-Jun Wei
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Serdar E Bulun
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Debabrata Chakravarti
- Correspondence address. Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 303 E Superior Street, Lurie 4-119, Chicago, IL 60611, USA. E-mail:
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Thompson SM, Gorny KR, Koepsel EMK, Welch BT, Mynderse L, Lu A, Favazza CP, Felmlee JP, Woodrum DA. Body Interventional MRI for Diagnostic and Interventional Radiologists: Current Practice and Future Prospects. Radiographics 2021; 41:1785-1801. [PMID: 34597216 DOI: 10.1148/rg.2021210040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical use of MRI for guidance during interventional procedures emerged shortly after the introduction of clinical diagnostic MRI in the late 1980s. However, early applications of interventional MRI (iMRI) were limited owing to the lack of dedicated iMRI magnets, pulse sequences, and equipment. During the 3 decades that followed, technologic advancements in iMRI magnets that balance bore access and field strength, combined with the development of rapid MRI pulse sequences, surface coils, and commercially available MR-conditional devices, led to the rapid expansion of clinical iMRI applications, particularly in the field of body iMRI. iMRI offers several advantages, including superior soft-tissue resolution, ease of multiplanar imaging, lack of ionizing radiation, and capability to re-image the same section. Disadvantages include longer examination times, lack of MR-conditional equipment, less operator familiarity, and increased cost. Nonetheless, MRI guidance is particularly advantageous when the disease is best visualized with MRI and/or when superior soft-tissue contrast is needed for treatment monitoring. Safety in the iMRI environment is paramount and requires close collaboration among interventional radiologists, MR physicists, and all other iMRI team members. The implementation of risk-limiting measures for personnel and equipment in MR zones III and IV is key. Various commercially available MR-conditional needles, wires, and biopsy and ablation devices are now available throughout the world, depending on the local regulatory status. As such, there has been tremendous growth in the clinical applications of body iMRI, including localization of difficult lesions, biopsy, sclerotherapy, and cryoablation and thermal ablation of malignant and nonmalignant soft-tissue neoplasms. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Scott M Thompson
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Krzysztof R Gorny
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Erica M Knavel Koepsel
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Brian T Welch
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lance Mynderse
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Aiming Lu
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Christopher P Favazza
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joel P Felmlee
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David A Woodrum
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Comparison of Clinical Performance Between Two Generations of Magnetic Resonance-guided Focused Ultrasound Systems in Treatments of Uterine Leiomyomas. Acad Radiol 2021; 28:1361-1367. [PMID: 32631759 DOI: 10.1016/j.acra.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of technology improvements on the outcomes of magnetic resonance-guided focused ultrasound (MRgFUS) treatments of symptomatic uterine leiomyomas (uterine fibroids). The study compared ablation volumes and incidence of adverse events in patient groups treated with two generations of MRgFUS systems from a single vendor. METHODS The present study describes the results of a retrospective comparative study of two groups of women with symptomatic uterine leiomyomas who were clinically treated with MRgFUS at a single institution. Group 1 (n = 130) was treated using the first-generation system between March 2005 and December 2009. Group 2 (n = 71) was treated using the second-generation between December 2013 and September 2019. RESULTS The second-generation MRgFUS system resulted in significantly improved nonperfused volume ratios in both dark and bright T2 fibroid categories compared with the first-generation system (dark - 80% versus46 %, p = 0.00002 and bright - 46% versus 32%, p = 0.001). There have been no recorded hospital admissions, no skins burns, and no reported major adverse events since the introduction of this second-generation ExAblate 2100 system with advanced safety and treatment planning features. CONCLUSION This study has demonstrated that improvements to current MRgFUS technology resulted in significantly increased efficacy and patient safety of clinical treatments of patients with symptomatic uterine leiomyomas.
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Wang Y, Liu X, Wang W, Tang J, Song L. Long-term Clinical Outcomes of US-Guided High-Intensity Focused Ultrasound Ablation for Symptomatic Submucosal Fibroids: A Retrospective Comparison with Uterus-Sparing Surgery. Acad Radiol 2021; 28:1102-1107. [PMID: 32527707 DOI: 10.1016/j.acra.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/09/2023]
Abstract
RATIONALE AND OBJECTIVES Uterus-sparing surgery and ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation are both treatment options for symptomatic submucosal fibroids. No study had compared the long-term clinical outcomes between the two techniques. Therefore, the aim of this study was to compare the long-term clinical outcomes between US-guided HIFU ablation and uterus-sparing surgery for the treatment of symptomatic submucosal fibroids. MATERIALS AND METHODS A retrospective study was conducted on 245 women who were treated by US-guided HIFU ablation and 129 women who underwent uterus-sparing surgery for type I or type II symptomatic submucosal fibroids in a single institution from January 2007 to January 2015. The mean diameter of the fibroids was about 6 cm in both groups. They were followed up until December 2018. The symptom relief rate, symptom recurrence rate and incidence of major complications were compared between the two groups. RESULTS The symptom relief rate was 95.9% for US-guided HIFU ablation and 89.1% for uterus-sparing surgery. The cumulative symptom recurrence rate at 1-, 3-, 5-, and 8 years was 1.7%, 6.8%, 9.4%, and 11.9% for US-guided HIFU ablation and 6.1%, 12.2%, 22.6%, and 27.8% for uterus-sparing surgery. Compared to uterus-sparing surgery group, US-guided HIFU ablation had a statistically higher symptom relief rate and a lower symptom recurrence rate (p < 0.05). The major complication rate was 3.1% in the uterus-sparing surgery group. No major complications occurred in the US-guided HIFU ablation group. CONCLUSION This study showed that the long-term clinical outcomes of US-guided HIFU ablation may be better that of uterus-sparing surgery for the treatment of symptomatic submucosal fibroids. US-guided HIFU ablation may also be safer than uterus-sparing surgery. Further larger randomized trials are needed to confirm these findings.
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Laughlin-Tommaso SK, Gorny KR, Hesley GK, Vaughan LE, Woodrum DA, Lemens MA, Stewart EA. Uterine and Fibroid Imaging Analysis from the FIRSTT Study. J Womens Health (Larchmt) 2021; 31:546-554. [PMID: 34242085 DOI: 10.1089/jwh.2020.8892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Women with uterine fibroids often seek uterine-preserving treatments, rather than hysterectomy. Imaging-defined endpoints following nonsurgical treatments for fibroids are limited. Materials and Methods: Fibroid Interventions: Reducing Symptoms Today and Tomorrow (FIRSTT), a randomized controlled trial of uterine artery embolization (UAE) versus magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS), enrolled premenopausal women with symptomatic uterine fibroids. In this subanalysis, we report imaging results up to 36 months after UAE or MRgFUS. Magnetic resonance imaging (MRI) was performed at baseline for all women and during the 36 months after treatment if they did not meet other study endpoints. The main outcome of this subanalysis was fibroid volume reduction (defined both in terms of total fibroid load and volume of the largest fibroid), uterine volume reduction, and nonperfused volume. Results: During 2010-2014, 25 of the 37 women who were randomized and treated at Mayo Clinic had a 24-month follow-up MRI (11 UAE; 14 MRgFUS); among these women, 15 (7 UAE and 8 MRgFUS) had a 36-month follow-up MRI. Average age for the cohort was 44.1 (standard deviation, SD = 4.4) years. Nine patients had a second fibroid procedure by 36 months (seven in the MRgFUS arm and two in UAE arm). Median total fibroid load reduction was ∼50% in both treatment arms at both 24- and 36-month follow-up. Volume of the largest fibroid decreased more in the MRgFUS arm, whereas uterine volume decreased more in the UAE arm (neither reached statistical significance). At 24 months, median nonperfused volume was higher in the UAE arm (92%) than the MRgFUS arm (10%). Conclusions: Similar fibroid volume reduction was seen for the MRgFUS and UAE treatments in this comparative effectiveness study. Nonperfused volume 24 months after the procedure was higher in the UAE arm than in the MRgFUS arm. Clinical Trial Registration Number: NCT00995878, clinicaltrials.gov.
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Affiliation(s)
| | | | - Gina K Hesley
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maureen A Lemens
- Department of Obstetrics and Gynecology and Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology and Mayo Clinic, Rochester, Minnesota, USA
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Browne JE, Tiegs-Heiden CA, Lehman VT, Long Z, Hangiandreou NJ, Watson RE, Hesley GK, Gorny KR. Magnetic Resonance Imaging–Guided Focused Ultrasound Ablation of Lumbar Facet Joints of a Patient With a Magnetic Resonance Image Non-Conditional Pacemaker at 1.5T. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:464-468. [PMID: 32793874 PMCID: PMC7411156 DOI: 10.1016/j.mayocpiqo.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Patient and Methods Results Conclusion
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Yu SCH, Cheung ECW, Leung VYF, Fung LWY. Oxytocin-Augmented and Non-Sedating High-Intensity-Focused Ultrasound (HIFU) for Uterine Fibroids Showed Promising Outcome As Compared To HIFU Alone or Uterine Artery Embolization. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3207-3213. [PMID: 31493956 DOI: 10.1016/j.ultrasmedbio.2019.07.410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
The use of a modified energy transmission protocol and oxytocin augmentation is being proposed as a high-intensity-focused ultrasound (HIFU) treatment for uterine fibroids, to aim for an effective and well-tolerable treatment to be given as an out-patient procedure without anesthesia or sedation. The objective of this study was to evaluate the safety and treatment effectiveness of this new protocol. The treatment outcomes of 9 consecutive patients (study group) were compared with those of 51 patients (control group) who had been randomized (1:1) to receive HIFU (n = 24) or uterine artery embolization ([UAE] n = 27). There was no major adverse event. At 3 mo, the median proportion of fibroid volume compared with the baseline was 51.1% in the study group, significantly smaller than that in the control groups (HIFU 76.6%, UAE 66.2%). At 6 mo, all patients in the study group became symptom free (9/9, 100%), a result significantly better than that of both control groups. The proportion of patients with good quality of life was significantly higher in the study group (5/7, 71.4%) compared with the control groups (HIFU 3/24, 12.5%; UAE 7/27, 25.9%). Within 24 mo, none of the patients in the study HIFU group required re-intervention, a result significantly better than that in the control HIFU group (15/24, 62.5%). The treatment could result in a very promising long-term imaging and clinical outcome that may be better than those of UAE; however, a randomized control trial of larger scale is required for further evaluation of this treatment.
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Affiliation(s)
- Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR; Vascular and Interventional Radiology Clinical Science Center, The Chinese University of Hong Kong, Hong Kong SAR.
| | - Eva Chun-Wai Cheung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vivian Yee-Fong Leung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Linda Wen-Ying Fung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong SAR
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Sinha V, Mehta S, Kalantzis G, Steinberg F, LeBlang SD. Artifact from myomectomy/C-Section on MRI images - what does this mean for MR-guided focused ultrasound candidacy for uterine fibroids? Int J Hyperthermia 2019; 36:1079-1083. [PMID: 31709842 DOI: 10.1080/02656736.2019.1682689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Magnetic resonance-guided focused ultrasound (MRgFUS) is used for non-surgical treatment of uterine fibroids, often in patients who have had prior myomectomy or Cesarean section. The presence of post-surgical MRI artifacts along the beam path are a common contraindication to MRgFUS treatment. While potential problems arising from superficial cutaneous scars can be circumvented through scar patching and other techniques, deeper artifacts are difficult to bypass. Consequently, many patients with deeper artifacts are often excluded from treatment because of the assumption that these artifacts could deflect the ultrasound beam resulting in off target heating or perturb accurate MR thermometry. We sought to determine if these deep artifacts affect MRgFUS treatment efficacy or safety.Materials and Methods: A search of a MRgFUS center patient database yielded 19 patients with prior uterine surgery who had artifacts along the FUS beam path visible on MRI. Charts, operative reports (when available), screening MRI scans, and MRgFUS treatment scans were reviewed by an experienced MRgFUS treatment physician and artifacts were graded as mild, moderate, or severe.Results: One-way ANOVA showed no significant correlation between artifact severity and percent non-perfused volume (%NPV) (p = .41) or between fibroid size and % NPV (p = .49). There were no adverse events in this patient population except for one case of endometritis that occurred months after the operation, unlikely to be related to the MRgFUS treatments.Conclusion: Patients with uterine fibroids with post-operative susceptibility artifacts in the near-field can be successfully treated with MRgFUS.
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Affiliation(s)
- Vikash Sinha
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Shahil Mehta
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Suzanne D LeBlang
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.,University of Miami Miller School of Medicine, Miami, FL, USA.,University MRI, Boca Raton, FL, USA
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Lee JY, Chung HH, Kang SY, Park EJ, Park DH, Son K, Han JK. Portable ultrasound-guided high-intensity focused ultrasound with functions for safe and rapid ablation: prospective clinical trial for uterine fibroids—short-term and long-term results. Eur Radiol 2019; 30:1554-1563. [DOI: 10.1007/s00330-019-06468-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022]
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Verpalen IM, Anneveldt KJ, Nijholt IM, Schutte JM, Dijkstra JR, Franx A, Bartels LW, Moonen CT, Edens MA, Boomsma MF. Magnetic resonance-high intensity focused ultrasound (MR-HIFU) therapy of symptomatic uterine fibroids with unrestrictive treatment protocols: A systematic review and meta-analysis. Eur J Radiol 2019; 120:108700. [DOI: 10.1016/j.ejrad.2019.108700] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022]
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Dillon C, Rezvani M, McLean H, Adelman M, Dassel M, Jarboe E, Janát-Amsbury M, Payne A. A tissue preparation to characterize uterine fibroid tissue properties for thermal therapies. Med Phys 2019; 46:3344-3355. [PMID: 31152601 DOI: 10.1002/mp.13639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Treating uterine fibroids with less invasive therapies such as magnetic resonance-guided focused ultrasound (MRgFUS) is an attractive alternative to surgery. Treatment planning can improve MRgFUS procedures and reduce treatment times, but the tissue properties that currently inform treatment planning tools are not adequate. This study aims to develop an ex vivo uterine fibroid model that can emulate the in vivo environment allowing for characterization of the uterus and fibroid MR, acoustic, and thermal tissue properties while maintaining viability for the necessary postsurgical histopathological assessments. METHODS Women undergoing a hysterectomy due to fibroid-related symptoms were invited to undergo a preoperative pelvic MRI and to permit postoperative testing of their uterine specimen. Patients that declined or could not be scheduled for a pre-operative MRI were still able to allow post-operative testing of their excised tissue. Following surgical removal of the uterus, nonmorcellated tissues were reperfused with a Krebs-Henseleit buffer solution. An MR-compatible perfusion system was designed to maintain tissue viability inside the MR suite during scanning. MR imaging protocols utilized preoperatively were repeated on whole sample, reperfused ex vivo uterus specimens. Thermal properties including thermal diffusivity and thermal conductivity of the uterus and fibroids were determined using an invasive needle sensor device in 50% of the specimens. Acoustic property measurements (density, speed of sound and attenuation) were obtained for approximately 20% of the tissue samples using both through-transmission and radiation force balance techniques. Differences between fibroid and uterus and in vivo and ex vivo measurements were evaluated with a two-tailed Student t test. RESULTS Fourteen patients participated in the study and measurements were obtained from 22 unique fibroids. Of the 16 fibroids available for preoperative MRI testing, 69% demonstrated classic hypo-intensity relative to the myometrium, with the remainder presenting with iso- (25%) or hyper-intensity (6%). While thermal diffusivity was not significantly different between fibroid and myometrium tissues (0.217 ± 0.047 and 0.204 ± 0.039 mm2 /s, respectively), the acoustic attenuation in fibroid tissue was significantly higher than myometrium (0.092 ± 0.021 and 0.052 ± 0.023 Np/cm/MHz, respectively). When comparing in vivo with ex vivo MRI T1 and T2 measurements in fibroids and myometrium tissue, the only difference was found in the fibroid T2 property (P < 0.05). Finally, the developed perfusion protocol successfully maintained tissue viability in ex vivo tissues as evaluated through histological analysis. CONCLUSIONS This study developed an MR-compatible extracorporeal perfusion technique that effectively maintains tissue viability, allowing for the direct measurement of patient-specific MR, thermal, and acoustic property values for both fibroid and myometrium tissues. These measured tissue property values will enable further development and validation of treatment planning models that can be utilized during MRgFUS uterine fibroid treatments.
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Affiliation(s)
- Christopher Dillon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Maryam Rezvani
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Hailey McLean
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Marisa Adelman
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Mark Dassel
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Elke Jarboe
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Margit Janát-Amsbury
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
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Multiparametric MRI Characterization of Funaki Types of Uterine Fibroids Considered for MR-Guided High-Intensity Focused Ultrasound (MR-HIFU) Therapy. Acad Radiol 2019; 26:e9-e17. [PMID: 30064919 DOI: 10.1016/j.acra.2018.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/09/2018] [Accepted: 05/19/2018] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES To compare quantitative multiparametric magnetic resonance imaging (mpMRI) data of symptomatic uterine fibroids being considered for MR-guided high-intensity focused ultrasound ablation with fibroid characterization based on the Funaki Classification scheme. MATERIALS AND METHODS This was a prospective, Institutional Review Board -approved, Health Insurance Portability, and Accountability Act-compliant study. Informed consent was obtained. From December 2013 to April 2015, 48 women with symptomatic fibroids underwent screening with mpMRI protocol including sagittal/axial T2-weighted fast spin-echo, sagittal diffusion-weighted, and sagittal dynamic contrast-enhanced 3D T1-weighted gradient echo imaging on a 3T magnet. All fibroids were assigned Funaki type 1, 2, or 3 based on T2-weighted imaging. Differences in size, perfusion, and diffusion/intravoxel incoherent motion parameters among the three Funaki types were determined using linear mixed model. A logistic regression analysis was performed to select the best model in predicting type 3 fibroids. RESULTS A total of 100 fibroids were assessed (20 type 1, 66 type 2, and 14 type 3). Apparent diffusion coefficient and D of type 3 fibroids were significantly higher than those of type 1 (P < 0.0001, P < 0.0001) and 2 fibroids (P = 0.004, P < 0.0001) respectively. Transfer constant of type 3 fibroids was significantly higher than type 1 (P = 0.0357), but not than type 2 (P = 0.0752). A cutoff value of D = 1 × 10-3 mm2/s offers an accuracy, sensitivity, and specificity of 76%, 71%, and 77%, respectively, for the diagnosis of Funaki 3 fibroids. CONCLUSION mpMRI-derived quantitative parameters may enable a more objective selection of patients prior to MR-guided high-intensity focused ultrasound therapy.
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Laughlin-Tommaso S, Barnard EP, AbdElmagied AM, Vaughan LE, Weaver AL, Hesley GK, Woodrum DA, Jacoby VL, Kohi MP, Price TM, Nieves A, Miller MJ, Borah BJ, Moriarty JP, Gorny KR, Leppert PC, Severson AL, Lemens MA, Stewart EA. FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery. Am J Obstet Gynecol 2019; 220:174.e1-174.e13. [PMID: 30696556 DOI: 10.1016/j.ajog.2018.10.032] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Uterine leiomyomas (fibroid tumors) cause considerable symptoms in 30-50% of women and are the leading cause of hysterectomy in the United States. Women with uterine fibroid tumors often seek uterine-preserving treatments, but comparative effectiveness trials are lacking. OBJECTIVE The purpose of this study was to report treatment effectiveness and ovarian function after uterine artery embolization vs magnetic resonance imaging-guided focused ultrasound surgery from the Fibroid Interventions: Reducing Symptoms Today and Tomorrow study. STUDY DESIGN The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study, which is a randomized controlled trial of uterine artery embolization vs magnetic resonance imaging-guided focused ultrasound surgery, enrolled premenopausal women with symptomatic uterine fibroid tumors; women who declined randomization were enrolled in a parallel observational cohort. A comprehensive cohort design was used for outcomes analysis. Our target enrollment was 220 women, of which we achieved 41% (n=91) in the randomized and parallel arms of the trial. Primary outcome was reintervention for uterine fibroid tumors within 36 months. Secondary outcomes were change in serum anti-Müllerian hormone levels and standardized measures of fibroid symptoms, quality of life, pain, and sexual function. RESULTS From 2010-2014, 83 women (mean age, 44.4 years) were treated in the comprehensive cohort design (43 for magnetic resonance imaging-guided focused ultrasound surgery [27 randomized]; 40 for uterine artery embolization [22 randomized]); baseline clinical and uterine characteristics were similar between treatment arms, except for higher fibroid load in the uterine artery embolization arm. The risk of reintervention was higher with magnetic resonance imaging-guided focused ultrasound surgery than uterine artery embolization (hazard ratio, 2.81; 95% confidence interval, 1.01-7.79). Uterine artery embolization showed a significantly greater absolute decrease in anti-Müllerian hormone levels at 24 months compared with magnetic resonance imaging-guided focused ultrasound surgery. Quality of life and pain scores improved in both arms but to a greater extent in the uterine artery embolization arm. Higher pretreatment anti-Müllerian hormone level and younger age at treatment increased the overall risk of reintervention. CONCLUSION Our study demonstrates a lower reintervention rate and greater improvement in symptoms after uterine artery embolization, although some of the effectiveness may come through impairment of ovarian reserve. Both pretreatment anti-Müllerian hormone level and age are associated with risk of reintervention. CLINICAL TRIAL REGISTRATION NUMBER NCT00995878, clinicaltrials.gov.
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Affiliation(s)
| | - Emily P Barnard
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | | | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Thomas M Price
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Angel Nieves
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | | | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Phyllis C Leppert
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | | | - Maureen A Lemens
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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Liu X, Xue L, Wang Y, Wang W, Tang J. Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids. Int J Hyperthermia 2018; 35:510-517. [PMID: 30354861 DOI: 10.1080/02656736.2018.1510548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Xin Liu
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Lijuan Xue
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yang Wang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Wei Wang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas. Curr Opin Obstet Gynecol 2018; 30:279-286. [PMID: 29975307 DOI: 10.1097/gco.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy. RECENT FINDINGS In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk-benefit profile of nonexcisional procedures for management of leiomyomas will be addressed. SUMMARY This provides an update on the information available for more conservative options for symptomatic leiomyoma management.
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Qu F, Hor PH, Fischer J, Muthupillai R. Tissue characterization of uterine fibroids with an intravoxel incoherent motion model: The need for T 2 correction. J Magn Reson Imaging 2018; 48:994-1001. [PMID: 29504178 DOI: 10.1002/jmri.25988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/03/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Diminished signal intensity of uterine fibroids in T2 -weighted images is routinely used as a qualitative marker of fibroid hypoperfusion. However, quantitative classification of fibroid perfusion with intravoxel incoherent motion (IVIM) model-based metrics is not yet clinically accepted. PURPOSE To investigate the influence of T2 correction on the estimation of IVIM model parameters for characterizing uterine fibroid tissue. STUDY TYPE Prospective. POPULATION Fourteen women with 41 fibroids (12 Type I and 29 Type II, per Funaki classification) underwent diffusion-weighted imaging and T2 mapping. FIELD STRENGTH Diffusion-weighted images (b values: 0, 20, 40, 60, 100, 200, 400, 600, 800, 1000 s/mm2 ) and T2 maps were obtained at 1.5T. ASSESSMENT The effect of uterine fibroid T2 variation on IVIM model parameters (diffusion coefficient, perfusion coefficient, and perfusion volume fraction) were numerically modeled and experimentally evaluated without (D, D*, f) and with (Dc , <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:msubsup><mml:mi>D</mml:mi> <mml:mi>c</mml:mi> <mml:mo>*</mml:mo></mml:msubsup> </mml:mrow> </mml:math> , fc ) T2 correction. The relationship of T2 with D and the T2 -corrected perfusion volume fraction (fc ) was also examined. STATISTICAL TEST D-values and f-values estimated with and without T2 correction were compared by using a two-tailed Student's t-test. RESULTS Type II fibroids had higher D and f than Type I fibroids, but the differences were not significant (Type I vs. Type II, D: 0.83 ± 0.20 vs. 0.80 ± 0.25 mm2 /s, P = 0.78; f: 23.64 ± 4.87% vs. 25.27 ± 7.46%, P = 0.49). For Type I and Type II fibroids, fc was lower than f, and fc of Type II fibroids was significantly higher than that of Type I fibroids (Type I vs. Type II, fc : 7.80 ± 1.88% vs. 11.82 ± 4.13%, P = 0.003). Both D and fc exponentially increased with the increase of fibroid T2 as functions: <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:msub><mml:mi>D</mml:mi> <mml:mi>c</mml:mi></mml:msub> <mml:mrow><mml:mo>(</mml:mo> <mml:mrow><mml:msub><mml:mi>T</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> <mml:mo>)</mml:mo></mml:mrow> <mml:mo>=</mml:mo> <mml:mo>-</mml:mo> <mml:mn>1.52</mml:mn> <mml:mo>×</mml:mo> <mml:msup><mml:mrow><mml:mn>10</mml:mn></mml:mrow> <mml:mrow><mml:mo>-</mml:mo> <mml:mn>3</mml:mn></mml:mrow> </mml:msup> <mml:mo>⋅</mml:mo> <mml:msup><mml:mi>e</mml:mi> <mml:mrow><mml:mo>-</mml:mo> <mml:mn>3.42</mml:mn> <mml:mfrac> <mml:mrow><mml:msub><mml:mi>T</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> <mml:mrow><mml:mn>290</mml:mn></mml:mrow> </mml:mfrac> </mml:mrow> </mml:msup> <mml:mo>+</mml:mo> <mml:mn>1.84</mml:mn> <mml:mo>×</mml:mo> <mml:msup><mml:mrow><mml:mn>10</mml:mn></mml:mrow> <mml:mrow><mml:mo>-</mml:mo> <mml:mn>3</mml:mn></mml:mrow> </mml:msup> </mml:mrow> </mml:math> and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:msub><mml:mi>f</mml:mi> <mml:mi>c</mml:mi></mml:msub> <mml:mrow><mml:mo>(</mml:mo> <mml:mrow><mml:msub><mml:mi>T</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> <mml:mo>)</mml:mo></mml:mrow> <mml:mo>=</mml:mo> <mml:mo>-</mml:mo> <mml:mn>0.2336</mml:mn> <mml:mo>⋅</mml:mo> <mml:msup><mml:mi>e</mml:mi> <mml:mrow><mml:mo>-</mml:mo> <mml:mn>3.217</mml:mn> <mml:mfrac> <mml:mrow><mml:msub><mml:mi>T</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> <mml:mrow><mml:mn>290</mml:mn></mml:mrow> </mml:mfrac> </mml:mrow> </mml:msup> <mml:mo>+</mml:mo> <mml:mn>0.2269</mml:mn> <mml:mo>,</mml:mo></mml:mrow> </mml:math> respectively. D asymptotically approached 1.79 × 10-3 mm2 /s, and fc approached 21.74%. DATA CONCLUSION T2 correction is important when using IVIM-based models to characterize uterine fibroid tissue. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:994-1001.
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Affiliation(s)
- Feifei Qu
- Department of Physics, University of Houston, Houston, Texas, USA.,Texas Center for Superconductivity, Houston, Texas, USA
| | - Pei-Herng Hor
- Department of Physics, University of Houston, Houston, Texas, USA.,Texas Center for Superconductivity, Houston, Texas, USA
| | - John Fischer
- Department of Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Raja Muthupillai
- Department of Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas, USA.,Texas Heart Institute, Houston, Texas, USA
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Gingold JA, Gueye NA, Falcone T. Minimally Invasive Approaches to Myoma Management. J Minim Invasive Gynecol 2018; 25:237-250. [DOI: 10.1016/j.jmig.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Percutaneous High Frequency Microwave Ablation of Uterine Fibroids: Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2360107. [PMID: 29511672 PMCID: PMC5817312 DOI: 10.1155/2018/2360107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/29/2017] [Indexed: 01/20/2023]
Abstract
Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids.
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Cheung VY. High-intensity focused ultrasound therapy. Best Pract Res Clin Obstet Gynaecol 2018; 46:74-83. [DOI: 10.1016/j.bpobgyn.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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Hou R, Wang L, Li S, Rong F, Wang Y, Qin X, Wang S. Pilot study: safety and effectiveness of simple ultrasound-guided high-intensity focused ultrasound ablating uterine leiomyoma with a diameter greater than 10 cm. Br J Radiol 2017; 91:20160950. [PMID: 29091474 DOI: 10.1259/bjr.20160950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The study aimed to prospectively investigate whether uterine leiomyoma greater than 10 cm in diameter could be treated with simple ultrasound-guided high-intensity focused ultrasound (USgHIFU) in one-time treatment. METHODS A total of 36 patients with 36 symptomatic uterine leiomyoma greater than 10 cm in diameter who underwent simple USgHIFU treatment alone were analysed. Enhanced MRI was performed before and after HIFU treatment, and all patients had follow-up for 6 months after treatment. Symptom severity scores, treatment time, treatment speed, ablation rate, energy effect ratio, uterine leiomyoma regression rate, adverse events, liver and kidney functions, coagulation function and routine blood count were included in the study endpoints. RESULTS The mean diameter of uterine leiomyoma was 11.2 ± 1.3 cm (10.0-14.3 cm). The median treatment time and treatment speed were 104.0 min (90.0-140.0 min) and 118.8 cm3 h-1 (86.2-247.1 cm3 h-1), respectively. The ablation rate of uterine leiomyoma was 71.9 ± 20.4% (32.1-100.0%), and the regression rate of uterine leiomyoma was 40.8 ± 7.5% (25.6-59.9%) at 6 months after treatment. The mean symptom severity scores decreased by an average of approximately 8.6 ± 2.3 (5-14) points. There were no significant changes in haemogram and blood chemical indexes of patients, except for the transient elevation of aspartate aminotransferase, total bilirubin and white blood cells after treatment. No serious adverse reactions occurred. CONCLUSION According to our preliminary results, simple USgHIFU is a safe and effective single-treatment method of treating uterine leiomyoma greater than 10 cm in diameter and is an almost innocuous alternative therapeutic strategy. Advances in knowledge: The conclusions indicate simple USgHIFU is safe and effective as one-time treatment of uterine leiomyoma greater than 10 cm in diameter, it could be a promising therapeutic strategy.
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Affiliation(s)
- Ruijie Hou
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
| | - Liwei Wang
- 2 Department of Ultrasound,The First Affiliated Hospital of Xinxiang Medical , The First Affiliated Hospital of Xinxiang Medical , Weihui, Henan , PR China
| | - Shaoping Li
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
| | - Fengmin Rong
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
| | - Yuanyuan Wang
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
| | - Xuena Qin
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
| | - Shijin Wang
- 1 Department of Gynecology and Gynecology and Obstetrics,The First Affiliated Hospital of Xinxiang Medical University , The First Affiliated Hospital of Xinxiang Medical University , Weihui, Henan , PR China
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Peregrino PFM, de Lorenzo Messina M, dos Santos Simões R, Soares-Júnior JM, Baracat EC. Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids. Clinics (Sao Paulo) 2017; 72:637-641. [PMID: 29160427 PMCID: PMC5666446 DOI: 10.6061/clinics/2017(10)08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/04/2017] [Indexed: 12/15/2022] Open
Abstract
Uterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period. Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women. The aim of this study is to review the role of Magnetic resonance-guided high-intensity focused ultrasound in the treatment of uterine fibroids in symptomatic patients. We performed a review of the MEDLINE and Cochrane databases up to April 2016. The analysis and data collection were performed using the following keywords: Leiomyoma, High-Intensity Focused Ultrasound Ablation, Ultrasonography, Magnetic Resonance Imaging, Menorrhagia. Two reviewers independently performed a quality assessment; when there was a disagreement, a third reviewer was consulted. Nineteen studies of Magnetic resonance-guided high-intensity focused ultrasound-treated fibroid patients were selected. The data indicated that tumor size was reduced and that symptoms were improved after treatment. There were few adverse effects, and they were not severe. Some studies have reported that in some cases, additional sessions of Magnetic resonance-guided high-intensity focused ultrasound or other interventions, such as myomectomy, uterine artery embolization or even hysterectomy, were necessary. This review suggests that Magnetic resonance-guided high-intensity focused ultrasound is a safe and effective technique. However, additional evidence from future studies will be required before the technique can be recommended as an alternative treatment for fibroids.
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Affiliation(s)
- Pedro Felipe Magalhães Peregrino
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcos de Lorenzo Messina
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo dos Santos Simões
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Dillon CR, Rieke V, Ghanouni P, Payne A. Thermal diffusivity and perfusion constants from in vivo MR-guided focussed ultrasound treatments: a feasibility study. Int J Hyperthermia 2017; 34:352-362. [DOI: 10.1080/02656736.2017.1340677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Christopher R. Dillon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques. Radiology 2017; 280:675-92. [PMID: 27533290 DOI: 10.1148/radiol.2016141693] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.
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Affiliation(s)
- James E Silberzweig
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - Daniel K Powell
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - Alan H Matsumoto
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
| | - James B Spies
- From the Department of Radiology, Mount Sinai Beth Israel, New York, NY (J.E.S.); West Cancer Center, University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, TN 38138 (D.K.P.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (A.H.S.); and Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (J.B.S.)
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Barnard EP, AbdElmagied AM, Vaughan LE, Weaver AL, Laughlin-Tommaso SK, Hesley GK, Woodrum DA, Jacoby VL, Kohi MP, Price TM, Nieves A, Miller MJ, Borah BJ, Gorny KR, Leppert PC, Peterson LG, Stewart EA. Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis. Am J Obstet Gynecol 2017; 216:500.e1-500.e11. [PMID: 28063909 DOI: 10.1016/j.ajog.2016.12.177] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/21/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Uterine fibroids are a common problem for reproductive-aged women, yet little comparative effectiveness research is available to guide treatment choice. Uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery are minimally invasive therapies approved by the US Food and Drug Administration for treating symptomatic uterine fibroids. The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study is the first randomized controlled trial to compare these 2 fibroid treatments. OBJECTIVE The objective of the study was to summarize treatment parameters and compare recovery trajectory and adverse events in the first 6 weeks after treatment. STUDY DESIGN Premenopausal women with symptomatic uterine fibroids seen at 3 US academic medical centers were enrolled in the randomized controlled trial (n = 57). Women meeting identical criteria who declined randomization but agreed to study participation were enrolled in a nonrandomized parallel cohort (n = 34). The 2 treatment groups were analyzed by using a comprehensive cohort design. All women undergoing focused ultrasound and uterine artery embolization received the same postprocedure prescriptions, instructions, and symptom diaries for comparison of recovery in the first 6 weeks. Return to work and normal activities, medication use, symptoms, and adverse events were captured with postprocedure diaries. Data were analyzed using the Wilcoxon rank sum test or χ2 test. Multivariable regression was used to adjust for baseline pain levels and fibroid load when comparing opioid medication, adverse events, and recovery time between treatment groups because these factors varied at baseline between groups and could affect outcomes. Adverse events were also collected. RESULTS Of 83 women in the comprehensive cohort design who underwent treatment, 75 completed postprocedure diaries. Focused ultrasound surgery was a longer procedure than embolization (mean [SD], 405 [146] vs 139 [44] min; P <.001). Of women undergoing focused ultrasound (n = 43), 23 (53%) underwent 2 treatment days. Immediate self-rated postprocedure pain was higher after uterine artery embolization than focused ultrasound (median [interquartile range], 5 [1-7] vs 1 [1-4]; P = .002). Compared with those having focused ultrasound (n = 39), women undergoing embolization (n = 36) were more likely to use outpatient opioid (75% vs 21%; P < .001) and nonsteroidal antiinflammatory medications (97% vs 67%; P < .001) and to have a longer median (interquartile range) recovery time (days off work, 8 [6-14] vs 4 [2-7]; P < .001; days until return to normal, 15 [10-29] vs 10 [10-15]; P = .02). There were no significant differences in the incidence or severity of adverse events between treatment arms; 86% of adverse events (42 of 49) required only observation or nominal treatment, and no events caused permanent sequelae or death. After adjustment for baseline pain and uterine fibroid load, uterine artery embolization was still significantly associated with higher opioid use and longer time to return to work and normal activities (P < .001 for each). Results were similar when restricted to the randomized controlled trial. CONCLUSION Women undergoing uterine artery embolization have longer recovery times and use more prescription medications, but women undergoing focused ultrasound have longer treatment times. These findings were independent of baseline pain levels and fibroid load.
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Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound 2017; 5:8. [PMID: 28194274 PMCID: PMC5299783 DOI: 10.1186/s40349-017-0088-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. The aim of this study was to explore if a sedation regimen with low-dose propofol and ketamine performed by trained non-medical sedation practitioners could result in relief of discomfort for the patient and in adequate working conditions for MR-HIFU treatment for uterine fibroids. Methods In this study, conducted from August 2013 until November 2014, 20 patients were subjected to MR-HIFU treatment of uterine fibroids. Patients were deeply sedated using intravenous propofol and esketamine according to a standardised hospital protocol to allow synchronisation of the breathing pattern to the MR-HIFU. The quality of sedation for MR-HIFU and complications were recorded and analysed. The side effects of the sedation technique, the propofol and esketamine consumption rate, the duration of recovery, and patient satisfaction after 24 h were examined. Results A total of 20 female patients (mean age 42.4 [range 32–53] years) were enrolled. Mean propofol/esketamine dose was 1309 mg/39.5 mg (range 692–1970 mg/ 23.6–87.9 mg). Mean procedure time was 269 min (range 140–295 min). Application of the sedation protocol resulted in a regular breathing pattern, which could be synchronised with the MR-HIFU procedures without delay. The required treatment was completed in all cases. There were no major adverse events. Hypoxemia (oxygen desaturation <92%) and hallucinations were not observed. Conclusions The use of a specific combination of IV propofol and esketamine for procedural sedation and analgesia reduced the discomfort and pain during MR-guided HIFU treatments of uterine fibroids. The resulting regular breathing pattern allowed for easy synchronisation of the MR-HIFU procedure. Based on our results, esketamine and propofol sedation performed by trained non-medical sedation practitioners is feasible and safe, has a low risk of major adverse events, and has a short recovery time, avoiding a session of general anaesthesia. Electronic supplementary material The online version of this article (doi:10.1186/s40349-017-0088-9) contains supplementary material, which is available to authorized users.
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Moroni RM, Martins WP, Messina MDL, Ferriani RA, Peregrino P, Rosa-e-Silva JC, Nogueira AA, Brito LG. High-intensity focused ultrasound for symptomatic uterine fibroids. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rafael M Moroni
- University of Sao Paulo; Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto; Avenida Bandeirantes, 3900, 8th floor ? Monte Alegre Ribeirao Preto Ribeirao Preto Brazil 14049-900
| | - Wellington P Martins
- University of Sao Paulo; Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto; Avenida Bandeirantes, 3900, 8th floor ? Monte Alegre Ribeirao Preto Ribeirao Preto Brazil 14049-900
| | - Marcos de Lorenzo Messina
- School of Medicine, University of São Paulo; Department of Obstetrics and Gynecology; Avenida Doutor Eneas de Carvalho Aguiar, 255 Sao Paolo Brazil 05403-010
| | - Rui A Ferriani
- University of Sao Paulo; Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto; Avenida Bandeirantes, 3900, 8th floor ? Monte Alegre Ribeirao Preto Ribeirao Preto Brazil 14049-900
| | - Pedro Peregrino
- University of Sao Paulo; School of Medicine; Avenida Doutor Eneas de Carvalho Aguiar, 255 Sao Paulo Brazil 05403-010
| | - Julio Cesar Rosa-e-Silva
- University of São Paulo; Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto; Avenida Bandeirantes 3900 Ribeirão Preto Brazil 14049-900
| | - Antonio Alberto Nogueira
- Medical School of Ribeirão Preto, University of São Paulo; Department of Obstetrics and Gynecology; Avenida dos Bandeirantes, 3900 Ribeirão Preto Brazil 14049-900
| | - Luiz Gustavo Brito
- State University of Campinas (UNICAMP); Department of Gynecology and Obstetrics; Rua Alexander Fleming, 101 Cidade Universitária Zeferino Vaz Campinas Sao Paulo Brazil 13083-881
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Chang I, Hwang KJ, Choi HJ, Yoon HJ, Lee ES, Choi SY. HIFU: Effects and Clinical Effectiveness of Non-surgical Therapy for Uterine Fibroids. J Menopausal Med 2016; 22:59-61. [PMID: 27617237 PMCID: PMC5016503 DOI: 10.6118/jmm.2016.22.2.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/13/2016] [Accepted: 06/30/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ikjin Chang
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
| | - Kyung Jin Hwang
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
| | - Ho Jin Choi
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
| | - Hyo Jin Yoon
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
| | - Eung Seok Lee
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
| | - Sun Young Choi
- Department of Obstetrics and Gynecology, Grace Women's Hospital, Goyang, Korea
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Zhu Y, Keserci B, Viitala A, Wei J, Yang X, Wang X. Volumetric MR-guided high-intensity focused ultrasound ablation to treat uterine fibroids through the abdominal scars using scar patch: a case report. J Ther Ultrasound 2016; 4:20. [PMID: 27525101 PMCID: PMC4982143 DOI: 10.1186/s40349-016-0064-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal scars pose a challenge in magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) therapies, limiting patient selection and increasing the risk of skin burns. Especially, scars arising from longitudinal incisions are problematic as they usually lie medially at the lower abdomen where the ultrasound beam has to go through. Volumetric sonication has been shown to efficiently enlarge the ablated volume per sonication, but they nevertheless require more thermal energy to be deposited per sonication which increases the temperature in the near-field area located between the transducer and the target region. CASE PRESENTATION The scar patch was used in three patients undergoing MR-HIFU ablation of fibroids using volumetric technique, one with transverse incision and the other two with longitudinal incision. No severe adverse effects were observed. The relative shrinkage of the fibroid of these patients at 6-month follow-up were 67, 78, and 59 %, respectively. CONCLUSIONS Our preliminary experience suggests that the use of scar patch on MR-HIFU ablation of fibroids using volumetric technique provides an effective treatment option for patients who were previously excluded from MR-HIFU treatment due to the abdominal scars.
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Affiliation(s)
- Ying Zhu
- Radiology Department, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034 China
| | | | | | - Juan Wei
- Philips Research China, Shanghai, China
| | - Xuedong Yang
- Radiology Department, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034 China
| | - Xiaoying Wang
- Radiology Department, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034 China
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Zupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia F. Nonsurgical Alternatives for Uterine Fibroids. Best Pract Res Clin Obstet Gynaecol 2015; 34:122-31. [PMID: 26711881 DOI: 10.1016/j.bpobgyn.2015.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022]
Abstract
Uterine leiomyomata are the direct cause of a significant health-care burden for women, their families, and society as a whole. Because of the long experience with the mode of treatment, surgical myomectomy remains the gold standard for treating reproductive-age women; however, in the recent years, the wide evolution of less invasive approaches led to a change in the options used by the clinician to treat symptomatic fibroids. Minimally invasive procedures such as uterine artery embolization (UAE) are increasingly used to treat symptomatic fibroids. Other alternative treatments are becoming more diffuse, such as magnetic resonance-guided high-frequency focused ultrasound surgery (MRgFUS), cryomyolysis, vaginal occlusion, and laparoscopic closure of the uterine arteries. Both advantages and limitations of these techniques under development must be taken into account, but this wider range of choices is being increasingly considered for a tailored treatment. This article aims to enable health-care providers with the tools to provide the latest evidence-based care in the minimally invasive or noninvasive management of this common problem.
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Affiliation(s)
- Errico Zupi
- Department of Biomedicine and Prevention University of Tor Vergata, Rome, Italy.
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lorenzo Sabbioni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - István Máté Argay
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Zhao WP, Chen JY, Chen WZ. Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images. Exp Ther Med 2015; 11:328-334. [PMID: 26889263 DOI: 10.3892/etm.2015.2879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/02/2015] [Indexed: 01/20/2023] Open
Abstract
The aim of the present study was to investigate the efficacy of dynamic contrast-enhanced magnetic resonance imaging (MRI) in predicting the outcome of using ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of uterine fibroids with T2 hyperintensity under MRI. A total of 131 uterine fibroids from 131 patients that appeared hyperintense under T2-weighted MRI were analyzed. The uterine fibroids were subjectively categorized into slight, irregular or regular enhancement groups, according to pretreatment dynamic contrast-enhanced MRI in the arterial phase within 60 sec after the injection of gadolinium. The non-perfused volume (NPV), which is indicative of successful ablation, was represented as the non-perfused area inside the uterine fibroids on enhanced MRI scans following treatment. Additionally, the treatment duration, treatment efficiency, sonication duration, energy efficiency ratio and any adverse events were recorded. The results indicated that the average NPV ratio for all the treated fibroids was 68.5%, while the average NPV ratios for fibroids with slight, irregular or regular enhancement were 84.7, 70.6 and 57.1%, respectively. Fibroids with regular enhancement were associated with the lowest NPV ratio and the lowest treatment efficiency, but exhibited the highest energy effect ratio and an elevated risk of severe adverse effects. The results of the present study indicate that hyperintense uterine fibroids with slight and irregular enhancement in the arterial phase of dynamic contrast-enhanced MRI are suitable for USgHIFU treatment. By contrast, uterine fibroids with regular enhancement were associated with the lowest treatment efficacy and safety.
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Affiliation(s)
- Wen-Peng Zhao
- State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China; Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wen-Zhi Chen
- State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China; Clinical Center for Tumor Therapy, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
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Three cases of complications after high-intensity focused ultrasound treatment in unmarried women. Obstet Gynecol Sci 2015; 58:542-6. [PMID: 26623424 PMCID: PMC4663238 DOI: 10.5468/ogs.2015.58.6.542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/27/2015] [Accepted: 06/09/2015] [Indexed: 01/20/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) has been regarded as a non-surgical, minimally invasive therapeutic option for patients who prioritize uterus-conservation. Although many studies have shown that HIFU therapy is a safe and effective treatment of uterine fibroid, not all fibroids are suitable for HIFU due to risks of serious complications. We experienced three cases of complications after the HIFU ablation for huge uterine fibroids, including two cases of rapid myoma enlargement and one case of heavy vaginal bleeding.
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Chen J, Chen W, Zhang L, Li K, Peng S, He M, Hu L. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: A review of 9988 cases. ULTRASONICS SONOCHEMISTRY 2015; 27:671-676. [PMID: 26093678 DOI: 10.1016/j.ultsonch.2015.05.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the incidence and severity of adverse reactions to ultrasound-guided ultrasound ablation of uterine fibroids through a multicenter, large-scale retrospective study. METHODS Between July 2006 and June 2007, 9988 patients with uterine fibroids or adenomyosis were enrolled and received ultrasound ablation treatment under conscious sedation. Forty-two doctors administrated the treatment following a standardized clinical protocol. In-treatment and post-treatment side effects and complications were monitored and each patient was followed up for at least 6 months after the treatment. Complications were classified and graded according to the SIR classification system. The technical success and safety of the treatment were evaluated. RESULTS The mean age of the 9988 patients was 40.4±5.8 years (range, 20-56 years). Among them, 7438 had uterine fibroids and 2549 had adenomyosis. Specifically, 6545 patients had solitary uterine fibroid, 818 had multiple uterine fibroids, and 76 had fibroids complicated with adenomyosis. There were mainly three types of fibroids: submucous myoma in 89 patients (12.0%), intramural myoma in 5059 patients (68.0%) and subserosal myoma in 1478 patients (20.0%). In terms of fibroid location, 3496 fibroids were found in the anterior wall (47.0%), 2306 in the posterior wall (31.0%), 447 in the lateral wall (6.0%), and 1190 in fundus (16.0%). The length of treatment for uterine fibroids and adenomyosis averaged 84.2±38.8 min (range, 30.0-240.0 min) and 93.3±55.4 min (range, 15.0-240.0 min), respectively; and the lengths of sonication were 1243.8±725.2 s (range, 506.0-2658.0 s) and 1169.7±707.7 s (range, 185.0-3600.0 s), respectively. Of the uterine fibroids patients, 98.38% (7319/7439) underwent successful ablation with a mean volume ablation rate of 83.1%±15.6% (range, 25-100%). Of the adenomyosis patients, 94.59% (2411/2549) underwent successful ablation with a mean volume ablation rate of 73.2%±23.6% (range, 21-100%). A total of 1062 patients (10.6%) presented with 1305 events of adverse reactions. According to the SIR classification system, 1228 (94.1%) of these reactions fell under Class A; 45 (3.4%) fell under Class B; 24 (1.8%) fell under Class C; and the rest 8 (0.6%) fell under Class D. Adverse reactions included 874 cases (8.67%) of vaginal secretion, 225 cases (2.23%) of lower abdominal pain 24h after the treatment but requiring no painkillers, 76 cases (0.76%) of melosalgia or buttock pain, 52 cases (0.52%) of odynuria, 20 cases (0.20%) of menstruation-like vaginal bleeding, 2 cases (0.2%) of temporary blurred vision, 26 cases (0.26%) of blisters or tangerine pericarp-like burns in the abdominal skin, 16 cases (0.16%) of urinary retention, 4 cases (0.4%) of fever of 38.5°C, 3 cases (0.3%) of acute renal insufficiency, 2 cases (0.2%) of intestinal perforation, and 1 case (0.01%) of long-term lateral ventral syndrome. No permanent injury or fatal complication occurred. CONCLUSIONS Based on our observations from 9988 cases, ultrasound ablation treatment for uterine fibroid and adenomyosis is highly effective and safe. Adverse reactions to ultrasound ablation under conscious sedation are slight and temporary for both conditions. Hence, this clinically effective and safe treatment is an alternative treatment for women with uterine fibroids and adenomyosis.
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Affiliation(s)
- Jinyun Chen
- The Institute of Ultrasound Engineering in Medicine, Chongqing Medical University, 1 Yixueyuan Road, Box 153, Chongqing 400016, China
| | - Wenzhi Chen
- The Institute of Ultrasound Engineering in Medicine, Chongqing Medical University, 1 Yixueyuan Road, Box 153, Chongqing 400016, China; Clinical Center for Tumor Therapy, The 2nd Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing 400010, China.
| | - Lian Zhang
- Clinical Center for Tumor Therapy, The 2nd Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing 400010, China
| | - Kequan Li
- Department of Obstetrics of Chongqing Haifu Hospital, Qingsong Road, Renhe, Yubei District, Chongqing 401121, China
| | - Song Peng
- The Institute of Ultrasound Engineering in Medicine, Chongqing Medical University, 1 Yixueyuan Road, Box 153, Chongqing 400016, China
| | - Min He
- Department of Obstetrics of Chongqing Haifu Hospital, Qingsong Road, Renhe, Yubei District, Chongqing 401121, China
| | - Liang Hu
- The Institute of Ultrasound Engineering in Medicine, Chongqing Medical University, 1 Yixueyuan Road, Box 153, Chongqing 400016, China
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Thiburce AC, Frulio N, Hocquelet A, Maire F, Salut C, Balageas P, Bouzgarrou M, Hocké C, Trillaud H. Magnetic resonance-guided high-intensity focused ultrasound for uterine fibroids: Mid-term outcomes of 36 patients treated with the Sonalleve system. Int J Hyperthermia 2015; 31:764-70. [DOI: 10.3109/02656736.2015.1063169] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Militello C, Vitabile S, Rundo L, Russo G, Midiri M, Gilardi MC. A fully automatic 2D segmentation method for uterine fibroid in MRgFUS treatment evaluation. Comput Biol Med 2015; 62:277-92. [DOI: 10.1016/j.compbiomed.2015.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 04/01/2015] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
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Abstract
In addition to surgical methods of treating uterine fibroids, numerous non-invasive treatments have been developed. Many of these involve the use of hyperthermia, the heating of tissue by a variety of methods. These include the use of lasers, radiofrequency, microwave energy and high intensity focused ultrasound, guided by both ultrasound and magnetic resonance imaging. In this review we examine the technology behind these treatment modalities and review the current evidence for their use.
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Affiliation(s)
- Stephen Derek Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London and
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Carrasco-Choque AL, Lara YFD, Vivas-Bonilla I, Romero-Trejo C, Villa AR, Roldan-Valadez E. Perfusion volume correlates, percentage of involution, and clinical efficacy at diverse follow-up survey times after MR-guided focused ultrasound surgery in uterine fibroids: first report in a Mexican mestizo population. Eur Radiol 2015; 25:2905-12. [PMID: 25809744 DOI: 10.1007/s00330-015-3707-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the clinical efficacy of magnetic resonance-guided focused ultrasound surgery in a Mexican mestizo population. METHODS This retrospective study included 159 women (mean age 37 ± 6.4 years, range 22-53 years) from 2008 to 2010. Two hundred sixty-eight symptomatic uterine fibroids were treated using MR-guided focused ultrasound surgery. Parameters included initial perfused volume, final perfused volume, non-perfused volume (NPV), and treated volume ratio (TVR). Follow-up up to 15 months assessed treatment efficacy and symptomatic relief. Non-parametric statistics and the Kaplan-Meier method were performed. RESULTS T2-weighted hypointense fibroids showed a frequency of 93.6%; isointense and hyperintense fibroids had frequencies of 5.60 and 1.1%. There was a negative correlation between NPV and age (r = -0.083, p = 0.307) and treatment time (r = -0.253, p = 0.001). Median TVR was 96.0% in small fibroids and 76.5% in large fibroids. Involution of 50% and 80% was achieved at months 6-7 and month 11, respectively. Relief of symptoms was significant (p < 0.05). CONCLUSIONS Our data show that higher TVR attained immediately post-treatment of MRgFUS favours higher involution percentages at follow-up; however, careful patient selection and use of pretreatment imaging are important components for predicting success using MR-guided focused ultrasound surgery. KEY POINTS • Type 1 fibroids were the most common (93.2%). • Age and treated volume were not correlated (r s = -0.215, p = 0.165). • Small fibroids achieved a higher treated volume than large (96.0% vs. 76.5%). • A 50% involution was achieved at 6-month follow-up for type-1 fibroid. • A decrease of 80% was reached at 11 months for type-1 fibroids.
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Abstract
Ultrasound therapy has been investigated for over half a century. Ultrasound can act on tissue through a variety of mechanisms, including thermal, shockwave and cavitation mechanisms, and through these can elicit different responses. Ultrasound therapy can provide a non-invasive or minimally invasive treatment option, and ultrasound technology has advanced to the point where devices can be developed to investigate a wide range of applications. This review focuses on non-cancer clinical applications of therapeutic ultrasound, with an emphasis on treatments that have recently reached clinical investigations, and preclinical research programmes that have great potential to impact patient care.
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Babashov V, Palimaka S, Blackhouse G, O'Reilly D. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) for Treatment of Symptomatic Uterine Fibroids: An Economic Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2015; 15:1-61. [PMID: 26357531 PMCID: PMC4558770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Uterine fibroids, or leiomyomas, are the most common benign tumours in women of childbearing age. Some women experience symptoms (e.g., heavy bleeding) that require aggressive forms of treatment such as uterine artery embolization (UAE), myomectomy, magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU), and even hysterectomy. It is important to note that hysterectomy is not appropriate for women who desire future childbearing. OBJECTIVES The objective of this analysis was to evaluate the cost-effectiveness and budgetary impact of implementing MRgHIFU as a treatment option for symptomatic uterine fibroids in premenopausal women for whom drugs have been ineffective. REVIEW METHODS We performed an original cost-effectiveness analysis to assess the long-term costs and effects of MRgHIFU compared with hysterectomy, myomectomy, and UAE as a strategy for treating symptomatic uterine fibroids in premenopausal women aged 40 to 51 years. We explored a number of scenarios, e.g., comparing MRgHIFU with uterine-preserving procedures only, considering MRgHIFU-eligible patients only, and eliminating UAE as a treatment option. In addition, we performed a one-year budget impact analysis, using data from Ontario administrative sources. Four scenarios were explored in the budgetary impact analysis: •MRgHIFU funded at 2 centres •MRgHIFU funded at 2 centres and replacing only uterine-preserving procedures •MRgHIFU funded at 6 centres •MRgHIFU funded at 6 centres and replacing only uterine-preserving procedures Analyses were conducted from the Ontario public payer perspective. RESULTS The base case determined that the uterine artery embolization (UAE) treatment strategy was the cost-effective option at commonly accepted willingness-to-pay values. Compared with hysterectomy, UAE was calculated as having an incremental cost-effectiveness ratio (ICER) of $46,480 per quality-adjusted life-year (QALY) gained. The MRgHIFU strategy was extendedly dominated by a combination of UAE and hysterectomy, and myomectomy was strictly dominated by MRgHIFU and UAE. In the scenario where only MRgHIFU-eligible patients were considered, MRgHIFU was the cost-effective option for a willingness-to-pay threshold of $50,000. In the scenario where only MRgHIFU-eligible patients were considered and where UAE was eliminated as a treatment option (due to its low historic utilization in Ontario), MRgHIFU was cost-effective with an incremental cost of $39,250 per additional QALY. The budgetary impact of funding MRgHIFU for treatment of symptomatic uterine fibroids was estimated at $1.38 million in savings when funded to replace all types of procedures at 2 centres, and $1.14 million when funded to replace only uterine-preserving procedures at 2 centres. The potential savings increase to $4.15 million when MRgHIFU is funded at 6 centres to treat all women eligible for the procedure. Potential savings at 6 centres decrease slightly, to $3.42 million, when MRgHIFU is funded to replace uterine-preserving procedures only. CONCLUSIONS Our findings suggest that MRgHIFU may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds, after examining the uncertainty in model parameters and several likely scenarios. In terms of budget impact, the implementation of MRgHIFU could potentially result in one-year savings of $1.38 million and $4.15 million in the scenarios where MRgHIFU is implemented in 2 or 6 centres, respectively. From a patient perspective, it is important to consider that MRgHIFU is the least invasive of all fibroid treatment options for women who have not responded to pharmaceuticals; it is the only one that is completely noninvasive. Also important, from a societal point of view, is the potential benefit from faster recovery times. Despite these benefits, implementation of MRgHIFU beyond the 2 centres which currently offer the treatment faces logistical challenges (for example, competing demands for use of existing equipment), as well as financial challenges, with hospitals needing to fundraise to purchase new equipment.
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Pron G. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2015; 15:1-86. [PMID: 26357530 PMCID: PMC4558769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. OBJECTIVES The objectives of the analysis were to evaluate patients' eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. METHODS A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. RESULTS The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and other guidance methods, other minimally invasive treatments, or surgeries for symptomatic uterine fibroids. Limitations with MRgHIFU included restricted eligibility, requirement for a dedicated MR device to guide the treatment, lengthy procedure time, and loss of MR opportunity time. CONCLUSIONS For women failing medical therapy and seeking alternatives to hysterectomy for symptomatic uterine fibroids, MRgHIFU provides a safe and effective, noninvasive, uterine-preserving treatment from which they rapidly recover. The treatment advantages of MRgHIFU are potentially offset by restrictive eligibility, lengthy procedure time, and dependence on availability of an MR device. The lack of comparative evidence between MRgHIFU and other, more established uterine-preserving treatments limits informed decision making among treatment options.
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