title: [French first results using magnetic resonance-guided focused ultrasound for myoma treatment].
abstract: OBJECTIVE
  Many women with myomas desire uterine conservation. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a new non-invasive therapy. We describe our early results regarding efficacy and safety of MRgFUS for the treatment of uterine leiomyomas.
  
  
  METHODS
  Fifty-two French women, over 18 years of age, who were candidates for surgical myomectomy, hysterectomy or uterine artery embolization due to symptomatic myomas were treated by MRgFUS (ExAblate 2000(®), InSightec) and followed up for at least 6 months. Intramural or subserous myomas with a size between 4-12 cm and a T2 low intensity MRI image were selected in women with no abdominal scar and no bowel interposition. The modified symptom severity score (SSS) was examined before and after the treatment at 6 months. Second treatment rate during the first follow-up year was reported.
  
  
  RESULTS
  No serious complications were recorded during the treatments or follow-up period. Seven women had initial failure mostly because of bowel interposition, six of them had uterine artery embolisation. The mean modified SSS value for patients before MRgFUS was 41/100 and the values diminished significantly to a mean value of 22/100. A total of 65% of women had a reduction of at least 10 points (n=22) (initial score of 41 [29; 62] and 22 [16; 46] at 6 month follow-up). Good correlation was observed between myomas destruction and the symptoms score. During the follow-up period, ten patients (19%) required invasive interventions (six hysterectomies, two embolisations and two myomectomies). The average reduction in myoma volume determined by MR imaging at 6 months after treatment was 14%. This volume reduction is poorly correlated with the myoma's treated volume of 36.4% (6-74%).
  
  
  CONCLUSIONS
  MRgFUS can safely be used for symptomatic treatment and avoid the need for surgical intervention in most patients. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach and to obtain reimbursement.
authors.affiliation: Service de gynécologie, CHU de Bretonneau, Tours, France. marret@med.univ-tours.fr
authors.forename: H
authors.initials: H
authors.lastname: Marret
authors.forename: A
authors.initials: A
authors.lastname: Bleuzen
authors.forename: A
authors.initials: A
authors.lastname: Guérin
authors.forename: M-A
authors.initials: MA
authors.lastname: Lauvin-Gaillard
authors.forename: D
authors.initials: D
authors.lastname: Herbreteau
authors.forename: F
authors.initials: F
authors.lastname: Patat
authors.forename: F
authors.initials: F
authors.lastname: Tranquart
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014464:Ultrasonic Therapy / Q000379:methods; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000628:therapy*