MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice.
OBJECTIVE
To evaluate a novel feedback-regulated volumetric sonication method in MRguided 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 TMR 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
H
H
Ruhnke
T
T
Eckey
M K
MK
Bohlmann
M P
MP
Beldoch
A
A
Neumann
A
A
Agic
J
J
Hägele
K
K
Diedrich
J
J
Barkhausen
P
P
Hunold
D000328:Adult; D003287:Contrast Media; D004867:Equipment Design; D005246:Feedback; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D009942:Organometallic Compounds; D056888:Patient Positioning; D013696:Temperature; D014159:Transducers; D016896:Treatment Outcome; D047368:Tumor Burden; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000601:surgery
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol