Nguyen Minh Duc

The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids

AbstractObjectiveTo comparatively evaluate the role of magnetic resonance (MR) T1 perfusion-based time–signal intensity (SI) curves of fibroid tissue and the myometrium in classification of fibroids for predicting treatment outcomes of high-intensity focused ultrasound (HIFU) treatment.MethodsThe fibroids of 74 women who underwent MR-HIFU treatment were classified into group A (time–SI curve of fibroid lower than that of the myometrium) and group B (time–SI curve of fibroid equal to or higher than that of the myometrium). Non-perfused volume (NPV) ratios immediately after treatment and fibroid volume reduction ratios and symptom severity scores (SSS) at the 6-month follow-up were retrospectively assessed.ResultsThe immediate NPV ratios in groups A and B were 95.3 ± 6.3% (n = 62) and 63.8 ± 11% (n = 12), respectively. At the 6-month follow-up, the fibroid volume reduction ratios in groups A and B were 0.52 ± 0.14 (n = 50) and 0.07 ± 0.14 (n = 11), with the corresponding improvement in mean transformed SSS being 0.86 ± 0.14 and 0.19 ± 0.3, respectively. No serious adverse effects were reported.ConclusionsOur novel classification method could play an important role in classifying fibroids for predicting the immediate outcomes of HIFU treatment.Key Points• MRI is an important modality for outcome prediction in HIFU treatment • Patient selection is a significant factor for achieving high NPV ratio • NPV ratio is very strongly correlated with T1 perfusion-based classification • T1 perfusion-based classification is a strong predictor of treatment outcome

The role of T1 perfusion-based classification in predicting the outcome of magnetic resonance-guided high-intensity focused ultrasound treatment of adenomyosis

Abstract Objective: To assess the relationship between magnetic resonance (MR) T1 perfusion-based classification and the outcome of MR-guided high intensity focused ultrasound treatment of adenomyosis, defined as nonperfused volume (NPV) ratio. Methods: The adenomyosis of 31 women was classified into group A (time–signal intensity [SI] curve of adenomyosis lower than that of the myometrium) and group B (time–SI curve of adenomyosis equal to or higher than that of the myometrium) on the basis of time–SI curves on dynamic contrast enhanced (DCE) MR images acquired at screening. NPV ratios immediately after treatment and adenomyosis volume reduction ratios and symptom severity scores (SSS) at the six-month follow-up were retrospectively assessed. Univariate and multivariate analysis of pretreatment parameters conducted to assess independent factors impacting on immediate NPV ratio. All adverse effects were recorded. Results: The immediate NPV ratios in groups A and B were 89.2 ± 6.7% and 42.4 ± 19.0%, respectively. At the six-month follow-up, the adenomyosis volume reduction ratios in groups A and B were 0.27 ± 0.8 and 0.04 ± 0.1, respectively, with corresponding improvements of 0.7 ± 0.18 and 0.26 ± 0.25, respectively, in the mean transformed SSS. Univariate and multivariate analysis revealed that only T1 perfusion-based classification as an independent factor associated with the outcome of MR-guided high intensity focused ultrasound treatment. No serious adverse effects were reported. Conclusions: Our novel classification method introduced in this study might be clinically beneficial in classifying adenomyosis for predicting the immediate outcome of MR-guided high intensity focused ultrasound treatment.

OC12.08: High-intensity focused ultrasound of uterine fibroids: the role histogram parameters of quantitative T1 perfusion in predicting treatment outcome

Czech Republic; 11Centre of Obstetrics and Gynecology, Vilnius University Hospital, Santariskiu Clinic, Vilnius, Lithuania; 12Obstetrics and Gynecology, University of Navarra, Pamplona, Spain; 13Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; 14Department of Pathology, Karolinska University Hospital, Stockholm, Sweden; 15Obstetrics and Gynecology, Lund University, Malmö, Sweden; 16Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; 17Department of Women and Children’s Health, Karolinska University Hospital, Stockholm, Sweden; 18Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic; 19Department of Development and Regeneration, KU Leuven, Leuven, Belgium

Influences of screening magnetic resonance imaging parameters on high-intensity focused ultrasound outcome for adenomyosis

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Reports in Medical Imaging 2018:11 9–14 Reports in Medical Imaging Dovepress

Effect of magnetic resonance imaging characteristics on uterine fibroid treatment

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Reports in Medical Imaging 2018:11 1–8 Reports in Medical Imaging Dovepress

Magnetic resonance imaging features influencing high-intensity focused ultrasound ablation of adenomyosis with a nonperfused volume ratio of ≥90% as a measure of clinical treatment success: retrospective multivariate analysis

Abstract Objective: This retrospective study aimed (1) to investigate the magnetic resonance imaging (MRI) features influencing a nonperfused volume ratio (NPVr) ≥ 90% after high-intensity focussed ultrasound (HIFU) ablation of adenomyosis, and (2) to assess the safety, which was defined in terms of adverse events (AEs) and changes in anti-Mullerian hormone (AMH) concentrations, and clinical efficacy, which was defined in terms of adenomyosis volume reduction and symptom improvement at 6 months’ follow-up. Methods: Sixty-six women who underwent HIFU treatment were divided into groups A (NPVr ≥90%; n = 26) and B (NPVr <90%, n = 40). Multivariate logistic regression analyses of MRI features were conducted to identify the potential predictors of an NPVr ≥90%. Results: Generalized estimating equation (GEE) analysis was used to model the prediction of an NPVr ≥90% with four significant predictors from multivariate analyses: the thickness of the subcutaneous fat layer, adenomyosis volume, T2 signal intensity (SI) ratio of adenomyosis to myometrium, and the Ktrans ratio of adenomyosis to myometrium. Clinical efficacy was significantly greater in group A than in group B. The findings showed no serious AEs and no significant differences between AMH concentrations before and 6 months after treatment. Conclusions: The present retrospective study demonstrated that achievement of NPVr ≥90% as a measure of clinical treatment success in MRI-guided HIFU treatment of adenomyosis using multivariate analyses and a prediction model is clinically possible without compromising the safety of patients.

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids

Magnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) is an effective noninvasive treatment option for symptomatic uterine fibroids. However, tissue characteristics of uterine fibroids and technical limitations can limit the patient population that can benefit from this therapy. In this article, we present our literature review focusing on the influential clinical factors that might reduce the risk of an unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids.

Magnetic Resonance Imaging-Guided FocusedUltrasound Surgery for Patients with MultipleLeiomyomas and/or Huge Leiomyoma

Uterine fibroids (known as leiomyoma) which disrupt the functions of the uterus and cause menorrhagia, dysmenorrhea, anemia, pelvic pressure or pain, urinary incontinence, recurrent pregnancy loss and infertility, represent the most common tumor in women. The lifetime prevalence of fibroids is more than 80% among black women and about 70% among white women [1]. Patients with symptomatic multiple leiomyomas and huge leiomyoma desired to conserve the uterus for further delivery birth which generated one of the most common problematic medical conditions which have gynecologist needed to be considered and find the appropriate treatments cautiously. Magnetic Resonance Imaging (MRI)-guided Focused Ultrasound Surgery (FUS) which combines the anatomical and functional imaging of MR with the thermal ablation possibilities of FUS, is an alternative treatment to hysterectomy for the treatment of uterine fibroids and preserves the uterus [2,3]. In this short communication, we aimed to display one tough case of 15 leiomyomas and another tough case of huge leiomyoma ablated profitably by FUS along with the pros and cons of these findings.

Volumetric magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids through abdominal scars: the impact of a scar patch on therapeutic efficacy and adverse effects

BackgroundTo retrospectively compare the treatment success, therapeutic efficacy, and adverse effects of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment for uterine fibroid patients with and without abdominal scars.MethodsSeventy-six women who underwent treatment were divided into group 1 (patients with abdominal scars, which were covered with scar patches that prevents ultrasound energy from reaching the scar tissue immediately behind the patch) and group 2 (patients without abdominal scars). Non-perfused volume (NPV) ratios immediately after treatment, and fibroid volume reduction ratios and symptom severity scores (SSS) at the 6-months follow-up were assessed. All adverse effects were recorded.ResultsThe mean NPV ratios in groups 1 and 2 were 87.0 ± 14.1% and 91.5 ± 13.3%. At the 6-months follow-up, the fibroid volume reduction ratios in groups 1 and 2 were 0.45 ± 0.27 and 0.43 ± 0.21, and the corresponding improvement in mean transformed SSS were 0.7 ± 0.39 and 0.79 ± 0.28, respectively. No serious adverse effects were reported. The minor adverse effects encountered in this study are likely related to the temperature increase in the near-field of the ultrasound beam path, which inevitably leads to skin burns, or far-field heat absorption by distant bony structures (i.e., sciatic nerve symptoms), and are typically manifested inter-procedurally and resolved shortly thereafter.ConclusionsThe findings in this study suggest that the scar patch could be used safely and efficiently in MRgHIFU treatment for the patients with uterine fibroids and abdominal scars in the ultrasound beam path.