ParticipantsBilgin Keserci, PhD, Kota Bharu, Malaysia (Presenter) Nothing to Disclose
Nguyen Minh Duc, MD, Ho Chi Minh, Vietnam (Abstract Co-Author) Nothing to Disclose
Younis M. Firwana, MSc,BMBCh, Kota Bharu, Malaysia (Abstract Co-Author) Nothing to Disclose
Chandran Nadarajan, MD, Kota Bharu, Malaysia (Abstract Co-Author) Nothing to Disclose
Rajiv Chopra, PhD, Dallas, TX (Abstract Co-Author) Stockholder, Profound Medical Corporation; Stockholder, Solenic Medical Inc
bsnguyenminhduc@pnt.edu.vn
PURPOSETo comparatively evaluate therapeutic efficacy of high-intensity focused ultrasound (HIFU) ablation of uterine leiomyomas based on T1-perfusion and T2 signal intensity (SI)-based classifications.
METHOD AND MATERIALSA total of 74 women with symptomatic leiomyomas (age, 39.1 ± 5.9 years) who underwent HIFU treatment were classified according to (i) T2 SI-based classification as type I (n = 10, if SI of lesion was lower than or equal to that of skeletal muscle), type II (n = 40, if SI of lesion was lower than that of the myometrium but higher than that of skeletal muscles) and type III (n = 17, if SI of lesion was higher than that of the myometrium ), and (ii) T1 perfusion-based classification as group A (n = 44, if the time-SI curve of lesion was lower than that of myometrium) and group B (n = 23, if the time-SI curve of lesion was higher than that of myometrium). The non-perfused volume (NPV) ratios immediately after treatment and volume reduction ratios and transformed symptom severity scores (tSSS) at the 6-month follow-up were retrospectively assessed.
RESULTSThe mean fibroid volume in type I, II, III, and groups A and B was 155.4ml, 207.7ml, 156.5ml (p > 0.05), and 206.1ml, 150.0ml (p > 0.05), respectively. The mean NPV ratio was significantly higher in group A than in group B (95.6%, 51.9%, respectively; p<0.05). However, no statistically significant difference was observed in the immediate NPV ratio among patients with type I, II and III (80.6%, 79.5%, 83.2%, respectively; p>0.05). The 6-month fibroid volume reduction ratio in group A was significantly greater compared to that in group B (52.7% and 3.6%, respectively; p<0.05), whereas no statistically significant difference was observed among type I, II and III (44.3%, 32.8%, 38.2%, respectively; p>0.05). The corresponding symptom improvement ratio was 70.3%, 53.7%, 55.3% in type I, II and III and 80.9% and 10.1% in group A and group B, respectively.
CONCLUSIONThis study suggests that tissue vascularity based on T1-perfusion based classification could play an important role in not only classifying and stratifying the uterine leiomyomas but also predicting the treatment outcome of HIFU ablation.
CLINICAL RELEVANCE/APPLICATIONIn addition to tissue cellularity, vascularity also should be considered in the screening phase to improve the prediction of treatment response.