title: Targeted vessel ablation for more efficient magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids.
abstract: OBJECTIVE
  To report the first clinical experience with targeted vessel ablation during magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic uterine fibroids.
  
  
  METHODS
  Pretreatment T1-weighted contrast-enhanced magnetic resonance angiography was used to create a detailed map of the uterine arteries and feeding branches to the fibroids. A three-dimensional overlay of the magnetic resonance angiography images was registered on 3D T2-weighted pretreatment imaging data. Treatment was focused primarily on locations where supplying vessels entered the fibroid. Patients were followed 6 months after treatment with a questionnaire to assess symptoms and quality of life (Uterine Fibroid Symptom and Quality of Life) and magnetic resonance imaging to quantify shrinkage of fibroid volumes.
  
  
  RESULTS
  In two patients, three fibroids were treated with targeted vessel ablation during MR-HIFU. The treatments resulted in almost total fibroid devascularization with nonperfused volume to total fibroid volume ratios of 84, 68, and 86%, respectively, of treated fibroids. The predicted ablated volumes during MR-HIFU in patients 1 and 2 were 45, 40, and 82 ml, respectively, while the nonperfused volumes determined immediately after treatment were 195, 92, and 190 ml respectively, which is 4.3 (patient 1) and 2.3 (patient 2) times higher than expected based on the thermal dose distribution. Fibroid-related symptoms reduced after treatment, and quality of life improved. Fibroid volume reduction ranged 31-59% at 6 months after treatment.
  
  
  CONCLUSIONS
  Targeted vessel ablation during MR-HIFU allowed nearly complete fibroid ablation in both patients. This technique may enhance the use of MR-HIFU for fibroid treatment in clinical practice.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. m.voogt@umcutrecht.nl
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Voogt
authors.forename: Marijn
authors.initials: M
authors.lastname: van Stralen
authors.forename: Marlijne E
authors.initials: ME
authors.lastname: Ikink
authors.forename: Roel
authors.initials: R
authors.lastname: Deckers
authors.forename: Koen L
authors.initials: KL
authors.lastname: Vincken
authors.forename: Lambertus W
authors.initials: LW
authors.lastname: Bartels
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D014594:Uterine Neoplasms / Q000628:therapy*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol