Suzanne Denise LeBlang MD, Presenter: Nothing to Disclose

To determine the percentage of women with symptomatic uterine fibroids that are candidates for MRgFUS based on screening MRI exams

179 women with symptomatic uterine fibroids were screened with MRI exams with and without contrast utilizing T2 coronal and axial, T2 fat suppressed sagittal, and T1 axial precontrast images and post contrast images in 3 planes. Patients were considered candidates if there were <6 fibroids, no other pelvic pathology was identified, and the fibroids were enhancing after contrast.  Also, it was determined if a non perfused volume of at least 50% could be obtained during the ablation due to position of the fibroid in the pelvis.

131 out of the 179 patients (73%) were considered satisfactory candidates for the MRgFUS procedure.  118 have been treated.  13 candidates are still considereing the treatment.  Of the 49 non candidates, 12 had significant adenomyosis unknown to the patient and not seen on screening ultrasound exams, 8 had nonenhancing fibroids (calcified, hemorrhagic, or necrotic), and 6 had too many fibroids (>6).  5 patients had findings suspicious for cancer, of those, 2 were proven malignancies (endometrial cancer and uterine sarcoma), 1 had a benign fibroid, and 2 had no pathology to date.  4 patients had fibroids that were too vascular, 4 had metal in the beam path, 3 had endometrial polyps in addition to fibroids, that necessitated treatment, 2 patients ahd liposuction scars in the beam path, 2 had fibroids that were too small (<2cm each) , 1 patient had a large fibroid causing IVC compression, 1 had a fibroid that was too far posterior, and 1 had a pedunculated fibroid. 

73%  (131/179) of patients that presented for possible MRgFUS treatment were suitable candidates that could achieve a desired non perfused volume of at least 50% for symptomatic relief.  The ability for physicians to be able to advise patients of their suitability for MRgFUS is critical to the success of the procedure and importantly, can also identify other pelvic pathology that was not seen on screening ultrasounds and obscured by the symptoms attributed to the fibroids such as uterine sarcoma, endometrial cancer, adenomyosis, and polyps. 

  The majority of women with symptomatic uterine fibroids are candidates for MrgFUS treatment and the screening MRI exam is critical to determine candidacy and exclude other important pelvic pathology.

LeBlang, S, Factors Influencing Patient Candidacy for Magnetic Resonance Guided Focused Ultrasound Treatment (MRgFUS) of Uterine Fibroids.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021400.html