Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid: utility of contrast-enhanced ultrasonography.
OBJECTIVE
To assess the utility of contrast-enhanced ultrasonography (ceUS) in the assessment of the therapeutic response to high intensity focused ultrasound (HIFU) ablation in patients with uterine fibroid.


METHODS
Sixty-four patients with a total of 64 uterine fibroids (mean: 5.3+/-1.2 cm; range: 3.2-8.9 cm) treated with HIFU ablation under the ultrasound guidance were evaluated with ceUS after receiving an intravenous bolus injection of a microbubble contrast agent (SonoVue) within 1 week after intervention. We obtained serial ceUS images during the time period from beginning to 5 min after the initiation of the bolus contrast injection. All of the patients underwent a contrast enhanced MRI (ceMRI) and ultrasound guided needle puncture biopsy within 1 week after HIFU ablation. And as a follow-up, all of the patients underwent US at 1, 3, 6 and 12 months after HIFU treatment. The volume change was observed and compared to pre- and post-HIFU ablation. The results of the ceUS were compared with those of the ceMRI in terms of the presence or absence of residual unablated tumor and pathologic change in the treated lesions.


RESULTS
On ceUS, diagnostic accuracy was 100%, while residual unablated tumors were found in three uterine fibroids (4.7%) and failed treatment was found in eight uterine fibroids (12.5%). All the 11 fibroids were subjected to additional HIFU ablation. Of the 58 ablated fibroids without residual tumors on both the ceUS and ceMRI after the HIFU ablation, the volumes of all the fibroids decreased in different degrees during the 1 year follow-up USs. And histologic examinations confirmed findings of necrotic and viable tumor tissue, respectively.


CONCLUSIONS
CEUS is potentially useful for evaluating the early therapeutic effect of percutaneous HIFU ablation for uterine fibroids.
Zhou
Xiao Dong
XD
Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, No. 17 West Changle Road, Xi'an 710032, China. zhouxd@fmmu.edu.cn
Ren
Xiao Long
XL
Zhang
Jun
J
He
Guang Bin
GB
Zheng
Min Juan
MJ
Tian
Xue
X
Li
Li
L
Zhu
Ting
T
Zhang
Min
M
Wang
Lei
L
Luo
Wen
W
D000328:Adult; D001707:Biopsy, Needle; D017115:Catheter Ablation; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007044:Hysterectomy; D007089:Image Enhancement; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018365:Neoplasm, Residual; D011184:Postoperative Period; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D018615:Ultrasonography, Doppler, Color; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*
D003287:Contrast Media; D019786:Gadolinium DTPA