Preservation of the endometrial enhancement after magnetic resonance imaging-guided high-intensity focused ultrasound ablation of submucosal uterine fibroids

Objective To 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.

In 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.

Among 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).

After 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. Key Points • After MR-HIFU ablation for submucosal fibroid, endometrium is mostly preserved/minimally impaired. • Endometrial-protruded submucosal fibroid is susceptible to more severe endometrial impairment. • The impaired endometrium may recover spontaneously at follow-up MR exams. Similar content being viewed by others Abbreviations - FDA: - Food and Drug Administration - FSH: - Follicle-stimulating hormone - GEE: - Generalized estimating equation - GnRHa: - Gonadotropin-releasing hormone agonist - MR-HIFU: - Magnetic resonance imaging-guided high-intensity focused ultrasound - NPV: - Non-perfused volume - US-HIFU: - Ultrasonography-guided high-intensity focused ultrasound

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Statistics and biometry Two of the authors have significant statistical expertise. Ethical approval Institutional Review Board approval was obtained. Informed consent Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts overlap No study subjects or cohorts have been previously reported. Methodology Retrospective, observational, performed at one institution. Rights and permissions About this article Cite this article Kim, 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 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-017-4765-4