{"paper_id":"5dd44ff1-c09a-43a0-a90f-40cfb4e81774","body_text":"Abstract\nObjective\nTo evaluate the integrity of endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of submucosal uterine fibroids based on contrast-enhanced MRI findings, and to identify the risk factors for endometrial impairment.\nMethods\nIn total, 117 submucosal fibroids (diameter: 5.9 ± 3.0 cm) in 101 women (age: 43.6 ± 4.4 years) treated with MR-HIFU ablation were retrospectively analysed. Endometrial integrity was assessed with contrast-enhanced T1-weighted images at immediate (n = 101), 3-month (n = 62) and 12-month (n = 15) follow-ups. Endometrial impairment was classified into grades 0 (continuous endometrium), 1 (pin-point, full-thickness discontinuity), 2 (between grade 1 and 3), or 3 (full-thickness discontinuity >1 cm). Risk factors were assessed with generalized estimating equation (GEE) analysis.\nResults\nAmong 117 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed at initial examination in 56.4%, 24.8%, 13.7% and 4.3%, respectively. Among 37 fibroid cases of endometrial impairment for which follow-ups were conducted, 30 showed improvements at 3- and/or 12-month follow-up. GEE analysis revealed the degree of endometrial protrusion was significantly associated with severity of endometrial injury (P < 0.0001).\nConclusions\nAfter MR-HIFU ablation of submucosal fibroids, endometrial enhancement was preserved intact or minimally impaired in most cases. Impaired endometrium, which is more common after treating endometrially-protruded fibroids, may recover spontaneously.\nKey Points\n• After MR-HIFU ablation for submucosal fibroid, endometrium is mostly preserved/minimally impaired.\n• Endometrial-protruded submucosal fibroid is susceptible to more severe endometrial impairment.\n• The impaired endometrium may recover spontaneously at follow-up MR exams.\nSimilar content being viewed by others\nAbbreviations\n- FDA:\n-\nFood and Drug Administration\n- FSH:\n-\nFollicle-stimulating hormone\n- GEE:\n-\nGeneralized estimating equation\n- GnRHa:\n-\nGonadotropin-releasing hormone agonist\n- MR-HIFU:\n-\nMagnetic resonance imaging-guided high-intensity focused ultrasound\n- NPV:\n-\nNon-perfused volume\n- US-HIFU:\n-\nUltrasonography-guided high-intensity focused ultrasound\nReferences\nAl Hilli MM, Stewart EA (2010) Magnetic resonance-guided focused ultrasound surgery. 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J Magn Reson Imaging 24:1350–1356\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Dr. Young-sun Kim.\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nFunding\nThe authors state that this work has not received any funding.\nStatistics and biometry\nTwo of the authors have significant statistical expertise.\nEthical approval\nInstitutional Review Board approval was obtained.\nInformed consent\nWritten informed consent was waived by the Institutional Review Board.\nStudy subjects or cohorts overlap\nNo study subjects or cohorts have been previously reported.\nMethodology\nRetrospective, observational, performed at one institution.\nRights and permissions\nAbout this article\nCite this article\nKim, Ys., Kim, TJ., Lim, H.K. et al. Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids. Eur Radiol 27, 3956–3965 (2017). https://doi.org/10.1007/s00330-017-4765-4\nReceived:\nRevised:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-017-4765-4","source_license":"CC0","license_restricted":false}