title: Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio.
  
  
  METHODS
  This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio.
  
  
  RESULTS
  Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio.
  
  
  CONCLUSIONS
  With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.
authors: Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, München, Germany. christoph.trumm@med.lmu.de
authors: Christoph G
authors: CG
authors: Trumm
authors: Robert
authors: R
authors: Stahl
authors: Dirk-André
authors: DA
authors: Clevert
authors: Peter
authors: P
authors: Herzog
authors: Irene
authors: I
authors: Mindjuk
authors: Sabine
authors: S
authors: Kornprobst
authors: Christina
authors: C
authors: Schwarz
authors: Ralf-Thorsten
authors: RT
authors: Hoffmann
authors: Maximilian F
authors: MF
authors: Reiser
authors: Matthias
authors: M
authors: Matzko
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology; D057086:High-Intensity Focused Ultrasound Ablation / Q000706:statistics & numerical data*; D006801:Humans; D062069:Inventions / Q000706:statistics & numerical data; D007889:Leiomyoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D047368:Tumor Burden; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*