Uterine Peristalsis Before and After Ultrasound-Guided High-Intensify Focused Ultrasound (USgHIFU) Treatment for Symptomatic Uterine Fibroids

Abstract

BACKGROUND This study investigated uterine peristalsis before and after ultrasound-guided high-intensify focused ultrasound (USgHIFU) treatment for symptomatic uterine fibroids by cine magnetic resonance imaging (cine MRI). MATERIAL AND METHODS A total of 30 patients with symptomatic uterine fibroids were treated by USgHIFU, who were subjected to cine MRI before and after USgHIFU treatment in the periovulatory phase. The images were analyzed for the existence, direction, and frequency of uterine peristalsis. The effects of uterine volume, the largest fibroid volume and location, and the fibroid number were examined before and after USgHIFU treatment. RESULTS The incidence of uterine peristalsis was significantly increased after USgHIFU treatment. The main direction of uterine peristalsis before and after USgHIFU was cervix-to-fundus. In 12 cases, uterine peristalsis newly emerged after USgHIFU, and the largest fibroid volumes in these 12 cases were significantly smaller than in the remaining 18 cases before and after USgHIFU. The reduction rates of the largest fibroid volume in the 12 cases were significantly higher than in the remaining 18 cases. The largest fibroids were mainly located in the intramural area before and after USgHIFU. CONCLUSIONS USgHIFU treatment may contribute to the recovery of uterine peristalsis in patients with symptomatic fibroids, as detected by cine MRI. Uterine peristalsis recovery was related to the largest fibroid volume, especially for intramural fibroids.

Figure 1

A 42-year-old woman with fibroids receiving USgHIFU treatment. (A, B) Representative pictures indicating fibroids (arrowheads) before (A) and 6 months after (B) USgHIFU treatment.

Figure 2

Uterine peristalsis in a 42-year-old fibroid patient before undergoing USgHIFU treatment in the periovulatory phase. (A–D) Static images of uterine peristalsis. The patient showed no peristalsis. No changes were observed in the signal intensities of both the junctional zone and the configuration of the endometrium.

Figure 3

Uterine peristalsis in the same patient showing uterine peristalsis recovery. (A–D) Static images of recovered uterine peristalsis. The peristalsis was in the cervix-to-fundus direction, in the periovulatory phase, 6 months after USgHIFU treatment. The conduction of low signal intensity in the junctional zone and the stripping movement of the endometrium from cervix to fundus (arrow) are shown.