Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Immediate Therapeutic Response of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Symptomatic Uterine Fibroids

作者：Kim Young sun; Lim Hyo K^*; Kim Jae Hun; Rhim Hyunchul; Park Byung Kwan; Keserci Bilgin; Koehler Max O; Bae Duk Soo; Kim Byoung Gie; Lee Jeong Won; Kim Tae Joong; Sokka Shunmugavelu; Lee Jung Hee

来源：Investigative Radiology, 2011, 46(10): 639-647.

DOI：10.1097/RLI.0b013e318220785c

• dynamic contrast-enhanced magnetic resonance imaging
• high-intensity focused ultrasound
• uterine fibroid
• ablation therapy

Objectives: To evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in the prediction of the immediate therapeutic response of MR-guided high-intensity focused ultrasound (HIFU) therapy in the treatment of symptomatic uterine fibroids
Materials and Methods: Institutional review board approved this study, and informed consent was obtained from all participants. A total of 10 symptomatic uterine fibroids (diameter: mean, 8.9 cm; range, 4.7-12 cm) in 10 female patients (mean age, 42.2 years) were treated with MR-HIFU therapy using the volumetric ablation technique. DCE-MRI and conventional contrast-enhanced MRI were obtained as a baseline and as an immediate follow-up study, respectively. After regions of interest of each treatment cell were properly registered to both MRI studies, DCE-MRI parameters (K(trans), v(e), v(p)) and operator-controllable therapy parameters (power, treatment cell size, sonication depth) were investigated on a cell-by-cell basis to reflect tissue inhomogeneity. Two types of ablation efficacy indices (volume of 240 equivalent minutes at 43 degrees C/treatment-cell volume, nonperfused volume/treatment-cell volume) were then correlated with those parameters using multiple linear regression analysis to determine which factors were significant predictors for ablation efficacy.
Results: We used 293 treatment cells (4 mm, n = 12; 8 mm, n = 115; 12 mm, n = 149; 16 mm, n = 17), and all of them were analyzable. Ablation efficacies were 1.06 +/- 0.58 and 0.67 +/- 0.39. K(trans) (B = -12.035, P < 0.001 and B = -11.516, P < 0.001, respectively) among DCE-MRI parameters and acoustic power (B = 0.008, P < 0.001; B = 0.010, P < 0.001, respectively) among therapy parameters were revealed to be independently significant predictors for both types of ablation efficacy.
Conclusions: A higher K(trans) value at baseline DCE-MRI suggested a poor ablation efficacy of MR-HIFU therapy for symptomatic uterine fibroids.

• 出版日期2011-10