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Clinical Consideration of Treatment to Ablate Uterine Fibroids with Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound (MRgFUS): Sonalleve

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS.

Methods: This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio.

Results: When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly.

Conclusions: In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.

No MeSH data available.


Related in: MedlinePlus

Coronal (A) and sagittal (B) magnetic resonance (MR) thermometry images show temperature overlay and the magnetic resonance (MR); white lines, white arrow) during volumetric MR imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) ablation with a 16 mm treatment cell. X-shaped two white triangles are their presumed sonication pathway. Yellow box indicate the 30-240 EM area, the possible thermal damage (yellow arrow). MR thermometry show the temperature of abdominal skin (C) & tissues adjacent to sacrum (D).
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Figure 1: Coronal (A) and sagittal (B) magnetic resonance (MR) thermometry images show temperature overlay and the magnetic resonance (MR); white lines, white arrow) during volumetric MR imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) ablation with a 16 mm treatment cell. X-shaped two white triangles are their presumed sonication pathway. Yellow box indicate the 30-240 EM area, the possible thermal damage (yellow arrow). MR thermometry show the temperature of abdominal skin (C) & tissues adjacent to sacrum (D).

Mentions: All of the patients fasted for 8 hours then visited the outpatient unit to do the general preparations for a surgical operation and moved to the MRI room. The patients took a prone position on the MRI bed. The HIFU coils were placed on the patients and MRI scan was implemented to adjust a precise focus. If the intestine was found in front of uterus in the first MRI test scan just before the treatment, modified BRP (bladder and rectum filling and bladder emptying) technique was conducted to avoid possible intestinal injury by high intensity ultrasound. Modified BRP technique is to change the position of uterus or intestine by filling in the bladder with normal saline or rectum with glycerin or through other diverse techniques in order not to expose intestine to HIFU for intestine damage prevention. To control patients' pain, Fentanyl (Fentanyl inj., 500 ug/10 mL) and Ketorolac (Keromin inj., 30 mg/1 mL) were injected through infusion pump. If the operation duration is longer than 60 minutes, epidural catheter was inserted then Fentanyl and Bupivacaine (Bupivacaine MYM inj., 50 mg/20 mL) were administered to control pain. The patients received uterine stimulant, Carbetocin (Duratocin inj., 100 ug/1 mL), together, if necessary. For the sake of safety, an emergency stop button was placed in the patients' hand. Then, HIFU treatment was conducted under real-time MRI scanning. The HIFU treatment was done under quasi real time MRI scanning. Based on thermometry, HIFU-caused temperature change in the focus area was observed along with the temperature change in surrounding organs (Fig. 1). The Hospital's Sonalleve HIFU system is linked to Philips Achieva 1.5 Tesla MR. Its treatable depth is up to 12 cm inside from patients' skin; frequency of high intensity ultrasound is 1.2 or 1.4 MHz; and output can reach up to 200 W. Sonalleve HIFU system employs the volumetric heating algorithm and uses 4 mm, 8 mm, 12 mm, 16 mm-diameter treatment cells.17 The Hospital set the goal of focal point temperature increase to at least 57℃ and 240 eqivalent minutes (EM) and has applied diverse cell sizes. By using the minimum output power reaching the targeted focal point temperature, skin burn was minimized. To measure the tissue temperature change, the MRI-thermometry was recorded based on proton resonance frequency shift.1819 Every patient was scanned with pre-operative T2-, T1-weighted MRI and contrast enhanced T1-weighted MRI while receiving contrast enhanced T1-weighted MRI scanning immediately after the operation for non-perfused volume (NPV) check before completing the procedure (Fig. 2). Post-treatment NPV was calculated by measuring the circumference of sequential slice in the prolate ellipse (length × width × depth × 0.523) method.15


Clinical Consideration of Treatment to Ablate Uterine Fibroids with Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound (MRgFUS): Sonalleve
Coronal (A) and sagittal (B) magnetic resonance (MR) thermometry images show temperature overlay and the magnetic resonance (MR); white lines, white arrow) during volumetric MR imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) ablation with a 16 mm treatment cell. X-shaped two white triangles are their presumed sonication pathway. Yellow box indicate the 30-240 EM area, the possible thermal damage (yellow arrow). MR thermometry show the temperature of abdominal skin (C) & tissues adjacent to sacrum (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016510&req=5

Figure 1: Coronal (A) and sagittal (B) magnetic resonance (MR) thermometry images show temperature overlay and the magnetic resonance (MR); white lines, white arrow) during volumetric MR imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) ablation with a 16 mm treatment cell. X-shaped two white triangles are their presumed sonication pathway. Yellow box indicate the 30-240 EM area, the possible thermal damage (yellow arrow). MR thermometry show the temperature of abdominal skin (C) & tissues adjacent to sacrum (D).
Mentions: All of the patients fasted for 8 hours then visited the outpatient unit to do the general preparations for a surgical operation and moved to the MRI room. The patients took a prone position on the MRI bed. The HIFU coils were placed on the patients and MRI scan was implemented to adjust a precise focus. If the intestine was found in front of uterus in the first MRI test scan just before the treatment, modified BRP (bladder and rectum filling and bladder emptying) technique was conducted to avoid possible intestinal injury by high intensity ultrasound. Modified BRP technique is to change the position of uterus or intestine by filling in the bladder with normal saline or rectum with glycerin or through other diverse techniques in order not to expose intestine to HIFU for intestine damage prevention. To control patients' pain, Fentanyl (Fentanyl inj., 500 ug/10 mL) and Ketorolac (Keromin inj., 30 mg/1 mL) were injected through infusion pump. If the operation duration is longer than 60 minutes, epidural catheter was inserted then Fentanyl and Bupivacaine (Bupivacaine MYM inj., 50 mg/20 mL) were administered to control pain. The patients received uterine stimulant, Carbetocin (Duratocin inj., 100 ug/1 mL), together, if necessary. For the sake of safety, an emergency stop button was placed in the patients' hand. Then, HIFU treatment was conducted under real-time MRI scanning. The HIFU treatment was done under quasi real time MRI scanning. Based on thermometry, HIFU-caused temperature change in the focus area was observed along with the temperature change in surrounding organs (Fig. 1). The Hospital's Sonalleve HIFU system is linked to Philips Achieva 1.5 Tesla MR. Its treatable depth is up to 12 cm inside from patients' skin; frequency of high intensity ultrasound is 1.2 or 1.4 MHz; and output can reach up to 200 W. Sonalleve HIFU system employs the volumetric heating algorithm and uses 4 mm, 8 mm, 12 mm, 16 mm-diameter treatment cells.17 The Hospital set the goal of focal point temperature increase to at least 57℃ and 240 eqivalent minutes (EM) and has applied diverse cell sizes. By using the minimum output power reaching the targeted focal point temperature, skin burn was minimized. To measure the tissue temperature change, the MRI-thermometry was recorded based on proton resonance frequency shift.1819 Every patient was scanned with pre-operative T2-, T1-weighted MRI and contrast enhanced T1-weighted MRI while receiving contrast enhanced T1-weighted MRI scanning immediately after the operation for non-perfused volume (NPV) check before completing the procedure (Fig. 2). Post-treatment NPV was calculated by measuring the circumference of sequential slice in the prolate ellipse (length × width × depth × 0.523) method.15

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS.

Methods: This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio.

Results: When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly.

Conclusions: In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.

No MeSH data available.


Related in: MedlinePlus