Sameer Surendra Soneji DMRD, Presenter: Nothing to Disclose

Ritu Manoj Kakkar MBBS, Abstract Co-Author: Nothing to Disclose

Shrinivas Balaji Desai MD, Abstract Co-Author: Nothing to Disclose

To assess the efficacy of MR guided focused ultrasound surgery (MRGFUS) in treating adenomyosis by evaluation of non-perfused volumes (NPV) and symptom severity score (SSS).

19 Indian women with significant symptomatic adenomyosis (SSS > 21) were selected. Patients underwent evaluation of the adenomyosis with post contrast MRI of pelvis. Those with focal and diffuse adenomyosis with definable treatable areas were treated by MRGFUS. Post treatment post contrast MRI pelvis was performed to assess the NPV. 6 months follow up with SSS questionnaire and MRI pelvis with contrast.

MRgFUS treatment of adenomyosis resulted in significant reduction in SSS in 74% patients. The post treatment SSS at 6 months and reduction in score was 16± 4.8 (SD) and 12.6 ± 5.4 (SD) respectively which showed strong correlation with the NPV and percentage of adenomyosis reduction (p < 0.01). NPV had a strong and highly positive correlation with reduction in SSS (p<0.01, r= 0.92). The unpaired t-test determined that there was significant difference in NPV values in patients who had clinically significant reduction in SSS (p < 0.01). The ROC of NPV with reduction in SSS showed that an NPV > 22% resulted in significantly reduced SSS. Nearly 80% of our patients were adverse event free with the remaining having self-limited complications like abdominal pain, early menses and back pain. There was 1 patient of 1st degree burn due to previous surgery scar which also resolved within a month of the treatment.

MRgFUS can provide effective treatment of adenomyosis. The treatment is able to achieve NPV values that will result in clinically significant reduction in symptoms. The reduction in the SSS and percentage of adenomyosis reduction follows the NPV very closely and linearly, which means that achieving greater NPV will essentially result in significant symptom reduction. This procedure is safe with minimal adverse effects.

MRgFUS should be used to treatment focal or diffuse adenomyosis where a treatable area can be defined. NPV more than 20% should be therapeutic, however highest possible NPV that can be safely achieved should be sought for better symptom reduction.

Soneji, S, Kakkar, R, Desai, S, Efficacy of MR Guided Focused Ultrasound Surgery in Treating Adenomyosis: Study of 19 Indian Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045771.html