title: Uterine fibroids: semiquantitative perfusion MR imaging parameters associated with the intraprocedural and immediate postprocedural treatment efficiencies of MR imaging-guided high-intensity focused ultrasound ablation.
abstract: OBJECTIVE
  To determine whether semiquantitative perfusion magnetic resonance (MR) imaging parameters are associated with therapeutic effectiveness of MR imaging-guided high-intensity focused ultrasound ( HIFU high-intensity focused ultrasound ) ablation of uterine fibroids and which semiquantitative perfusion parameters are significant with regard to treatment efficiency.
  
  
  METHODS
  This study was approved by the institutional review board, and informed consent was obtained from all subjects. Seventy-seven women (mean age, 43.3 years) with 119 fibroids (mean diameter, 7.5 cm) treated with MR imaging-guided HIFU high-intensity focused ultrasound ablation were analyzed. The correlation between semiquantitative perfusion MR parameters (peak enhancement, relative peak enhancement, time to peak, wash-in rate, washout rate) and heating and ablation efficiencies (lethal thermal dose volume based on MR thermometry and nonperfused volume based on immediate contrast-enhanced image divided by intended treatment volume) were evaluated by using a linear mixed model on a per-fibroid basis. The specific value of the significant parameter that had a substantial effect on treatment efficiency was determined.
  
  
  RESULTS
  The mean peak enhancement, relative peak enhancement, time to peak, wash-in rate, and washout rate of the fibroids were 1293.1 ± 472.8 (range, 570.2-2477.8), 171.4% ± 57.2 (range, 0.6%-370.2%), 137.2 seconds ± 119.8 (range, 20.0-300.0 seconds), 79.5 per second ± 48.2 (range, 12.5-236.7 per second), and 11.4 per second ± 10.1 (range, 0-39.3 per second), respectively. Relative peak enhancement was found to be independently significant for both heating and ablation efficiencies (B = -0.002, P < .001 and B = -0.003, P = .050, respectively). The washout rate was significantly associated with ablation efficiency (B = -0.018, P = .043). Both efficiencies showed the most abrupt transitions at 220% of relative peak enhancement.
  
  
  CONCLUSIONS
  Relative peak enhancement at semiquantitative perfusion MR imaging was significantly associated with treatment efficiency of MR imaging-guided HIFU high-intensity focused ultrasound ablation of uterine fibroids, and a value of 220% or less is suggested as a screening guideline for more efficient treatment.
authors.affiliation: From the Department of Radiology and Center for Imaging Science (Y.S.K., H.R., H.K.L.) and Department of Obstetrics and Gynecology (B.G.K., D.S.B., J.W.L., T.J.K., C.H.C., Y.Y.L.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 138-225, Korea.
authors.forename: Young-sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Byoung-Gie
authors.initials: BG
authors.lastname: Kim
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Tae-Joong
authors.initials: TJ
authors.lastname: Kim
authors.forename: Chel Hun
authors.initials: CH
authors.lastname: Choi
authors.forename: Yoo-Young
authors.initials: YY
authors.lastname: Lee
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D018231:Leiomyomatosis / Q000473:pathology* / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000473:pathology* / Q000628:therapy*
chemical_list: D003287:Contrast Media