The value of susceptibility weighted imaging for immediate assessing the hyperacute outcome of MRgFUS ablation for uterine fibroids: a preliminary study.

PURPOSE: To investigate the value of susceptibility weighted imaging (SWI) for assessing the hyperacute outcome of ablation of uterine fibroids immediately after magnetic resonance-guided focused ultrasound (MRgFUS) treatment. METHODS: This retrospective imaging study included patients who underwent SWI and contrast-enhanced (CE) MR within 15 min of MRgFUS ablation for uterine fibroids. Two readers independently assessed the SWI features of ablative lesions and their association with the non-perfused volume (NPV) ratio. The intraclass correlation coefficient (ICC) and diagnostic value of SWI findings were calculated. RESULTS: A total of 27 uterine fibroids from 21 participants (mean age 40.1 ± 7.2 years) were analyzed. 51.9% (14/27) leiomyomas had NPV ratio ≥90%. In post-ablation SWI images, the interobserver ICC for the relative signal intensity and hypointense peripheral rim were 0.613 and 0.843, respectively (both p < .001). There was a significant difference in the prevalence of hypointense peripheral rim in leiomyomas with NPV ratio ≥90% and < 90% (p < .01), while the prevalence of relative signal intensity showed no significant difference (p > .05). When using the complete hypointense peripheral rim as a diagnostic criterion to identify NPV ratio ≥ 90%, readers 1 and 2 showed diagnostic sensitivity, specificity, and accuracy of 85.7%, 76.9%, 81.5%, and 78.6%, 76.9%, 77.8%, respectively. CONCLUSION: Identifying a complete hypointense peripheral rim on SWI may be a potential imaging marker for assessing the hyperacute outcome of uterine fibroids ablation by MRgFUS, specifically in determining whether the NPV ratio is ≥90%.

Diffusion-weighted imaging as a potential non-gadolinium alternative for immediate assessing the hyperacute outcome of MRgFUS ablation for uterine fibroids.

The aim of this study was to investigate the value of diffusion-weighted imaging (DWI) as a potential non-gadolinium alternative for promptly assessing the hyperacute outcome of magnetic resonance-guided focused ultrasound (MRgFUS) treatment for uterine fibroids. In this retrospective study we included 65 uterine fibroids from 44 women, who underwent axial DWI (b-value: 800 s/mm2) and contrast-enhanced (CE) MR within 15 min post-ablation. Two blinded observers independently reviewed the DWI findings of ablated necrotic lesions and measured their volumes on DWI and CE images. The post-ablation DWI images revealed clear depiction of ablative necrotic lesions in all fibroids, which were classified into two types: the bull's eye sign (type 1) and the bright patch sign (type 2). The inter-observer intraclass correlation coefficient for classifying DWI signal types was 0.804 (p < 0.001). Volumetric analysis of ablated necrosis using DWI and CE T1-weighted imaging showed no significant variance, nor did the non-perfused volume ratios (all p > 0.05). Bland-Altman analysis revealed a mean difference of 2.38% and 1.71% in non-perfused volume ratios between DWI and CE, with 95% limits of agreement from - 19.06 to 23.82% and - 18.40 to 21.82%, respectively. The findings of this study support the potential of DWI as a viable non-gadolinium alternative for evaluating the hyperacute outcomes of MRgFUS ablation in uterine fibroids.

Efficacy and safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) ablation in the management of abnormal uterine bleeding due to uterine leiomyoma or adenomyosis.

PURPOSE: To investigate the efficacy and safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) ablation for abnormal uterine bleeding (AUB) due to uterine leiomyoma or adenomyosis. METHODS: In total, thirty patients with AUB due to uterine leiomyoma (AUB-L group) or adenomyosis (AUB-A group) were treated by MRgFUS ablation. After MRgFUS ablation, the short-term clinical efficacy within one year was assessed. RESULTS: Sixteen patients were classified into the AUB-L group and 14 patients into the AUB-A group. The average nonperfused volume (NPV) ratios of the AUB-L and AUB-A groups were 82.7% ± 13.6% and 83.3% ± 11.1%, respectively. Compared with the baseline, the lesion volumes in the AUB-L and AUB-A groups were reduced by 45.6% and 34.6%, respectively, at 3 months after MRgFUS ablation. The hemoglobin concentration was increased by 22.4% in the AUB-L group and 15.3% in the AUB-A group at 3 months posttreatment. No amenorrhea occurred during the 12-month follow-up. The duration of bleeding decreased significantly in the AUB-A group. The mean PBAC scores at 3, 6 and 12 months posttreatment were reduced by 50.8%, 48.4% and 42.8%, respectively, in the AUB-L group and by 50.9%, 53.8% and 47.9%, respectively, in the AUB-A group. Compared with the baseline, at 3, 6 and 12 months posttreatment, the HRQL score increased by 41.5%, 43.3% and 33.3%, respectively, in the AUB-L group and by 24.7%, 31.1% and 28.2%, respectively, in the AUB-A group. CONCLUSION: MRgFUS is an effective and safe noninvasive uterine-sparing treatment modality in the management of AUB-L and AUB-A. MRgFUS can target lesion for ablation effectively, remove the factors that lead to AUB, retain a normal menstrual cycle, relieve AUB symptoms significantly and improve quality of life.

[Calcium pyrophosphate dihydrate crystal deposition disease: a clinicopathologic analysis of 20 cases].

OBJECTIVE: To investigate the clinicopathologic features of calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD). METHODS: The clinical and pathologic profiles were retrospectively analysed in 20 cases of CPPD-CDD. RESULTS: CPPD-CDD was far more common in women, most frequently involving joints, especially the knees and presenting with various arthrisis. Abnormally calcified and the articular damages were characteristic features by imageing. Histologically, multifocal indigo granular calcinosis was seen in synovium and sometimes appeared as needle-shaped or rhomboid crystals, which characterized the CPPD. CONCLUSIONS: Though clinical symptoms of CPPD are quite variable, the definite diagnosis can be made by the abnormal calcification and joint damage radiographically and the indigo CPPD crystals histopathologically.