title: First experience of real-time elastography with transvaginal approach in assessing response to MRgFUS treatment of uterine fibroids.
abstract: OBJECTIVE
  Definition of the role of real-time elastography (RTE) in the evaluation of response to treatment of uterine fibroids using MRgFUS in symptomatic patients.
  
  
  METHODS
  28 women with 34 symptomatic fibroids, selected for MRgFUS, were enrolled. The patients were preliminarily studied with MRI and suprapubic and transvaginal ultrasound examination including RTE; the follow-up was performed immediately after treatment, at 3 months and 12 months with the same technique. Each lesion was evaluated by looking for ultrasound parameters (volume, resistance index) and RTE strain ratio (SR). Before and after treatment, all patients completed three questionnaires for symptom evaluation (e.g., uterine fibroids symptoms and quality of life).
  
  
  RESULTS
  Of the 27 treated fibroids, only 14 had an effective treatment with non-perfused volume (NPV) >70 %. After 3 months of treatment, 17/21 patients presented significant decrease of uterine bleeding. A positive correlation between %NVP and percentage of fibroid volume decrease was seen. Reduction of SR value from t0 to t2 was found in 19/27 fibroids, particularly significant in fibroids with NPV > 70 %. A significant positive correlation between the percentage of symptom decrease and %SR decrease was found. At the time of statistical analysis, 12/21 patients reached the 12-month follow-up: they showed a further reduction of SR.
  
  
  CONCLUSIONS
  RTE is a valid method able to support standard ultrasound examination in the evaluation of uterine fibroids, since it allows demonstrating the decrease of rigidity, which can be quantified with the SR parameter. It could be included in a pre-treatment multiparametric evaluation of patients looking for MRgFUS eligibility and in follow-up when it could assess the response to treatment.
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy. chiara.marigliano@uniroma1.it.
authors: Chiara
authors: http://orcid.org/0000-0002-3592-4073
authors: C
authors: Marigliano
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Giovanna
authors: G
authors: Panzironi
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Luisa
authors: L
authors: Molisso
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Alessandra
authors: A
authors: Pizzuto
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Federica
authors: F
authors: Ciolina
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Alessandro
authors: A
authors: Napoli
authors: Umberto I, Policlinico di Roma, Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Sapienza Università di Roma, Rome, Italy.
authors: Paolo
authors: P
authors: Ricci
mesh_terms: D000328:Adult; D054459:Elasticity Imaging Techniques; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D014621:Vagina
keywords: MRgFUS (magnetic resonance-guided focused ultrasound surgery); Transvaginal US; Ultrasound elastography; Uterine fibroids