title: Screening Magnetic Resonance Imaging-Based Prediction Model for Assessing Immediate Therapeutic Response to Magnetic Resonance Imaging-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids.
abstract: OBJECTIVE
  The aim of this study was to fit and validate screening magnetic resonance imaging (MRI)-based prediction models for assessing immediate therapeutic responses of uterine fibroids to MRI-guided high-intensity focused ultrasound (MR-HIFU) ablation.
  
  
  METHODS
  Informed consent from all subjects was obtained for our institutional review board-approved study. A total of 240 symptomatic uterine fibroids (mean diameter, 6.9 cm) in 152 women (mean age, 43.3 years) treated with MR-HIFU ablation were retrospectively analyzed (160 fibroids for training, 80 fibroids for validation). Screening MRI parameters (subcutaneous fat thickness [mm], x1; relative peak enhancement [%] in semiquantitative perfusion MRI, x2; T2 signal intensity ratio of fibroid to skeletal muscle, x3) were used to fit prediction models with regard to ablation efficiency (nonperfused volume/treatment cell volume, y1) and ablation quality (grade 1-5, poor to excellent, y2), respectively, using the generalized estimating equation method. Cutoff values for achievement of treatment intent (efficiency >1.0; quality grade 4/5) were determined based on receiver operating characteristic curve analysis. Prediction performances were validated by calculating positive and negative predictive values.
  
  
  RESULTS
  Generalized estimating equation analyses yielded models of y1 = 2.2637 - 0.0415x1 - 0.0011x2 - 0.0772x3 and y2 = 6.8148 - 0.1070x1 - 0.0050x2 - 0.2163x3. Cutoff values were 1.312 for ablation efficiency (area under the curve, 0.7236; sensitivity, 0.6882; specificity, 0.6866) and 4.019 for ablation quality (0.8794; 0.7156; 0.9020). Positive and negative predictive values were 0.917 and 0.500 for ablation efficiency and 0.978 and 0.600 for ablation quality, respectively.
  
  
  CONCLUSIONS
  Screening MRI-based prediction models for assessing immediate therapeutic responses of uterine fibroids to MR-HIFU ablation were fitted and validated, which may reduce the risk of unsuccessful treatment.
authors: From the *Department of Radiology and Center for Imaging Science, Samsung Medical Center, and †Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul; ‡Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon; §Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul; §Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and ¶MR Therapy Clinical Science, Philips Healthcare, Seoul, Korea.
authors: Young-sun
authors: YS
authors: Kim
authors: Hyo Keun
authors: HK
authors: Lim
authors: Min Jung
authors: MJ
authors: Park
authors: Hyunchul
authors: H
authors: Rhim
authors: Sin-Ho
authors: SH
authors: Jung
authors: Insuk
authors: I
authors: Sohn
authors: Tae-Joong
authors: TJ
authors: Kim
authors: Bilgin
authors: B
authors: Keserci
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000601:surgery*