Federica Ciolina MD, Presenter: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Francesco Sandolo, Abstract Co-Author: Nothing to Disclose

Carola Palla, Abstract Co-Author: Nothing to Disclose

Fabrizio Andrani, Abstract Co-Author: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

To retrospectively evaluate the outcome of patients affected by uterine leiomyoma and treated using either Magnetic Resonance Focused Ultrasound (MRgFUS), Uterine Artery Embolization (UAE) and Surgery.

451 women(group A)affected by uterine leiomyoma (mean age 39±5) referred our department for treatment of uterine fibroids with MRgFUS (July 2010-March 2014).Pre-treatment evaluation was done in order to assess symptoms and fibroids MR characteristics for MRgFUS viability.Patients not eligible for MRgFUS were addressed to UAE (group B) or surgery (group C).Primary endpoints were Symptoms Severity Score (SSS) (48.6±13.4), volume shrinkage (Group A and B) and the necessity for further treatment.Satisfaction related to different treatment was evaluated using a 5 point scale.

131/451 patients underwent MRgFUS (29%;Group A),320 were excluded(70%) and therefore assigned to Group B (123/451, 27%) and Group C (157/451, 35%).Remaining 40% patients (8%) were lost at follow up or refused the proposed treatment. In group A 112/131 patients (86%) showed a decrease in SSS(19.3±6.8),an average NPV of 70±15% (P=0.001), a volume shrinkage of 20±15% and an excellent satisfaction related to treatment. In 7/131 (5%) treatment was stopped at the beginning (bowel loops interposition or absence of compliance).4 patients had a pregnancy;3 patients experienced minor adverse events.In 12/131 patients (9%) we obtained NPV< 60% and patients needed surgical treatment.In group B patients showed a decrease in SSS (15.3±5.6), an average NPV of 98%(P=0.001), a volume shrinkage of up to 70% and a good satisfaction related to treatment.The major dissatisfaction was related to post-procedural pain that needed analgesic therapy. No pregnancy was observed.In Group C 80 patients underwent myomectomy,40 hysterectomy while the remaining refused other treatment.3 pregnancy were observed.

MRgFUS treatment of uterine fibroids is a reliable,noninvasive method for treatment symptomatic uterine fibroids;clinical success is directly related to NPV ratio.Eligibility is limited to 30% of screened women with symptomatic fibroids. All patients not suitable for this treatment should necessarily undergo surgery or UAE both with significant lower patient tolerance.

Screening MRI allow patients selection for successful MRgFUS treatment and enable to refer patients with uterine fibroids to the most appropriate kind of treatment.

Ciolina, F, Zaccagna, F, Sandolo, F, Palla, C, Andrani, F, Napoli, A, Screening MRI for Uterine Fibroids, Treatment Selection: MR-guided High Intensity Focused Ultrasound (MRgFUS), Uterine Artery Embolization (UAE) and Surgery. A per Group Analysis of Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045796.html