title: MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice.
abstract: OBJECTIVE
  To evaluate a novel feedback-regulated volumetric sonication method in MR-guided HIFU treatment of symptomatic uterine fibroids.
  
  
  METHODS
  27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 T MR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL).
  
  
  RESULTS
  In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 - 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 - 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 - 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded.
  
  
  CONCLUSIONS
  Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter and a less diversifying temperature.
  
  
  CONCLUSIONS
  ▶ MR-guided HIFU ablation of symptomatic uterine fibroids is a valuable treatment option. ▶ By non-invasive HIFU fibroid volumes can be reduced and symptoms improved. ▶ The novel feedback-regulated treatment cells offer advantages over standard treatment cells.
authors.affiliation: Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck/Germany.
authors.forename: H
authors.initials: H
authors.lastname: Ruhnke
authors.forename: T
authors.initials: T
authors.lastname: Eckey
authors.forename: M K
authors.initials: MK
authors.lastname: Bohlmann
authors.forename: M P
authors.initials: MP
authors.lastname: Beldoch
authors.forename: A
authors.initials: A
authors.lastname: Neumann
authors.forename: A
authors.initials: A
authors.lastname: Agic
authors.forename: J
authors.initials: J
authors.lastname: Hägele
authors.forename: K
authors.initials: K
authors.lastname: Diedrich
authors.forename: J
authors.initials: J
authors.lastname: Barkhausen
authors.forename: P
authors.initials: P
authors.lastname: Hunold
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002470:Cell Survival / Q000502:physiology; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D007889:Leiomyoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000601:surgery