title: Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles?
abstract: OBJECTIVE
  The aim of this study was to assess the safety and effectiveness of contrast-enhanced ultrasound (CEUS) on ultrasound guided high intensity focused ultrasound (USgHIFU) ablation of uterine fibroids.
  
  
  METHODS
  Thirty-three patients (37 fibroids) were randomly assigned to two groups: group A (17 patients, 20 fibroids) in which CEUS was used before, during and after HIFU treatment, and group B (16 patients, 17 fibroids) in which CEUS was not administered at all. Follow-up including contrast-enhanced magnetic resonance imaging (MRI) and a clinical questionnaire was performed, and technical success, ablation efficacy, volume reduction and complications were assessed.
  
  
  RESULTS
  Technical success was 100% in both groups. CEUS revealed residual enhancement in 40% of the patients in group A and the treatment was continued until the completion of ablation. MRI at 1 month after treatment revealed significant difference in the relative fibroid volume reduction rate between the two groups: 16.1% in group A versus 4.8%, in group B (p = 0.01). There was no statistically significant relative volume reduction rate for the results at 3, 6 and 12 months and no significant changes in the quality of life results or the complication rate.
  
  
  CONCLUSIONS
  CEUS was safe and effective in enhancing US guidance during HIFU ablation of uterine fibroids. Moreover, the use of CEUS during HIFU sonication increased the ablation efficacy, leading to a more relevant fibroid volume reduction at 1 and 3 months. This gap disappeared after 6 months, when there were no differences between the two groups of patients at MRI. However, in our experience, USgHIFU represented a very effective method for the treatment of uterine fibroids, and the use of CEUS during HIFU procedure reduced the treatment time and treatment repetitions for incomplete fibroid ablation.
authors.affiliation: Unit of Interventional Radiology, European Institute of Oncology , Milan , Italy .
authors.forename: Franco
authors.initials: F
authors.lastname: Orsi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Monfardini
authors.forename: Guido
authors.initials: G
authors.lastname: Bonomo
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Krokidis
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Vigna
authors.forename: Davide
authors.initials: D
authors.lastname: Disalvatore
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Contrast-enhanced ultrasound (CEUS); ultrasound guided high intensity focused ultrasound (USgHIFU); uterine fibroids