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. 2011 Aug;18(8):970-6.
doi: 10.1016/j.acra.2011.03.008.

MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes

Hyun S Kim  1 , Jun-Hyun Baik, Luu D Pham, Michael A Jacobs
Affiliations

MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes

Hyun S Kim et al. Acad Radiol. 2011 Aug.

Abstract

Rationale and objectives: To evaluate the long-term clinical outcomes of magnetic resonance--guided high-intensity focused ultrasound (MR-g HIFU) treatments for symptomatic uterine leiomyomata.

Materials and methods: Patients were recruited for a prospective study for MR-g HIFU treatments of symptomatic leiomyomata, with up to 3-year follow-up. The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act--compliant. Clinical assessments were obtained at 3 months, 6 months, and 1, 2, and 3 years after MR-g HIFU, as well as uterine fibroid symptom severity scores (SSS) and health-related quality of life questionnaires (UFS-QOL). MR imaging was performed at each follow-up to assess the efficacy of the treatment at 6 months, 1 year, 2 years, and 3 years.

Results: Fifty-one leiomyomata in 40 patients were treated. All patients were treated within the US Food and Drug Administration guidelines with leiomyomata localized on MR and treated with sonication. The mean baseline volume of treated leiomyomata was 336.9 cm(3). The mean improvement scores for transformed SSS was 47.8 (P < .001) and for tUFS-QOL was 39.8 (P < .001) at 3 years. The mean volume decrease in treated leiomyomata was 32.0% (P < .001), and, in the uterus, the volume decrease was 27.7% (P < .001) at 3 years. There were no long-term complications.

Conclusions: Long-term follow-up data from MR-g HIFU treatments show sustained symptomatic relief among enrolled patients. Although the results are preliminary, MR-g HIFU for the treatment of uterine leiomyomata may result in acceptable long-term outcomes at 3 years.

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Figures

Figure 1
Figure 1
Figure 1a. Baseline T2-weighed sagittal MR image showing a dominant leiomyoma (closed arrow) with the patient in a prone position. Note the top of uterus at the level of upper end plate of L5 vertebral body (open arrow). Figure 1b. Baseline T1-weighted axial MR image after Gd contrast with the patient in a prone position showing homogeneous enhancement (arrow) in the leiomyoma. Figure 1c. T1-weighted axial MR image, with the patient in a prone position, immediately after MR-g HIFU treatment demonstrates non-enhancing region (closed arrow) that corresponds to the treatment-effect area. Note the thick gel membrane (open arrow) with degassed water under the patient. Figure 1d. T2-weighted MR image, with the patient in a supine position three years after MR-g HIFU treatment. Note significant decrease in the dominant leiomyoma volume (open arrow). Note a closed arrow at the level of upper end plate of L5 vertebral body as a reference to compare to pre-MR-g HIFU treatment uterus and fibroid volumes.
Figure 1
Figure 1
Figure 1a. Baseline T2-weighed sagittal MR image showing a dominant leiomyoma (closed arrow) with the patient in a prone position. Note the top of uterus at the level of upper end plate of L5 vertebral body (open arrow). Figure 1b. Baseline T1-weighted axial MR image after Gd contrast with the patient in a prone position showing homogeneous enhancement (arrow) in the leiomyoma. Figure 1c. T1-weighted axial MR image, with the patient in a prone position, immediately after MR-g HIFU treatment demonstrates non-enhancing region (closed arrow) that corresponds to the treatment-effect area. Note the thick gel membrane (open arrow) with degassed water under the patient. Figure 1d. T2-weighted MR image, with the patient in a supine position three years after MR-g HIFU treatment. Note significant decrease in the dominant leiomyoma volume (open arrow). Note a closed arrow at the level of upper end plate of L5 vertebral body as a reference to compare to pre-MR-g HIFU treatment uterus and fibroid volumes.
Figure 1
Figure 1
Figure 1a. Baseline T2-weighed sagittal MR image showing a dominant leiomyoma (closed arrow) with the patient in a prone position. Note the top of uterus at the level of upper end plate of L5 vertebral body (open arrow). Figure 1b. Baseline T1-weighted axial MR image after Gd contrast with the patient in a prone position showing homogeneous enhancement (arrow) in the leiomyoma. Figure 1c. T1-weighted axial MR image, with the patient in a prone position, immediately after MR-g HIFU treatment demonstrates non-enhancing region (closed arrow) that corresponds to the treatment-effect area. Note the thick gel membrane (open arrow) with degassed water under the patient. Figure 1d. T2-weighted MR image, with the patient in a supine position three years after MR-g HIFU treatment. Note significant decrease in the dominant leiomyoma volume (open arrow). Note a closed arrow at the level of upper end plate of L5 vertebral body as a reference to compare to pre-MR-g HIFU treatment uterus and fibroid volumes.
Figure 1
Figure 1
Figure 1a. Baseline T2-weighed sagittal MR image showing a dominant leiomyoma (closed arrow) with the patient in a prone position. Note the top of uterus at the level of upper end plate of L5 vertebral body (open arrow). Figure 1b. Baseline T1-weighted axial MR image after Gd contrast with the patient in a prone position showing homogeneous enhancement (arrow) in the leiomyoma. Figure 1c. T1-weighted axial MR image, with the patient in a prone position, immediately after MR-g HIFU treatment demonstrates non-enhancing region (closed arrow) that corresponds to the treatment-effect area. Note the thick gel membrane (open arrow) with degassed water under the patient. Figure 1d. T2-weighted MR image, with the patient in a supine position three years after MR-g HIFU treatment. Note significant decrease in the dominant leiomyoma volume (open arrow). Note a closed arrow at the level of upper end plate of L5 vertebral body as a reference to compare to pre-MR-g HIFU treatment uterus and fibroid volumes.
Figure 2
Figure 2
Figure 2a. Treated leiomyoma volume changes and uterus volume changes over the three years after MR-g HIFU. Figure 2b. Non-perfused volume changes over the three years after MR-g HIFU.
Figure 2
Figure 2
Figure 2a. Treated leiomyoma volume changes and uterus volume changes over the three years after MR-g HIFU. Figure 2b. Non-perfused volume changes over the three years after MR-g HIFU.
Figure 3
Figure 3
Kaplan-Meier estimates of the time elapsed until the alternative treatments after the initial MR-g HIFU.
See this image and copyright information in PMC

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