title: Clinical predictors of successful magnetic resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma.
abstract: BACKGROUND
  Magnetic resonance-guided focused ultrasound (MRgFUS) is a relatively new minimally invasive treatment, approved by the US Food and Drug Administration in 2004 for treatments of symptomatic uterine leiomyomas (fibroids). The purpose of this work is to present retrospective cohort analysis of women that underwent commercial MRgFUS treatment between 2005 and 2009 at a single center, to identify baseline patient characteristics that predict successful MRgFUS fibroid treatment. Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.
  
  
  METHODS
  One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months. The main outcome measure of the follow-up was to identify patients who required additional fibroid treatment due to continued fibroid symptoms. Additionally, patient medical history and radiological findings obtained prior to MRgFUS were reviewed, and statistical analysis was performed to identify factors associated with reduced risk of having additional fibroid treatment.
  
  
  RESULTS
  Twenty-nine patients (22.3%) underwent additional fibroid treatment due to continued or recurrent fibroid symptoms during the follow up. Cumulative incidence of additional fibroid treatment was 9.7%, 29.3%, and 44.7% at 1, 2, and 3 years following MRgFUS, respectively. In multivariable Cox proportional hazard regression analyses, older age (hazard ratio (HR) 0.54 per 5-year increase in age, 95% confidence interval 0.39 to 0.76, p < 0.001), greater number of fibroids (HR 0.19 for more than three vs. one fibroid, 95% CI 0.05 to 0.67, p = 0.033), and greater fibroid volume (HR 0.70 per doubling in volume, 95% CI 0.51 to 0.96, p = 0.025) were significantly associated with less risk of having additional fibroid treatment.
  
  
  CONCLUSIONS
  Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.
authors.affiliation: Center for Uterine Fibroids, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA ; Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: Krzysztof R
authors.initials: KR
authors.lastname: Gorny
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester MN 55901, USA.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Woodrum
authors.affiliation: Center for Uterine Fibroids, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA ; Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stewart
authors.affiliation: Center for Uterine Fibroids, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA ; Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.
authors.forename: Gina K
authors.initials: GK
authors.lastname: Hesley
keywords: Clinical predictors; Fibroids; MRgFUS; Magnetic resonance-guided focused ultrasound surgery; Symptomatology; Treatment outcomes; Uterine leiomyoma