Magnetic resonance imaging parameters in predicting the ablative efficiency of high-intensity focused ultrasound for uterine fibroids.

OBJECTIVE: To evaluate the role of quantitative MRI parameters in predicting HIFU ablation results for uterine fibroids. MATERIAL AND METHODS: A total of 245 patients with uterine fibroids who underwent HIFU treatment in Chongqing Haifu Hospital were reviewed retrospectively. The patients were divided into two groups according to the non-perfused volume (NPV) ratio which was either higher or lower than 80%. The MRI parameters were measured, and a logistical regression analysis was performed to investigate the potential predictors associated with the NPV ratio. Receiver operating characteristics (ROC) analysis was used to determine the cut off value for MRI parameters in predicting a high NPV ratio. RESULTS: The subcutaneous fat thickness in the group of patients with an NPV ratio over 80% was significantly thinner than that in the group of patients with an NPV ratio less than 80% (15 mm versus 21 mm). The signal intensity ratio of fibroids to skeletal muscle on T2WI was significantly lower in the group of patients with an NPV ratio over 80% compared with the group with an NPV ratio lower than 80% (2.46 versus 3.23). The signal intensity ratio of fibroid to skeletal muscle correlated negatively with the NPV ratio and positively with the energy efficiency factor (EEF). The cut off value of signal intensity ratio of fibroid to muscle for predicting the NPV ratio over 80% is 3.045. CONCLUSION: The signal intensity ratio of fibroid to skeletal muscle on T2WI can be used as a factor for predicting the effectiveness of HIFU ablation of uterine fibroids.

Transrectal high-intensity focused ultrasound (HIFU) for management of rectosigmoid deep infiltrating endometriosis: results of Phase-I clinical trial.

OBJECTIVES: Deep infiltrating endometriosis (DIE) of the rectosigmoid is associated with painful symptoms. When medical treatment is ineffective, surgical resection remains the standard treatment, despite significant risk of adverse events. High-intensity focused ultrasound (HIFU) is a minimally invasive ablative procedure. Focal One® is a transrectal HIFU (TR-HIFU) device used in prostate cancer treatment. The primary objective of this study was to confirm the feasibility of treatment with TR-HIFU in patients presenting with posterior DIE with rectosigmoid involvement. We also assessed its safety and clinical efficacy in this context. METHODS: This was a non-controlled, prospective, Phase-I clinical trial in a French University Hospital which is a multidisciplinary center for management of endometriosis. Included were patients older than 25 years, without plans to conceive within 6 months, who presented with a single lesion of posterior DIE, with rectosigmoid invasion, after failure of hormonal therapy. All lesions were assessed preoperatively using transvaginal sonography and magnetic resonance imaging. Patients completed questionnaires on gynecological and intestinal symptoms (similar to a visual analog scale (VAS)), and on quality of life (Medical Outcomes Study 36-item short-form survey (SF-36) and, for the second half of patients recruited, symptom scoring system for constipation (KESS), female sexual function index (FSFI) and endometriosis health profile short-version score (EHP-5)), before, and at 1, 3 and 6 months after, TR-HIFU treatment with a Focal One real-time ultrasound-guided HIFU device. RESULTS: Twenty-three consecutive patients were included in the study between September 2015 and October 2019. All 23 lesions were visualized, giving a detection rate of 100%. Twenty lesions were treated ('feasibility rate', 87.0%): in 13 the whole lesion was treated and in seven the lesion was treated partially. The mean duration of the TR-HIFU procedure was 55.6 min. We observed a significant improvement in VAS score at 6 months, with differences relative to preoperative scores as follows, for: dysmenorrhea (-3.6, P = 0.004), dyspareunia (-2.4, P = 0.006), diarrhea (-3.0, P = 0.006), constipation (-3.0, P = 0.002), dyschezia (-3.2, P = 0.003), false urge to defecate (-3.3, P = 0.007), posterior pelvic pain (-3.8, P = 0.002) and asthenia (-3.8, P = 0.002). There was also a significant improvement in the SF-36 score, with an increase at 6 months relative to the preoperative score in both the physical component summary (+ 9.3%, P = 0.002) and mental component summary (+ 10.9%, P = 0.017). No major complications occurred during or after any procedure. CONCLUSIONS: TR-HIFU therapy for posterior DIE is feasible. If its efficacy and safety are confirmed, it could be a minimally invasive alternative to surgery for the treatment of rectosigmoid endometriosis. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

HIFU treatment for fibroadenoma - a clinical study at National Scientific Research Centre, Astana, Kazakhstan.

This randomized controlled study evaluated effect of low frequency high intensity focused ultrasound (HIFU) in 80 women with breast fibroadenomas randomly and evenly divided into main and control groups, treated with HIFU and sectoral resection accordingly. In- vitro trial of fibroadenoma samples exposed to different power levels:100 Watt (W), 200 W and 300 W, analysis of results shown that optimal ablation power 200W was enough for coagulation necrosis of tumour, while 300W ablation caused complete destruction of tissues. Results showed that 20% of control group (surgically treated) patients had post-operative complications and 12.5% - postponed recurrences, as opposed to zero incidence of either in the main group (HIFU treated). The average hospital stay following HIFU reduced by 52%. Both in-vitro and morphological studies showed that HIFU caused high precision coagulation necrosis of fibroadenoma and preservation of the surrounding tissues. HIFU enabled to avoid early postoperative complications and long-term recurrences. This technique can significantly improve quality of life by reducing pain intensity and enabling sooner activity..

Morphological active contour without edge-based model for real-time and non-rigid uterine fibroid tracking in HIFU treatment.

High-intensity focused ultrasound (HIFU) therapy represents an image-guided and non-invasive surgical approach to treat uterine fibroid. During the HIFU operation, it is challenging to obtain the real-time and accurate lesion contour automatically in ultrasound (US) video. The current intraoperative image processing is completed manually or semi-automatic. In this Letter, the authors propose a morphological active contour without an edge-based model to obtain accurate real-time and non-rigid US lesion contour. Firstly, a targeted image pre-processing procedure is applied to reduce the influence of inadequate image quality. Then, an improved morphological contour detection method with a customised morphological kernel is harnessed to solve the low signal-to-noise ratio of HIFU US images and obtain an accurate non-rigid lesion contour. A more reasonable lesion tracking procedure is proposed to improve tracking accuracy especially in the case of large displacement and incomplete lesion area. The entire framework is accelerated by the GPU to achieve a high frame rate. Finally, a non-rigid, real-time and accurate lesion contouring for intraoperative US video is provided to the doctor. The proposed procedure could reach a speed of more than 30 frames per second in general computer and a Dice similarity coefficient of 90.67% and Intersection over Union of 90.14%.

A continuous tri-phase transition effect for HIFU-mediated intravenous drug delivery.

Aiming at substantially enhanced efficacy and biosafety of clinical HIFU therapy, a natural solid medium, L-menthol (LM), characteristic of mild and controllable "solid-liquid-gas" (SLG) tri-phase transition, was adopted, instead of those conventional explosive liquid-gas (LG) bi-phase transitional media, in constructing a multifunctional theranostic system. Owing to the continuous and controllable characteristics of SLG tri-phase transition, such a novel tri-phase transition-based theranostic system has been demonstrated of the repeatedly enhanced HIFU efficacy ex vivo and in vivo under once intravenous injection and the significantly improved treatment precision, controllability and biosafety when comparing to the traditional bi-phase transition medium, perfluorohexane (PFH), thus promising great application potential in clinical HIFU treatment. Moreover, this theranostic system has been demonstrated a long blood-circulation lifetime and continuous accumulation in tumor in 24 h, which is very beneficial for the enhanced tumor ablation in vivo along with SLG tri-phase transition. More importantly, after loading multiple model drugs and real drug, such a theranostic system presents a HIFU-mediated temperature-responsive drug release property, and depending on the versatile miscibility of LM, co-loadings with hydrophobic and hydrophilic drugs are also achieved, which provides the possibility of synergistic treatment combining HIFU therapy and chemotherapy.