Abstract:
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Purpose: To evaluate the effects and clinical outcome of MRI-guided focused
ultrasound surgery (FUS) in the treatment of symptomatic uterine fibroids.
Methods and Materials: Patients with symptomatic fibroids enrolled into the
prospective multicenter study for 6 months. Fibroids were identified and
characterized on pretreatment MRI examination. Patients completed uterine
fibroid symptom and health-related quality of life questionnaire (UFS-QOL).
Targeted fibroids were identified using T2-weigthed images, and sonications
from the high intensity ultrasound were delivered to ablate the target.
MR-thermal images and phase-encoding MR images were obtained during each
sonication to assess tissue temperature change and accurate targeting of the
tissue. Patients were given IV conscious sedation and monitored. Diffusion and
post-contrast MR images were obtained post FUS to correlates with treatment
area. Clinic visit with UFS-QOL at 1 wk, 1, 3 and 6 month post FUS were
obtained, and f/u MRI was performed at 6 month post FUS to assess efficacy and
clinical outcome of the treatment.
Results: 16 pts (mean age 47 y.o. range 37-53) were treated, including 9 white
and 7 black women. 5 pts had myomectomy. IV sedation given with Versed (mean
3mg, range 0.5-6) and Fentanyl (mean 150 microgram, range 25-300). 6 patients
received treatments on 2 fibroids, while 10 patients received treatment on 1
fibroid. Total of 22 fibroids were treated with FUS. 100% initial technical
success to localize and treat intended fibroids with sonication. One fibroid
was not treated after initial sonication due to heavy calcification. 22
fibroids included 13 submucosal, 7 intramural and 2 subserosal fibroids. Mean
volume of treated fibroid was 114.1cc (range 5.5-621.7). Mean ablated volume
was 21cc (range 1-87.9). 88% (14 patients) had improved symptom severity score
(UFS-QOL) with mean decrease in the score of 12.5 after FUS. Mean volume
decrease in treated fibroids was 57%. No significant pain was noted during
treatment. No unintended ablation or MR evidence of adjacent tissue
damage/edema is noted. No report of bladder or bowel symptom was noted. One
minor skin burn was observed. One patient developed leg paresthesia, which
improved with conservative therapy. All were treated as outpatients. 81% (13
pts) had no loss of work post-FUS, and 19% (3 pts) lost average of 1 day of
work.
Conclusion: Early experience of FUS in the treatment of uterine fibroids
appears safe and accurate with minimal postoperative morbidity. Short-term
results of FUS appear efficacious for uterine fibroids. (H.S.K. received a
grant from TxSonics/Insightec. J.F.G. is on the board of TxSonics/Insightec.)
Questions about this event email: sikhkim@jhmi.edu
Kim MD, H,
Non-Invasive MRI-guided Focused Ultrasound Surgery in the Treatment of Uterine Fibroids: Johns Hopkins Experience. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3108622.html