MRI guidance of focused ultrasound therapy of uterine fibroids: early results.
OBJECTIVE
The purpose of this study was to explore our hypothesis that MRI-guided focused ultrasound therapy for the treatment of uterine fibroids will lead to a significant reduction in symptoms and improvement in quality of life. We describe focused ultrasound therapy applications and the method for monitoring the thermal energy deposited in the fibroids, including the MRI parameters required, in a prospective review of 108 treatments.


METHODS
Patients presenting with symptomatic uterine fibroids who attained a minimal symptom severity score and who would otherwise have been offered a hysterectomy were recruited. Thermal lesions were created within target fibroids using an MRI-guided focused ultrasound therapy system. The developing lesion was monitored using real-time MR thermometry, which was used to assess treatment outcome in real time to change treatment parameters and achieve the desired outcome. Fibroid volume, fibroid symptoms, and quality-of-life scores were measured before treatment and 6 months after treatment. Adverse events were actively monitored and recorded.


RESULTS
In this study, 79.3% of women who had been treated reported a significant improvement in their uterine fibroid symptoms on follow-up health-related quality-of-life questionnaires, which supports our hypothesis. The mean reduction in fibroid volume at 6 months was 13.5%, but nonenhancing volume (mean, 51 cm(3)) remained within the treated fibroid at 6 months.


CONCLUSIONS
This early description of MRI-guided focused ultrasound therapy treatment of fibroids includes follow-up data and shows that, although the volume reduction is moderate, it correlates with treatment volume and the symptomatic response to this treatment is encouraging.
Hindley
Jonathan
J
Department of Magnetic Resonance Imaging, Interventional MR Unit, St Mary's Hospital London and Imperial College School of Medicine, Praed St., London W2 1NY, England.
Gedroyc
Wladyslaw M
WM
Regan
Lesley
L
Stewart
Elizabeth
E
Tempany
Clare
C
Hynyen
Kullervo
K
Hynnen
Kullervo
K
Mcdannold
Nathan
N
Macdanold
Nathan
N
Inbar
Yael
Y
Itzchak
Yacov
Y
Rabinovici
Jaron
J
Kim
Hyun S
HS
Kim
Kevin
K
Geschwind
Jean-François
JF
Hesley
Gina
G
Gostout
Bobbie
B
Gostout
Brian
B
Ehrenstein
Tillman
T
Hengst
Sylvia
S
Sklair-Levy
Miri
M
Shushan
Asher
A
Jolesz
Ferenc
F
D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011187:Posture; D011788:Quality of Life; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D014594:Uterine Neoplasms / Q000628:therapy*
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA