The follow-up of uterine fibroids treated with HIFU: role of DWI and Dynamic contrast-study MRI

Vallini, Valentina
2011 · doi:10.1594/ecr2011/c-1137 · W6925097655
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MRI diffusion-weighted imaging and dynamic contrast studies assessed uterine fibroid response to high intensity focused ultrasound, showing a 65% volume reduction and increased apparent diffusion coefficient values at six months.

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This study evaluated the utility of diffusion-weighted imaging and dynamic contrast-enhanced MRI in monitoring uterine fibroid response to high-intensity focused ultrasound treatment. The researchers analyzed eight patients with symptomatic fibroids who underwent MRI scans before and six months after the procedure, finding a mean tumor volume reduction of 65 percent. While ADC values increased post-treatment contrary to expectations for coagulative necrosis, both imaging modalities effectively assessed treatment response, though the authors noted the small sample size requires confirmation in larger studies. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Keywords

Treatment effects, MR-Diffusion/Perfusion, MR, Pelvis, Interventional non-vascular, Genital / Reproductive system female, Ablation procedures, Neoplasia Authors: V. Zampa, V. Vallini, S. Ortori, F. Porcelli, C. Bartolozzi; Pisa/IT DOI: 10.1594/ecr2011/C-1137 Purpose To evaluate the role of MRI: diffusion-weighted imaging (DWI) Dynamic contrast-study in assessing the response of uterine fibroids to high intensity focused ultrasound (HIFU) treatment.

Methods

and Materials From December 2008 to February 2010: 8 patients (mean age, 48 years, age range 46-52) with symptomatic uterine fibroids free of other pelvic pathology that required surgical intervention all patients underwent HIFU patients underwent MRI before and 6 months after treatment MAGNETIC RESONANCE IMAGING (MRI): multiplanar capacity and excellent soft tissue contrast resolution reflecting pathology Imaging protocol: 1.5-T MRI scanner and a multi-phased array coil (cardiac, 8 channels) T2-weighted FSE in the sagittal, axial; coronal planes when needed Dynamic-contrast study (FSPGR) DW imaging (b value=...

Results

Size before treatment: - Range : 5,2 cm to 15 cm - Mean : 7.8 cm Symptom presentation of 8 patients: - abdominal pain, menorrhagia, dysmenorrheal The mean ADC value of fibroids before treatment was: - 1,10 e-9 - range 0,42-1,40 e-9 The mean ADC value of fibroids after treatment increased andwas: - 1.73 e-9 - range1,60-2,00 e-9 Median reduction in tumor size as a percentage of initial tumor volume at 6 months after HIFU treatment was of 65% Mean fibroid enhancement before treatment was:...

Conclusion

HIFU ablation appears to be an effective and safe treatment in reducing uterine fibroids volume. Both dynamic studyand DWI may serve as imaging tools to assess treatment response. In spite of the expected reduction of ADC values related to coagulative necrosis, we observed an increase of ADC values. This data should be confirmed in a larger study group and can be a matter of speculation in understanding the cellular effect of HIFU. Further studies are needed to understand the reliability of DWI and, particularly, if...

References

[1].O. Kilickesmez, et al. Quantitative Diffusion-Weighted Magnetic Resonance Imaging of Noral and Diseased Uterine Zones. Acta Radiol 2009(3) [2]. Sala E, et al. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur J Radiol (2010), doi:10.1016/j.ejrad.2010.01.026 [3]. MITSUYOSHI I, et al. BLOOD FLOW OCCLUSION VIA ULTRASOUND IMAGE-GUIDED HIGHINTENSITY FOCUSED ULTRASOUND AND ITS EFFECT ON TISSUE PERFUSION. Ultrasound in Med. & Biol., Vol. 33, No. 3, pp. 452–459, 2007 [4]. J E KENNEDY, et al. High intensity focused ultrasound:... Personal Information Dr Virna Zampa, Dr Valentina Vallini Diagnostic and Interventional Radiology Department of Oncology, Transplants and Advanced Technologies in Medicine University of Pisa via Paradisa 2, 56100 Pisa email: [email protected], [email protected]

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