NetForum uses cookies to ensure that we give you the best experience on our website. If you continue to use the site, we'll assume that you are happy to receive these cookies on the NetForum website. Read about our cookies.
NetForum Community
Learn. Share. Optimize.
Log in | Sign up now | Submit content | Contact
Go to similar content

Manipulation techniques to increase conversion rates for MR-HIFU uterine therapy

Case Study
Beldoch, Michael, M.D. UKSH Lübeck • Germany
Hunold, Peter, M.D. University Hospital Schleswig Holstein, campus Lübeck • Germany

Patient history

49-year-old female. Diagnosed with singular, submucosal uterine fibroid and presented with severe hypermenorrhoea, metrorragia and abdominal pain. Patient desires to retain uterus and possibility for pregnancy.

MR-HIFU treatment

Sonalleve MR-HIFU V1 system with R3.2L3 version software was used along with an Achieva 1.5T. Treatment was performed by Michael Beldoch, M.D., under the guidance of Peter Hunold, M.D.

T2-weighted planning images

 T2-weighted planning image with bowels in nearfield T2-weighted planning image with bladder fill T2-weighted planning image with additional bladder fill
T2-weighted planning image with bowels in nearfield
T2-weighted planning image with bladder fill
T2-weighted planning image with additional bladder fill
 
 
On treatment day, the T2-weighted planning images were captured and showed that bowel was covering the entire anterior region of the fibroid, blocking the ultrasound beam path to the fibroid.

Objectives of the manipulation techniques were to push the bowel up out of the acoustic path and push the fibroid anteriorly. As shown above, the clinicians began with gradual bladder filling over the course of 20 minutes, where they first filled 300 mL, then 200 mL, and finally an additional 100 mL.

Following sufficient bladder filling to move the bowel upwards out of the beam path, the rectum was filled with standard ultrasound gel in order to push the fibroid forward, as well as pin the bowels up out of the beam path (shown below in series). The rectum filling is retained, and the bladder is slightly emptied to lower the fibroid and improve the patient comfort.
 
 T2-weighted planning image with filled bladder and rectal filling. T2-weighted planning image with filled bladder, filled rectum and some bladder emptying. T2-weighted planning image with filled bladder, filled rectum and additional bladder emptying.
T2-weighted planning image with filled bladder and rectal filling.
T2-weighted planning image with filled bladder, filled rectum and some bladder emptying.
T2-weighted planning image with filled bladder, filled rectum and additional bladder emptying.

MR-HIFU treatment

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

Results

Non-perfused volume (NPV) was 60 mL/85% total fibroid volume. NPV was calculated from the T1-weighted contrast enhanced image acquired immediately following therapy.
NPV was calculated by 3D overlay of a new NPV on the HIFU console on the post-contrast images. This method is faster and easier, but also a bit less precise, than contouring slice by slice. 

Considerations and lessons learned

Bowel can be manipulated by bladder and rectal filling and/or emptying.

Peer-to-peer dialogue and training is a critical component of surmounting the learning curve of a new technique and may come in the form of on-site training, but also through case studies of other treating hospitals.

This technique was coined by Dr. Young-sun Kim and colleagues* of Samsung Medical Center in Seoul Korea for patient manipulation, whereby the bladder is filled to push the fibroid up, followed by rectal filling to push the fibroid anterior and typically the bladder is emptied.


*M.J. Park, Y. S. Kim, H. Rhim, H. K. Lim, “Technique to Displace Bowel Loops in MRI-Guided High-Intensity Focused Ultrasound Ablation of Fibroids in the Anteverted or Anteflexed Uterus,” American Journal of Roentgenology, vol. 201, no. 5, pp. W761-W764, Nov 2013.
 
 
 
Note: Results from case studies are not predictive of results in other cases. Case results may vary.

NetForum case studies provide information about procedures performed by Philips users, yet Philips takes no responsibility for non-device content (medicine used, positioning preparation, etc.)

This content is intended for countries other than the USA.


This content has been made possible by NetForum Community.
Share this on: Share your link in twitter Share your link in facebook Share your link on LinkedIn Print Rate this article: Log in to vote

 
Rating:
Votes:
0
Views:
561
Added:
Feb 21, 2014

Rate this:
Log in to vote
 

Case Study
Achieva 1.5T, Sonalleve MR-HIFU
Body, MR-HIFU, Therapy, Uterine fibroid, Uterus, Women's health
 

Clinical News
Best Practices
Case Studies
Publications and Abstracts
White Papers
Web seminars and Presentations
ExamCards
Protocols
Application Tips and FAQ
Training
Try an Application
Business News
Case Studies
White Papers
Web Seminars and Presentations
Utilization Services
Contributing Professionals
Contributing Institutions
Become a Contributor