scholarly journals Magnetic resonance-guided high-intensity focused ultrasound of uterine fibroids: whole-tumor quantitative perfusion for prediction of immediate ablation response

2019 ◽  
Vol 61 (8) ◽  
pp. 1125-1133
Author(s):  
Chenxia Li ◽  
Chao Jin ◽  
Ting Liang ◽  
Xiang Li ◽  
Rong Wang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
High Intensity ◽  
Focused Ultrasound ◽  
Uterine Fibroids ◽  
Blood Perfusion ◽  
High Intensity Focused Ultrasound ◽  
Hifu Treatment ◽  
Quantitative Perfusion ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri

Background In magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids, the immediate ablation response is significantly affected by blood perfusion. The variability of measurement for blood perfusion is critical due to the inherent non-uniformity of tumor perfusion and its dependence on reproducible region of interest (ROI) placement. Purpose To investigate the value of whole-tumor ROI (ROIwt) analysis for quantitative perfusion in predicting immediate ablation response of uterine fibroids in MR-HIFU. Material and Methods Thirty-one fibroids in 28 eligible patients were treated with MR-HIFU. Quantitative perfusion parameters (Ktrans, Kep, and Vp) derived from dynamic contrast-enhanced MRI were obtained before MR-HIFU treatment. The ROIwt and single-layer ROI (ROIsl) were used for quantitative perfusion analysis. T1 contrast-enhanced MRI immediately after MR-HIFU treatment was conducted to determine the non-perfused volume ratio (NPVR). Intraclass correlation coefficient (ICC) was used for consistency test. Spearman’s correlation and multivariate linear regression were used to investigate the predictors of the NPVR. Received operating characteristic (ROC) curve was used to test the predictive efficacy of quantitative perfusion parameter. Results The intra- and inter-observer ICC of the quantitative perfusion parameters from ROIwt were higher than those from ROIsl. Multivariate analysis showed that the Ktrans of ROIwt was a predictor of the immediate ablation response. ROC analysis displayed that the AUC of Ktrans of ROIwt is 0.817 in predicting the ablation response. Conclusion Pretreatment Ktrans of ROIwt is more reliable and stable than that of ROIsl. It could be a predictor for the immediate ablation response of uterine fibroids in MR-HIFU.

scholarly journals Lessons learned during implementation of MR-guided High-Intensity Focused Ultrasound treatment of uterine fibroids

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
K. J. Anneveldt ◽  
I. M. Verpalen ◽  
I. M. Nijholt ◽  
J. R. Dijkstra ◽  
R. D. van den Hoed ◽  
...  
Keyword(s):  
Learning Curve ◽  
Patient Selection ◽  
High Intensity ◽  
Focused Ultrasound ◽  
Uterine Fibroids ◽  
Lessons Learned ◽  
High Intensity Focused Ultrasound ◽  
Patient Counseling ◽  
Hifu Treatment ◽  
Medical Specialists

Abstract Background Although promising results have been reported for Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, this treatment is not yet widely implemented in clinical practice. During the implementation of a new technology, lessons are learned and an institutional learning-curve often has to be completed. The primary aim of our prospective cohort study was to characterize our learning-curve based on our clinical outcomes. Secondary aims included identifying our lessons learned during implementation of MR-HIFU on a technical, patient selection, patient counseling, medical specialists and organizational level. Results Our first seventy patients showed significant symptom reduction and improvement of quality of life at 3, 6 and 12 months after MR-HIFU treatment compared to baseline. After the first 25 cases, a clear plateau phase was reached in terms of failed treatments. The median non-perfused volume percentage of these first 25 treatments was 44.6% (range: 0–99.7), compared to a median of 74.7% (range: 0–120.6) for the subsequent treatments. Conclusions Our findings describe the learning-curve during the implementation of MR-HIFU and include straightforward suggestions to shorten learning-curves for future users. Moreover, the lessons we learned on technique, patient selection, patient counseling, medical specialists and organization, together with the provided supplements, may be of benefit to other institutions aiming to implement MR-HIFU treatment of uterine fibroids. Trial registration ISRCTN14634593. Registered January 12, 2021—Retrospectively registered, https://www.isrctn.com/ISRCTN14634593.

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