title: Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids.
abstract: OBJECTIVE
  To assess the mid-term efficacy of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) using a volumetric ablation technique for treating uterine fibroids.
  
  
  METHODS
  Forty-six premenopausal women with 58 symptomatic uterine fibroids were prospectively included for MR-HIFU. After treatment, CE-MRI allowed measurement of the non-perfused volume (NPV) ratio, defined as the non-enhancing part of the fibroid divided by fibroid volume. Clinical symptoms and fibroid size on T2W-MRI were quantified at 3 and 6 months' follow-up. The primary endpoint was a clinically relevant improvement in the transformed Symptom Severity Score (tSSS) of the Uterine Fibroid Symptom and Quality of Life questionnaire, defined as a 10-point reduction.
  
  
  RESULTS
  Volumetric ablation resulted in a mean NPV ratio of 0.40 ± 0.22, with a mean NPV of 141 ± 135 cm(3). Mean fibroid volume was 353 ± 269 cm(3) at baseline, which decreased to 271 ± 225 cm(3) at 6 months (P < 0.001), corresponding to a mean volume reduction of 29 % ± 20 %. Clinical follow-up showed that 54 % (25/46) of the patients reported a more than 10-point reduction in the tSSS. Mean tSSS improved from 50.9 ± 18.4 at baseline to 34.7 ± 20.2 after 6 months (P < 0.001).
  
  
  CONCLUSIONS
  Volumetric MR-HIFU is effective for patients with symptomatic uterine fibroids. At 6 months, significant symptom improvement was observed in 54 % of patients.
  
  
  CONCLUSIONS
  • Volumetric MR-guided high-intensity focused ultrasound is a novel ablation technique for leiomyomatosis. • We prospectively evaluated the outcome of volumetric MR-HIFU ablation for symptomatic fibroids. • This study showed that volumetric MR-HIFU results in an effective treatment. • A randomised controlled trial would set this technique in an appropriate context.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands, m.ikink@umcutrecht.nl.
authors.forename: Marlijne E
authors.initials: ME
authors.lastname: Ikink
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Voogt
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: Paul N M
authors.initials: PN
authors.lastname: Lohle
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Schweitzer
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Lambertus W
authors.initials: LW
authors.lastname: Bartels
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
mesh_terms: D000293:Adolescent; D000328:Adult; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D017697:Premenopause; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014599:Uterus / Q000473:pathology* / Q000601:surgery; D055815:Young Adult