Department of Diagnostic and Interventional Radiology, Helios-Amper Klinikum Dachau, Dachau, Helios-Amper Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany,
Eur Radiol. 2015 May;25(5):1317-28. doi: 10.1007/s00330-014-3538-6. Epub 2014 Dec 16.
To assess the technical and clinical results of MRgFUS treatment and factors affecting clinical treatment success.
A total of 252 women (mean age, 42.1 ± 6.9 years) with uterine fibroids underwent MRgFUS. All patients underwent MRI before treatment. Results were evaluated with respect to post-treatment nonperfused volume (NPV), symptom severity score (SSS), reintervention rate, pregnancy and safety data.
NPV ratio was significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T1-weighted fat saturated MR images and in fibroids distant from the spine (>3 cm). NPV ratio was lower in fibroids with septations, with subserosal component and in skin-distant fibroids (p < 0.001). NPV ratio was highly correlated with clinical success: NPV of more than 80 % resulted in clinical success in more than 80 % of patients. Reintervention rate was 12.7 % (mean follow-up time, 19.4 ± 8 months; range, 3-38). Expulsion of fibroids (21 %) was significantly correlated with a high clinical success rate. No severe adverse events were reported.
Adequate patient selection and correct treatment techniques, based on the learning curve of this technology, combined with technical advances of the system, lead to higher clinical success rates with low complications rate, comparable to other uterine-sparing treatment options.
• MRgFUS appears to be a valid alternative to other uterus-preserving therapies • Patient selection is a significant factor in achieving high NPV ratios • MRI screening parameters correlate with the amount of fibroid ablation in MRgFUS • NPV results of more than 80 % correlate with higher clinical success rates.
评估磁共振引导聚焦超声（MRgFUS）治疗的技术和临床效果，以及影响临床治疗成功的因素。
共有 252 名患有子宫肌瘤的女性（平均年龄 42.1±6.9 岁）接受了 MRgFUS 治疗。所有患者在治疗前均进行 MRI 检查。根据治疗后无灌注体积（NPV）、症状严重程度评分（SSS）、再干预率、妊娠和安全性数据评估结果。
在增强 T1 加权脂肪饱和磁共振成像呈低信号强度和远离脊柱 (>3 cm) 的子宫肌瘤中，NPV 比值显著更高。在具有分隔、浆膜下成分和远离皮肤的子宫肌瘤中，NPV 比值较低（p<0.001）。NPV 比值与临床成功高度相关：NPV 超过 80%的患者中有超过 80%的患者临床成功。再干预率为 12.7%（平均随访时间 19.4±8 个月；范围 3-38 个月）。肌瘤排出（21%）与高临床成功率显著相关。未报告严重不良事件。
基于该技术的学习曲线，结合系统的技术进步，进行适当的患者选择和正确的治疗技术，可实现更高的临床成功率，同时并发症发生率低，与其他保留子宫的治疗选择相当。
• MRgFUS 似乎是其他保留子宫治疗方法的有效替代方法• 患者选择是实现高 NPV 比值的重要因素• MRI 筛查参数与 MRgFUS 中肌瘤消融量相关• NPV 结果超过 80%与更高的临床成功率相关。
