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Volumetric MR-guided High-Intensity Focused Ultrasound Ablation with a One-Layer Strategy to Treat Large Uterine Fibroids: Initial Clinical Outcomes.
MedLine Citation:
PMID:  22403170     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Purpose:To evaluate initial clinical outcomes of volumetric magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) ablation by using a one-layer strategy to treat large (>10 cm in diameter) uterine fibroids, with investigation of the correlation between effectiveness of the one-layer strategy and dynamic contrast material-enhanced (DCE) MR parameters.Materials and Methods:Institutional review board approval and informed consent were obtained. Twenty-seven women (mean age, 44.5 years) with 27 large uterine fibroids (mean diameter, 11.3 cm ± 1.4 [standard deviation] [range, 10.1-16.0 cm]; fibroid volume, 502.5 mL ± 214.3 [range, 253.8-1184.0 mL]) underwent volumetric MR-guided HIFU ablation with a one-layer strategy. (All treatment cells were placed in one coronal plane at a depth of half to anterior two-thirds of the anteroposterior dimension of fibroids.) Treatment time, immediate nonperfused volume (NPV), and effectiveness of a one-layer strategy (ratio of immediate NPV to total volume of treatment cells planned) correlating with baseline DCE MR parameters (volume transfer constant [K(trans)], fractional extravascular extracellular space, and fractional blood plasma volume [Pearson correlation test]), complications, 3-month follow-up volumes, and symptom severity score (SSS) changes (paired t test) were assessed retrospectively.Results:All treatments showed technical success in one session (mean treatment time, 166.2 minutes ± 38.9). NPV was 301.3 mL ± 119.1, which was 64.2% ± 19.9 (<50%, n = 4; ≥50%, n = 23) of fibroid volume. Ratio of immediate NPV to total volume of treatment cells (1.79 ± 0.61) negatively correlated with DCE MR imaging K(trans) values (r = 20.426, P = .017). Minor complications occurred in five patients (18.5% [thermal injury of abdominal wall, n = 3; 30-day leg numbness, n = 1; cystitis, n = 1]). At 3-month follow-up (n = 18), mean SSS had decreased from 37.4 at baseline to 24.0 (P < .001), and volume reduction ratio was 0.64 ± 0.15 (P < .001).Conclusion:Volumetric MR-guided HIFU ablation with a one-layer strategy is safe and effective for treatment of large uterine fibroids. Effectiveness of this strategy showed a significant negative correlation with K(trans) values at baseline DCE MR imaging.© RSNA, 2012Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111707/-/DC1.
Authors:
Young-Sun Kim; Jae-Hun Kim; Hyunchul Rhim; Hyo Keun Lim; Bilgin Keserci; Duk-Soo Bae; Byoung-Gie Kim; Jeong-Won Lee; Tae-Joong Kim; Chel Hun Choi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-8
Journal Detail:
Title:  Radiology     Volume:  -     ISSN:  1527-1315     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
High-Intensity Focused Ultrasound Center, Samsung Medical Center, Seoul, Korea; Department of Radiology and Center for Imaging Science and Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 138-225, Korea.
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