title: Three-dimensional quantitative assessment of lesion response to MR-guided high-intensity focused ultrasound treatment of uterine fibroids.
abstract: OBJECTIVE
  To investigate the response after magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment of uterine fibroids (UF) using a three-dimensional (3D) quantification of total and enhancing lesion volume (TLV and ELV, respectively) on contrast-enhanced MRI (ceMRI) scans.
  
  
  METHODS
  In a total of 24 patients, ceMRI scans were obtained at baseline and 24 hours, and 6, 12, and 24 months after MRgHIFU treatment. The dominant lesion was assessed using a semiautomatic quantitative 3D segmentation technique. Agreement between software-assisted and manual measurements was then analyzed using a linear regression model. Patients were classified as responders (R) or nonresponders (NR) on the basis of their symptom report after 6 months. Statistical analysis included the paired t-test and Mann-Whitney test.
  
  
  RESULTS
  Preprocedurally, the median TLV and ELV were 263.74 cm(3) (30.45-689.56 cm(3)) and 210.13 cm(3) (14.43-689.53 cm(3)), respectively. The 6-month follow-up demonstrated a reduction of TLV in 21 patients (87.5%) with a median TLV of 171.7 cm(3) (8.5-791.2 cm(3); P < .0001). TLV remained stable with significant differences compared to baseline (P < .001 and P = .047 after 12 and 24 months). A reduction of ELV was apparent in 16 patients (66.6%) with a median ELV of 158.91 cm(3) (8.55-779.61 cm(3)) after 6 months (P = .065). Three-dimensional quantification and manual measurements showed strong intermethod agreement for fibroid volumes (R(2) = .889 and .917) but greater discrepancy for enhancement calculations (R(2) = .659 and .419) at baseline and 6 months. No significant differences in TLV or ELV were observed between clinical R (n = 15) and NR (n = 3).
  
  
  CONCLUSIONS
  The 3D assessment has proven feasible and accurate in the quantification of fibroid response to MRgHIFU. Contrary to ELV, changes in TLV may be representative of the clinical outcome.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lynn J
authors.initials: LJ
authors.lastname: Savic
authors.affiliation: U/S Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, New York.
authors.forename: Ming De
authors.initials: MD
authors.lastname: Lin
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287.
authors.forename: Rüdiger E
authors.initials: RE
authors.lastname: Schernthaner
authors.affiliation: Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287. Electronic address: khong1@jhmi.edu.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Department of Diagnostic and Interventional Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D003287:Contrast Media
keywords: MR-guided high-intensity focused ultrasound; ablation; computer applications-3D; pelvic MR-imaging; uterine fibroids