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.