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MR-HIFU Therapy of 12.3 diameter subserosal Type 1 uterine fibroid

Case Study
Prof. Kim, Young-sun, M.D. Samsung Medical Center • Korea, Republic of
Keserci, Bilgin Philips Healthcare • Korea, Republic of

Patient presenting with large uterine fibroid

Patient history

40 year-old married female. 166 cm/51kg. Diagnosed with uterine fibroids with chief complaints of
urinary frequency for 1 year and a growing, palpating mass in her abdomen.

MR examination

Sonalleve MR-HIFU V1 system with R2.1L1 version software.

 

Planning images

T2w-screening image T2w-screening image T1w-contrast enhanced screening image
T2w-screening image
T2w-screening image
T1w-contrast enhanced screening image
On initial examination with MR imaging, a single large subserosal (SS) fibroid is observed.

Diameter measured at 12.3 cm and defined as Type I based on the Funaki classification.*

Images clearly show fibroid is compressing the urinary bladder.

*Funaki et. al. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. American Journal of Obstetrics and Gynecology, 2007, Vol 196,(2), 184.e1-184.e6)

Treatment strategy

A total of 49 treatment cells of 8, 12 and 16 mm were used in the following distribution:
  • 8 mm, n=1
  • 12 mm, n=26
  • 16 mm, n=22

Procedure times:
Total MR room time: 3 hours, 25 minutes
Procedure time: 2 hours, 42 minutes
Sonication time: 39.5 minutes
*note: difference between sonication time is made up of planning image acquisition, treatment planning and cooling times.

Temperature mapping images

Temperature map in coronal plane Temperature map in sagittal plane
Temperature map in coronal plane
Temperature map in sagittal plane

Case considerations

A potential challenge of this case was the treatment of a large fibroid using MR-HIFU. Long treatment times are not optimal for patient comfort or MR-utilization time. With volumetric MR-HIFU therapy we were able to successfully treat this 12.3 cm diameter fibroid in under 3.5 hours total MR room time.

Post-treatment MR images

T1-weighted, contrast-enhanced post-treatment sagittal image T1-weighted, contrast-enhanced post-treatment transverse image T1-weighted, contrast-enhanced post- treatment coronal image
T1-weighted, contrast-enhanced post-treatment sagittal image
T1-weighted, contrast-enhanced post-treatment transverse image
T1-weighted, contrast-enhanced post- treatment coronal image

Results

Non-perfused volume (NPV) was 88.5% of total fibroid volume. NPV was calculated slice-by-slice from the T1w-contrast enhanced image acquired immediately following treatment.

The treatment speed was 179 mL/hour, where treatment speed is the NPV/treatment time and treatment time refers to the time from the first to the last sonication.

Outcomes and follow-up

3-months follow-up was performed using ultrasonography (images below).

Fibroid reduction to 42.8% of the baseline volume at 3 months follow-up and symptom relief
achieved. Patient reported disappearance of urinary frequency and negative palpation of the mass.




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Jun 7, 2012

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Case Study
Sonalleve MR-HIFU
Body, fibroid, Interventional, Uterine fibroid, Uterus, Women's health
 

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