Original Article
Efficacy of MR-guided focused ultrasound surgery (MRgFUS) of uterine fibroids: evaluation of non perfused volume (NPV), fibroid shrinkage and clinical improvement at 6 months follow-up
Abstract
Main problem: To assess the efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment of uterine fibroids evaluating fibroid shrinkage and clinical improvement after 6 months and to determine the predictive role of post-treatment non perfused volume (ptNPV).
Materials and methods: This prospective study received the institutional review board approval. After giving informed consent, 60 women with 72 symptomatic uterine fibroids underwent MRgFUS treatment using the ExAblate 2000 system (InSightec, Haifa, Israel). Before treatment T2-weighted multiplanar magnetic resonance imaging (MRI) images were obtained to measure uterine fibroids volume. Immediately after treatment T1-weighted contrast-enhanced fat-suppressed multiplanar MR images were used to measure ptNPV. Similar images obtained 6±1 months after treatment were used to determine fibroids shrinkage. The symptom severity score (SSS) and quality of life score (QOLS) were examined before treatment and after 6 months. The ptNPV and 6-month fibroid shrinkage were correlated and compared with SSS and QOLS results.
Results: The average ptNPV was 67%±20%. Six months after treatment the treated fibroids average volume decreased from 134±139 to 96±116 cm³ (n=53) (P=0.0001) with an average volume reduction of 37%±22%. A linear regression model showed a significant correlation between ptNPV ratio (considered as ptNPV divided by initial volume) and fibroid shrinkage after 6 months (P=0.0116). The mean SSS value before MRgFUS was 53±23 and after 6 months it significantly decreased to 27±17 (P<0.001). Similarly the mean QOLS value before treatment was 49±24 and it significantly increased to 72±21 (P<0.001).
Conclusions: MRgFUS is a non invasive, effective treatment for uterine fibroids. The ptNPV resulted predictive of uterine fibroid shrinkage after 6 months.
Materials and methods: This prospective study received the institutional review board approval. After giving informed consent, 60 women with 72 symptomatic uterine fibroids underwent MRgFUS treatment using the ExAblate 2000 system (InSightec, Haifa, Israel). Before treatment T2-weighted multiplanar magnetic resonance imaging (MRI) images were obtained to measure uterine fibroids volume. Immediately after treatment T1-weighted contrast-enhanced fat-suppressed multiplanar MR images were used to measure ptNPV. Similar images obtained 6±1 months after treatment were used to determine fibroids shrinkage. The symptom severity score (SSS) and quality of life score (QOLS) were examined before treatment and after 6 months. The ptNPV and 6-month fibroid shrinkage were correlated and compared with SSS and QOLS results.
Results: The average ptNPV was 67%±20%. Six months after treatment the treated fibroids average volume decreased from 134±139 to 96±116 cm³ (n=53) (P=0.0001) with an average volume reduction of 37%±22%. A linear regression model showed a significant correlation between ptNPV ratio (considered as ptNPV divided by initial volume) and fibroid shrinkage after 6 months (P=0.0116). The mean SSS value before MRgFUS was 53±23 and after 6 months it significantly decreased to 27±17 (P<0.001). Similarly the mean QOLS value before treatment was 49±24 and it significantly increased to 72±21 (P<0.001).
Conclusions: MRgFUS is a non invasive, effective treatment for uterine fibroids. The ptNPV resulted predictive of uterine fibroid shrinkage after 6 months.
