Young-Sun Kim1,2, Tae-Joong Kim3, Hyo Keun Lim1,4, Hyunchul Rhim1, Sin-Ho Jung4,5, Joong Hyun Ahn6, Jeong-Won Lee7, Byoung-Gie Kim7. 1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Radiology, Uterine Fibroid Integrated Management Center, MINT Intervention Hospital, Seoul, Korea. 3. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea. tj28.kim@gmail.com. 4. Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea. 5. Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Korea. 6. Biostatistics Team, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea. 7. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
Abstract
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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Muneeb Ahmed; Luigi Solbiati; Christopher L Brace; David J Breen; Matthew R Callstrom; J William Charboneau; Min-Hua Chen; Byung Ihn Choi; Thierry de Baère; Gerald D Dodd; Damian E Dupuy; Debra A Gervais; David Gianfelice; Alice R Gillams; Fred T Lee; Edward Leen; Riccardo Lencioni; Peter J Littrup; Tito Livraghi; David S Lu; John P McGahan; Maria Franca Meloni; Boris Nikolic; Philippe L Pereira; Ping Liang; Hyunchul Rhim; Steven C Rose; Riad Salem; Constantinos T Sofocleous; Stephen B Solomon; Michael C Soulen; Masatoshi Tanaka; Thomas J Vogl; Bradford J Wood; S Nahum Goldberg Journal: J Vasc Interv Radiol Date: 2014-10-23 Impact factor: 3.464
Authors: Caroline L Hoad; Jonathan Fulford; Nick J Raine-Fenning; Bruce K Campbell; Ian R Johnson; Penelope A Gowland Journal: J Magn Reson Imaging Date: 2006-12 Impact factor: 4.813