title: Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: review of 138 patients with an average follow-up of 2.8 years.
abstract: OBJECTIVE
  To assess long-term outcomes of magnetic resonance (MR)-guided focused ultrasound (US) treatments of uterine fibroids.
  
  
  METHODS
  A retrospective follow-up of 138 patients treated at a single institution between March 2005 and November 2011 was conducted. The patients were not part of a clinical study and were followed through retrospective review of their medical records and telephone interviews to assess additional treatments for fibroid-related symptoms. Survival methods, including Cox proportional hazards models, were used to assess the association between incidence of additional treatments and patient data obtained during screening before treatment.
  
  
  RESULTS
  The average length of follow-up was 2.8 years (range, 1-7.2 y). The cumulative incidence of additional treatments at 36 months and 48 months after MR-guided focused US was 19% and 23%, respectively. Women who did not need additional treatment were older than women who did (46.3 y ± 5.6 vs 43.0 y ± 5.8; P = .006; hazard ratio, 0.855; 95% confidence interval, 0.789-0.925). Additionally, women with heterogeneous or bright fibroids on T2-weighted MR imaging were more likely to require additional treatment compared with women with homogeneously dark fibroids (hazard ratio, 5.185 or 5.937, respectively; 95% confidence interval, 1.845-14.569 or 1.401-25.166, respectively). Physician predictions of treatment success, recorded during the screening process, had significant predictive value (P = .018).
  
  
  CONCLUSIONS
  The long-term rates of additional interventions after MR-guided focused US of symptomatic uterine fibroids were found to be comparable with other uterine-sparing procedures, such as uterine artery embolization or myomectomy. Older patient age and homogeneously dark fibroids were associated with fewer additional treatments. Physician assessment of treatment success was found to be a valuable tool in patient screening.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Electronic address: gorny.krzysztof@mayo.edu.
authors.forename: Krzysztof R
authors.initials: KR
authors.lastname: Gorny
authors.affiliation: Department of Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: David A
authors.initials: DA
authors.lastname: Woodrum
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stewart
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
authors.forename: Gina K
authors.initials: GK
authors.lastname: Hesley
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007889:Leiomyoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000401:mortality; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*