Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation.
OBJECTIVE
To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy.


METHODS
Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL.


RESULTS
The pre-treatment target volume mean value was of 59.7 cc; the MRgFUS-TV had a mean value of 44.9 cc, and the mean value of CE MRI-TV, measured immediately after treatment, was of 52.8 cc, with an increase of 13.7%. The 86.5% of the lesion was treated. After 1 year from the treatment, 15/18 (83%) patients showed thickness of the junctional zone <12 mm; 3/18 (17%) had a junctional zone >12 mm.


CONCLUSIONS
MRgFUS is an encouraging mini-invasive treatment for adenomyosis that permits to maintain the integrity of the uterus in a pathology with limited therapeutic possibility.
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy. fabianaferrari@hotmail.it.
Fabiana
F
Ferrari
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Francesco
F
Arrigoni
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Anna
A
Miccoli
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Sara
S
Mascaretti
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Eva
E
Fascetti
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Giulio
G
Mascaretti
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Antonio
A
Barile
Dipartimento di Scienze Cliniche Applicate E Biotecnologiche, University of L'Aquila-San Salvatore Hospital, Via Lorenzo Natali, 67100, L'Aquila, Italy.
Carlo
C
Masciocchi
D062788:Adenomyosis / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D059708:Ultrasonic Surgical Procedures / Q000379:methods*; D055815:Young Adult
Adenomyosis; HIFU; MRgFUS; Mini-invasive treatment; Uterine fibroids