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 Printable version |
Uterine artery embolisation and focused ultrasound therapy for fibroids destruction |
MT / médecine de la reproduction, gynécologie et endocrinologie. Volume 11, Number 2, 158-63, mars-avril 2009, Revue
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 Résumé
Article gratuit
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Author(s) : H Marret, F Tranquart, D Herbreteau, J-P Cottier, A Bleuzen, L Benebu, S Fichet, G Body |
Summary : ObjectiveTo assess the utility of contrast-enhanced ultrasound in the monitoring of high intensity focused ultrasound (HIFU) ablation (ExAblate
® 2000, InSightec) in patients with uterine fibroids.Materials and methodsPatients presenting with symptomatic uterine fibroids were recruited and evaluated by MRI. Women were selected for HIFU therapy if a clear pathway from the anterior abdominal wall to the fibroid without passing through the bowel or a skin scar was possible. Fibroids of less than 5 cm and more than 10 cm in diameter were excluded\; unique fibroid with a low signal intensity on T2-weighted images with homogeneous enhancement following gadolinium injection was suitable for HIFU therapy. Twenty women were evaluated with contrast enhanced ultraound using intravenous bolus injection of 2.4 mL of a microbubble contrast agent (SonoVue) before and 24 hours after intervention. Fibroid characteristics and woman symptoms were reported before and 6 months after treatment. Adverse events were actively monitored and recorded.ResultsPreliminary results were available for the 40 first women who underwent HIFU therapy. In this study, 3 women could not be treated using ExAblate
® 2000 technic and 2 of them underwent uterine artery embolization following HIFU therapy failure. Contrast ultrasound results were concordant with post intervention immediate MRI and percentage of destroyed tissue. All women who have been successfully treated excepted 4 (3 hysterectomies and 1 myomectomy), reported a small (20%) or significant (30%) or major (50%) improvement in their uterine fibroid symptoms on follow-up health-related quality-of-life questionnaires, which supports our hypothesis. The volumes of all the treated fibroids decreased in different degrees (mean 18%) during the half-year follow-up.ConclusionContrast enhanced ultrasound is potentially useful for evaluating the early therapeutic effect of MRI-guided HIFU treatment of fibroids. Although the volume reduction is moderate, the symptomatic response to this treatment is encouraging. |
Keywords : fibroids, ultrasound, focused ultrasound therapy, MRI |
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