Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation

Purpose To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy.

Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL.

The pre-treatment target volume mean value was of 59.7 cc; the MRgFUS-TV had a mean value of 44.9 cc, and the mean value of CE MRI-TV, measured immediately after treatment, was of 52.8 cc, with an increase of 13.7 %. The 86.5 % of the lesion was treated. After 1 year from the treatment, 15/18 (83 %) patients showed thickness of the junctional zone 12 mm.

MRgFUS is an encouraging mini-invasive treatment for adenomyosis that permits to maintain the integrity of the uterus in a pathology with limited therapeutic possibility. Similar content being viewed by others

Peric H, Fraser IS (2006) The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20(4):547–555 (Epub 2006 Mar 2) Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I (2008) terine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed 17(2):244–248 Bird CC, McElin TW, Manalo-Estrella P (1972) The elusive adenomyosis of the uterus revisited. Am J Obstet Gynecol 112(5):583–593 Jha RC, Takahama J, Imaoka I, Korangy SJ, Spies JB, Cooper C, Ascher SM (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. Am J Roentgenol 181(3):851–856 Emge LA (1962) The elusive adenomyosis of the uterus. Its historical past and its present state of recognition. Am J Obstet Gynecol 83:1541–1563 Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4(4):312–322 Kelekci S, Kelekci KH, Yilmaz B (2012) Effects of levonorgestrel-releasing intrauterine system and T380A intrauterine copper device on dysmenorrhea and days of bleeding in women with and without adenomyosis. Contraception 86(5):458–463. doi:10.1016/j.contraception.2012.04.001 (Epub 2012 Jul 24) Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y (2008) Early Results of magnetic resonance—guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol 15(5):571–579. doi:10.1016/j.jmig.2008.06.010 Epub 2008 Jul 26 Stamatopoulos CP, Mikos T, Grimbizis GF, Dimitriadis AS, Efstratiou I, Stamatopoulos P, Tarlatzis BC (2012) Value of magnetic resonance imaging in diagnosis of adenomyosis and myomas of the uterus. J Minim Invasive Gynecol 19(5):620–626. doi:10.1016/j.jmig.2012.06.003 Siskin GP, Tublin ME, Stainken BF, Dowling K, Dolen EG (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177(2):297–302 Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA, MRgFUS Study Group (2010) Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 93(1):199–209. doi:10.1016/j.fertnstert.2008.10.001 (Epub 2008 Nov 14) Cline HE, Hynynen K, Watkins RD, Adams WJ, Schenck JF, Ettinger RH, Freund WR, Vetro JP, Jolesz FA (1995) Focused US system for MR imaging-guided tumor ablation. Radiology 194(3):731–737 Masciocchi C, Conchiglia A, Gregori LM, Arrigoni F, Zugaro L, Barile A (2014) Critical role of HIFU in musculoskeletal interventions. Radiol Med 119(7):470–475. doi:10.1007/s11547-014-0414-z (Epub 2014 Jun 4) Clark NA, Mumford SL, Segars JH (2014) Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr Opin Obstet Gynecol 26(3):151–161. doi:10.1097/GCO.0000000000000070 Fan TY, Zhang L, Chen W, Liu Y, He M, Huang X, Orsi F, Wang Z (2012) Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis. Eur J Radiol 81(11):3624–3630. doi:10.1016/j.ejrad.2011.05.036 Epub 2011 Jun 29 Abdullah B, Subramaniam R, Omar S, Wragg P, Ramli N, Wui A, Lee C, Yusof Y (2010) Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids. Biomed Imaging Interv J 6(2):e15. doi:10.2349/biij.6.2.e15 (Epub Apr 1, 2010) Spies JB, Coyne K, Guaou GN, Boyle D, Skyrnarz-Murphy K, SM Gonsalves (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300 Tamai K, Koyama T, Umeoka S, Saga T, Fujii S, Togashi K (2006) Spectrum of MR features in adenomyosis. Best Pract Res Clin Obstet Gynaecol 20(4):583–602 (Epub 2006 Mar 24) Maheshwari A, Gurunath S, Fatima F, Bhattacharya S (2012) Adenomyosi and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update 18(4):374–392. doi:10.1093/humupd/dms006 (Epub 2012 Mar 22) Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X (2015) Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Womens Health 15:182. doi:10.1186/s12905-015-0182-5 (Epub 2015 Mar 13) Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R (2010) Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril 94(2):715–719. doi:10.1016/j.fertnstert.2009.03.046 (Epub 2009 May 5) Huang BS, Seow KM, Tsui KH, Huang CY, Lu YF, Wang PH (2012) Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: long-term follow-up in a series of nine patients. Taiwan J Obstet Gynecol. 51(2):212–216. doi:10.1016/j.tjog.2012.04.008 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Rights and permissions About this article Cite this article Ferrari, F., Arrigoni, F., Miccoli, A. et al. Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation. Radiol med 121, 153–161 (2016). https://doi.org/10.1007/s11547-015-0580-7 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s11547-015-0580-7