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Near total (> 90%) ablation of anterior wall fibroid

Case Study
Dr. Raghunatharao, Ramachandra Medall-Clumax Banagalore • India
Dr. Kale, Sudhir , M.D. Clumax Diagnostics - a Medall Company • India
Mr. Pinto, Raymand, B.Sc. Clumax • India

Patient history

A 38-year-old mother of 2 children presented with severe menorrhagia and pelvic pain.
Ultrasound scan showed anterior wall fibroid, 6cmX5cm.

She was not responding to conservative management and was referred to MR-HIFU, as she was not a surgical candidate due to a pre-existing cardiac condition i.e. Pulmonary hypertension.

The UFS-QOL was performed prior to MR-HIFU therapy with a score of 111/185.

MR examination

The T2-weighted planning images showed an intramural fibroid located on the anterior wall measuring approximately 5.8cm x 5cm x 5cm with a volume of 75cc.


T1-weighted contrast-enhanced imaging showed a fibroid with dark signal intensity, which was classified as Type I based on the Funaki classification system.

MR-HIFU treatment

Sonalleve MR-HIFU V2 system with R3.2L2 version software was used.

These T2-weighted planning images show treatment cell placement

A total of 7/ 8 mm treatment cells, 9/ 12 mm treatment cells and 13/14 mm treatment cells were used for therapy. Total sonication time was 129 minutes.

Type I fibroid, patient co-operated well and the result being > 90%.
She tolerated the prone position well and did not have any issues related to her hypertension.

Post-treatment MR images

T1-weighted, contrast-enhanced post-treatment coronal and transaxial images.
T1-weighted, contrast-enhanced post-treatment sagittal images.
 

Results

Post-procedure gadolinium-enhanced THRIVE images were showing:

The ablated area was measured at 69cc, giving 92% NPV based on a total fibroid volume of 75cc.
Osirix software was used to calculate the volume slice-by-slice.

No complications were reported during MR-HIFU therapy. Patient had  no skin irritation or no complications related to her medical condition. 

3 months follow-up

 T1-weighted, contrast-enhanced post-treatment coronal image T1-weighted, contrast-enhanced post-treatment sagital image T1-weighted, contrast-enhanced post-treatment transaxial image
T1-weighted, contrast-enhanced post-treatment coronal image
T1-weighted, contrast-enhanced post-treatment sagital image
T1-weighted, contrast-enhanced post-treatment transaxial image
 
In the 3 months follow-up the reduction of the NPV is 58cc (from 75cc).
The UFS-QOF score was 49. On the treatment day it was 111.

Case considerations

With her cardiac illness, the patient was a high risk surgical candidate and hence the treating physician did not want to pursue a surgical procedure. The patient observed no relief with conservative management, making MR-HIFU one of few available options. With an NPV of 92% we would anticipate durable treatment outcomes based on the studies by LeBlang, Steward and Okada.

References

E. A. Stewart, B. Gostout, J. Rabinovici, H. S. Kim, L. Regan, C. M. C. Tempany
Sustained Relief of Leiomyoma Symptoms by Using Focused Ultrasound Surgery
Obstetrics & Gynecology, vol. 110, no. 2, Part 1, 2007

A. Okada, Y. Morita, H. Fukunishi, K. Takeichi, and T. Murakami
Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: impact of the learning curve on patient outcome
Ultrasound Obstet Gynecol, vol. 34, pp. 579–83, 2009.


S. D. LeBlang, K. Hoctor, and F. L. Steinberg
Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients
AJR Am J Roentgenol, vol. 194, no. 1, pp. 274–280, Jan. 2010.





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)


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Case Study
Achieva 1.5T, Sonalleve MR-HIFU
Release 3.2
Pulsar
MRgHIFU, MR-HIFU, Oncology, Pelvis, Uterine fibroid, Uterus, Women's health
 

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