bsnguyenminhduc@pnt.edu.vn

To evaluate the efficacy and safety of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) ablation as an alternatively noninvasive therapy for patients with pedunculated subserosal leiomyoma.

This prospective study was approved by institutional review board. Over 3 years (from July 2015 to December 2018), 148 women with symptomatic leiomyoma underwent MRgHIFU at two centers. Of these women, 12 patients mean age 40 years (32-48y) had a single pedunculated subserosal fibroid. During treatment, these pedunculated fibroids were targeted, while sparing the stalk connection between the fibroid and the uterus. Contrast-enhanced T1-weighted MR images were obtained immediately after the treatment to measure the nonperfused volume ratio (NPVr) and to check stalk viability. Changes in tumor volume, diameter of the stalk, patient symptoms and adverse events were evaluated 6 months after treatment.

The mean volume of uterine fibroids was 142mL (82-222) and the mean NPV ratio was 82% (60-94). MR imaging follow-up at 6 months presented a 42% (18-60) reduction in the volume of the treated fibroids (P<0.05). All pedunculated subserosal fibroids remained connected to the uterus at 12-month post-treatment. The mean diameter of the stalk reduced from 2.8cm to 2.1cm with a mean 25% reduction ratio (p<0.05). The transformed symptom severity score improvement ratio at 6-month and 12-month post-treatment was 79% and 91%, respectively. There were no severe adverse events during the 12 months of follow-up.

The results in this study suggest that MRgHIFU could be an alternatively safe and efficacious method for pedunculated subserosal fibroids alternative to conventional surgeries. Further larger population studies with longer follow-up should be carried out to validate these results.

MRgHIFU should be considered as an alternatively noninvasive treatment for patients with pedunculated subserosal fibroids without significant adverse events.