The Imaging Study Of Magnetic Resonance-guided Focused Ultrasound Surgery For Symptomatic Uterine Fibroids

AbstractⅠStudy of efficacy and safety of MRgFUS for symptomatic uterine fibroidsObjectiveThis perspective clinical study included short-term and long-term follow-up of consecutive women with symptomatic uterine fibroids who underwent MRgFUS treatment on an ExAblate(?) 2100 system(InSightec Ltd, Haifa, Israel) to access the safety and clinical efficacy of MRgFUS in the treatment of symptomatic uterine fibroids.Material & Methods1. The gynecology and obstetrics outpatient department of Peking Union Medical College Hospital recruited these consecutive mothers with symptomatic uterine fibroids who volunteered to accept the MRgFUS treatment. Clinical and MRI examinations were used to determine who is qualified for the study.2. The subjective symptoms and objective indicators were observed, meanwhile, the adverse effects and the correlative statistics of volume change were recorded.3. The change of subjective symptoms and objective indicators were observed and compared after treatment at 1 week,1,3,6,12 months and several years follow-up using an uterine fibroid symptom and quality of life questionnaire.Results1.93 patients asked for the MRgFUS, while 26 patients(28.0%) were considered suitable for the treatment. Ultimately,25 patients who successfully completed the treatment for symptomatic uterine fibroids were included in this study.2. The mean NPV% immediately after the treatment was 64±23%(6-94%); significant reduction in standard SSS was seen at all the follow-up after the treatment compared to pre treatment SSS (P<0.05) except for the first week; significant reduction in the volume of the fibroids was seen at the 12 months follow-up compared to the pre treatment volume(P<0.05);there was no correlation between the volume or change of volume and the standard SSS or change of the standard SSS(P>0.05).3. No serious adverse effects were recorded during or after the treatment. The adverse effects correlating with the treatment at the follow-up after the procedure totaled up to 34,which were all mild to moderate and vanished at the last follow-up. Conclusions1. MRgFUS has sustained and good effect on improvement of symptomatic uterine fibroids;2. The level of NPV after treatment can be improved by the improvement of the operator’s skills and the screening standards’ stringency;3. The fibroids’ volume and the patients’ symptoms are effected by many factors, and there is no linear relationship between them;4. MRgFUS is a safe way to treat uterine fibroids.AbstractⅡPreliminary study of the texture analysis of uterine fibroidsObjectiveThis retrospective study analyzed each MR image of the patients with symptomatic uterine fibroids accepted MRgFUS treatment in the Peking Union medical college hospital from April 2010 to January 2013, adopted the method of image texture analysis to get the texture parameters and studied the change of the fibroids texture parameters at the MR images between before and after the treatment and the correlation between texture parameters and other parameters assessing the conditions of fibroids, in order to observe the relationship between fibroids texture parameters and the prognosis.Material & Methods1. Patients with symptomatic uterine fibroids of the Peking Union Medical College Hospital accepted MRgFUS treatment from April 2010 to January 2013, meanwhile, completed 12 months review and all the materials were completed without loss.2. The materials of screening group, immediately after treatment group and 12 months review group were chosen to be retrospectively studied. The TexRAD software was used to analyze the texture of T2WI sagittal image of each MR material, in addition, the significant texture parameters of the image of SSF2,4,6 were automatically granted. The uterine fibroid’s volume and the change rate of the volume were calculated by measuring the length of relevant lines of the target fibroids. The standardized score change rate were calculated from the standard SSS which was transformed from SSS figuring out from USF-QOL questionnaire.3. The differences of the parameters from different filter image among the image of screening, treatment and review were counted; the correlations between each texture parameter under the condition of different filtering radius in each image were studied and the laws of the correlation were analyzed and sought for. Looking for some efficacy parameter assess the prognosis.Results1. Ultimately,16 patients of the 25 patients who successfully completed the treatment for symptomatic uterine fibroids passing the texture analysis exclusion criteria were included in this study.2. The change of parameters mean, sd, entropy, mpp and skewness in each SSF image was in the presence of regularity; there was apparent correlation and regularity between parameters sd, entropy, kurtosis and the statistics relating to the fibroids’conditions.3. The parameters sd, entropy of immediately after the procedure were used to predict the change rate of the fibroids in 12months review, so that it could be think to predict the treatment effect.Conclusions1. There is positive correlation between image texture parameters and the treatment of uterine fibroids, the texture parameters verify the image change that can be seen through naked eye in MR image in a quantitative way.2. The conditions of the fibroids’texture play a key role in effecting the patients’symptoms.3. Some texture parameters can be used to predict the effect of MRgFUSt.