title: Ultrasound guided high-intensity focused ultrasound combined with gonadotropin releasing hormone analogue (GnRHa) ablating uterine leiomyoma with homogeneous hyperintensity on T2weighted MR imaging.
abstract: OBJECTIVE
  The study aimed to evaluate the safety and efficiency of ultrasound-guided high-intensity focused ultrasound (USgHIFU) combined with gonadotropin-releasing hormone analogue (GnRHa)-ablating symptomatic uterine leiomyoma with homogeneous hyperintensity on T2weighted MRI prospectively.
  
  
  METHODS
  A total of 34 patients with 42 symptomatic uterine leiomyomas with homogeneous hyperintensity on T2weighted MRI were enrolled in our study. In the patient who had multiple uterine leiomyomas, only one dominant leiomyoma was treated. According to the principles of voluntariness, 18 patients underwent a 3-month therapy of GnRHa (once a month) before the high-intensity focused ultrasound (HIFU) treatment, while 16 patients received only HIFU treatment. Enhanced MRI was performed before and after GnRHa and HIFU treatment. Evaluation of the main indicators included treatment time, sonication time, treatment efficiency, non-perfused volume (NPV) (indicative of successful ablation) ratio and energy effect ratio; adverse events were also recorded.
  
  
  RESULTS
  The treatment time and sonication time of the combination group were 102.0 min (55.8-152.2 min) and 25.4 min (12.2-34.1 min); however, they were 149.0 min (87.0-210.0 min) and 38.9 min (14.0-46.7 min) in the simple USgHIFU group. The treatment and sonication time for the combination group was significantly shorter than that for the simple USgHIFU group. Treatment efficiency, NPV ratio and energy effect ratio were 46.7 mm3s-1(28.5-95.8 mm3s-1), 69.2 ± 29.8% (35.5-97.4%) and 9.9 KJ mm-3(4.5-15.7 KJ mm-3) in the combination group, respectively; but, the lowest treatment efficiency, lowest NPV ratio and more energy effect ratio were observed in the simple HIFU group, which were 16.8 mm3s-1(8.9-32.9 mm3s-1), 50.2 ± 27.3% (0-78.6%) and 23.8 KJ mm-3(12.4-46.2 KJ mm-3), respectively. Pain scores in the combination group were 3.0 ± 0.5 points (2-4 points)-significantly less than the simple USgHIFU group. There were no significant adverse reactions in either group.
  
  
  CONCLUSIONS
  Our data suggest that USgHIFU combined with GnRHa may be performed to ablate symptomatic uterine leiomyoma with homogeneous hyperintensity on T2weighted MRI. Advances in knowledge: The conclusions indicate that GnRHa can improve the effectiveness of the USgHIFU treatment of a homogeneous hyperintense leiomyoma on T2weighted MRI, and combination treatment could be a promising alternative treatment for the uterine leiomyoma.
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Fanjing
authors.initials: F
authors.lastname: Kong
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Ruijie
authors.initials: R
authors.lastname: Hou
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Rong
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Nana
authors.initials: N
authors.lastname: Ma
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Shaoping
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Gynecology and Obstetrics, First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000628:therapy*; D016729:Leuprolide / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018084:Ultrasonography, Interventional / Q000379:methods; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; C083781:LHRH, Ala(6)-Gly(10)-ethylamide-; D016729:Leuprolide