MRI-guided focused ultrasound (MRgFUS) surgery in conserving therapy of adenomyosis

Zhumanova E, Е. Н. Жуманова, Lazutkina Y, Yu V Lazutkina, Yu O Gorbenko, Gorbenko Y, А. А. Ищенко, Е. А. Чунаева, Chunaeva E, A.A. Ishchenko, Ishchenko A, Mershina E, EA Mershina, VE Sinitsyn, Sinitsyn V
Journal of therapeutic ultrasound · 2014 · vol. 2(Suppl 1) , pp. A10 · doi:10.1186/2050-5736-2-s1-a10 · PMC4292017 · W2018255258
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This study investigated the efficacy of MRI-guided focused ultrasound ablation as an organ-preserving treatment for adenomyosis.

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This study evaluated the efficacy of MRI-guided focused ultrasound ablation as an organ-preserving treatment for symptomatic adenomyosis in fifteen women aged 25 to 45. Researchers utilized contrast-enhanced MRI and Doppler mapping to assess changes in uterine volume and vascularity at three months post-procedure, alongside patient-reported outcomes regarding pain and bleeding. The results indicated that eighty percent of participants experienced improved quality of life and pain reduction, while seventy percent showed a significant decrease in uterine volume and reduced blood flow to affected areas. Although symptoms did not recur within six months, the authors note that these findings require validation through larger, long-term studies to establish clinical reliability. This paper is centrally about adenomyosis — specifically evaluating a non-invasive surgical technique for its management.

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Abstract

Background Adenomyosis is a complex disorder that accounts up to one third of gynecological morbidity. Diffuse form of adenomyosis is most difficult to diagnose and treat. All attempts to create a “gold standard” in preserving therapy have not been successful so far. MRgFUS could be a promising technology for organ-preserving treatment of this disease. Purpose of this study was to determine the efficacy of MRgFUS ablation in organ-preserving treatment of adenomyosis.
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Results

12 of 15 pts (80%) reported an improvement of life quality in 3 months. Regression of pain was observed in 80% of cases (12 pts), a decrease of metrorrhagia - in 60% (9 pts). Recurrence of the symptoms in these patients was not observed 6 months after treatment. In 70% of cases (10 pts) the uterine volume decreased by 33% 3 months after ablation. In 60% of women (9 pts) non-perfused zones were described using MRI with contrast-enhancement, averaging 26% of the affected areas. Decrease of vascularity was confirmed by Doppler mapping technique.

Background

Adenomyosis is a complex disorder that accounts up to one third of gynecological morbidity. Diffuse form of adenomyosis is most difficult to diagnose and treat. All attempts to create a "gold standard" in preserving therapy have not been successful so far. MRgFUS could be a promising technology for organ-preserving treatment of this disease. Purpose of this study was to determine the efficacy of MRgFUS ablation in organ-preserving treatment of adenomyosis.

Conclusions

MRgFUS ablation may become a method of choice for conserving therapy of the patients with a confirmed diagnosis of adenomyosis especially in reproductive age. This method is non-invasive, does not require hospitalization. This requires further observation and confirmation in a bigger group of patients and in a long-term period.

Materials|Methods

15 women (25-45 yrs old) with symptomatic adenomyosis were included in the study. Informed consent was obtained in all cases. The diagnosis and the technical ability to follow the procedure protocol were confirmed by MRI. Ablation was performed using ExAblate-2000 (InSightec, Israel) by guidance of 1,5T MRI (General Electric, USA). Control MRI and Doppler mapping were performed immediately after and in 3 months after MRgFUS ablation to evaluate uterine volume and vascularity of myometrium. All the patients completed questionnaires before and 3 months after the procedure.

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adenomyosis

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