ABSTRACT
The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroid and adenomyoma. The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e. 200, 600 and 800 s/mm2) were obtained from nine fibroid and five adenomyoma patients, immediately after, and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment outcome evaluation. Our finding showed thatimmediately after MRgFUS treatment, the DWI acquired using 200 s/mm2 b-value gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/mm2 showed the best correlation (R2 = 0.938) with post-contrast NPV. At 12 months follow-up, there was no specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the post-contrast NPV and NPV ratio. We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm2), is feasible for delineation and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12 months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.
ABSTRACT
BACKGROUND: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre. METHOD: Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI. RESULTS: Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up. CONCLUSION: Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients ended up with total abdominal hysterectomy. These results suggest that UAE is an appealing alternative to hysterectomy or myomectomy for many women with symptomatic fibroids.
