Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Gyunggi-do, Republic of Korea 463-712.
J Vasc Interv Radiol. 2012 Dec;23(12):1589-93. doi: 10.1016/j.jvir.2012.08.018. Epub 2012 Oct 23.
To evaluate magnetic resonance (MR) imaging-guided focused ultrasound (US) as a treatment for pedunculated subserosal fibroids.
Over a 2-year period (March 2007 to March 2009), 135 women with symptomatic uterine fibroids were treated in the authors' institution using MR imaging-guided focused US. Of these women, nine (mean age, 39 years; range, 25-47 y) had a single pedunculated subserosal fibroid. During treatment, these pedunculated fibroids were targeted, while sparing the stalk connection between the fibroid and the uterus. Contrast-enhanced T1-weighted MR images were obtained immediately after the treatment to measure the nonperfused volume (NPV) ratio and to check stalk viability. Changes in tumor volume, diameter of the stalk, patient symptoms and adverse events were evaluated 6 months after treatment.
The volume of the treated fibroids (n=9) ranged from 79-380cm(3) (mean, 198cm(3)), and NPV ratio ranged from 45%-80% (mean, 67%). MR imaging follow-up at 6 months showed a 14%-48% (mean, 30%) reduction in the volume of the treated fibroids (P =.008). In all cases, the pedunculated subserosal fibroids remained connected to the uterus with a 13% average decrease in the mean diameter of the stalks (from 3.5 to 3.0cm; P=.008). Eight of nine patients (89%) reported improvement in bulk-related fibroid symptoms after treatment.
The results of this preliminary study suggest that MR imaging-guided focused US may be a safe and effective treatment for pedunculated subserosal fibroids. Larger prospective studies with longer follow-up are needed to confirm the suitability of MR imaging-guided focused US to treat this type of fibroid.
评估磁共振（MR）成像引导的聚焦超声（US）作为治疗有蒂浆膜下肌瘤的方法。
在 2 年期间（2007 年 3 月至 2009 年 3 月），作者所在机构对 135 例有症状的子宫肌瘤患者进行了 MR 成像引导的聚焦 US 治疗。这些患者中有 9 例（平均年龄 39 岁；范围，25-47 岁）患有单发有蒂浆膜下肌瘤。在治疗过程中，将这些有蒂肌瘤作为靶点，同时保留肌瘤与子宫之间的蒂连接。治疗后立即获得增强 T1 加权 MR 图像，以测量无灌注体积（NPV）比并检查蒂的存活情况。治疗 6 个月后评估肿瘤体积、蒂直径、患者症状和不良反应的变化。
治疗的肌瘤体积（n=9）范围为 79-380cm3（平均 198cm3），NPV 比范围为 45%-80%（平均 67%）。治疗后 6 个月的 MR 成像随访显示，治疗的肌瘤体积减少了 14%-48%（平均 30%）（P=.008）。在所有情况下，有蒂浆膜下肌瘤仍与子宫相连，蒂的平均直径缩小了 13%（从 3.5 至 3.0cm；P=.008）。9 例患者中有 8 例（89%）报告治疗后肿块相关的肌瘤症状改善。
这项初步研究的结果表明，MR 成像引导的聚焦超声可能是治疗有蒂浆膜下肌瘤的一种安全有效的方法。需要更大的前瞻性研究和更长时间的随访来证实 MR 成像引导的聚焦超声治疗这种类型的肌瘤的适宜性。
