MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success

作者：Machtinger Ronit; Inbar Yael; Cohen Eylon Shlomo; Admon Dahlia; Alagem Mizrachi Aviva; Rabinovici Jaron^*

来源：Human Reproduction, 2012, 27(12): 3425-3431.

DOI：10.1093/humrep/des333

• MRgFUS
• uterine fibroids
• long-term outcome

STUDY QUESTION: What are the factors associated with long-term success in patients with symptomatic uterine fibroids treated by magnetic resonance-guided focus ultrasound (MRgFUS) and can they be employed to create a clinically useful index that predicts long-term efficacy?
SUMMARY ANSWER: Hypo-intense fibroids on T2-weighted magnetic resonance imaging (MRI) and older age were associated with higher success rates and can be used to predict success rates on the basis of their presence or absence as pre-treatment parameters.
WHAT IS KNOWN ALREADY: The signal intensity of baseline T2-weighted MRI images and non-perfused volume at the end of the treatment can be correlated with MRgFUS outcome.
STUDY DESIGN, SIZE AND DURATION: This was a retrospective analysis of 81 patients who were treated by MRgFUS for symptomatic uterine fibroids, in an academic affiliated center between 2003 and 2008.
PARTICIPANTS/MATERIALS, SETTING AND METHODS: There was a post-treatment phone interview 6 months following MRgFUS for symptomatic uterine fibroids.
MAIN RESULTS AND THE ROLE OF CHANCE: The eighty-one patients completed a successful MRgFUS treatment during this period, of whom 74 were included in the final analysis (1 was post-menopausal at treatment and 5 were lost for follow-up). The mean time for the phone interview was 33.0 15.1 months (range: 653 months) after the MRgFUS treatment. Fifty-five patients (69) did not need any additional alternative treatment following MRgFUS. Nineteen patients (24) underwent other surgical interventions. Hypo-intense fibroids were associated with a higher chance of success than hyper-intense fibroids [odds ratio 2.96 (1.018.71); P 0.04] for surgery in hyper-intense fibroids). Women with long-term treatment success were significantly older at the time of treatment [46.3 3.8 (range: 3753) years versus 43.6 4.4 (range: 3651) years, respectively; P 0.02].
LIMITATIONS AND REASONS FOR CAUTION: Retrospective non-comparative studies are suboptimal and might overemphasize favorable outcomes.
WIDER IMPLICATIONS OF THE FINDINGS: This paper can contribute to selection of suitable candidates for the MRgFUS treatment for patients with uterine fibroids and can serve as a guide for gynecologists for a better patient selection.

• 出版日期2012-12