Home Three-Dimensional Quantitative Assessment of Lesion Response to MR-guided High-Intensity Focused Ultrasound Treatment of Uterine Fibroids
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Three-Dimensional Quantitative Assessment of Lesion Response to MR-guided High-Intensity Focused Ultrasound Treatment of Uterine Fibroids

Posted Aug 31, 2015 Updated Apr 10, 2023
By Lynn J. Savic BS , MingDe Lin PhD , Rafael Duran MD , Rüdiger E. Schernthaner MD , Bernd Hamm MD , Jean-François Geschwind MD , Kelvin Hong MD , Julius Chapiro MD
8 min read

Rationale and Objectives

To investigate the response after magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) treatment of uterine fibroids (UF) using a three-dimensional (3D) quantification of total and enhancing lesion volume (TLV and ELV, respectively) on contrast-enhanced MRI (ceMRI) scans.

Methods and Materials

In a total of 24 patients, ceMRI scans were obtained at baseline and 24 hours, and 6, 12, and 24 months after MRgHIFU treatment. The dominant lesion was assessed using a semiautomatic quantitative 3D segmentation technique. Agreement between software-assisted and manual measurements was then analyzed using a linear regression model. Patients were classified as responders (R) or nonresponders (NR) on the basis of their symptom report after 6 months. Statistical analysis included the paired t –test and Mann–Whitney test.

Results

Preprocedurally, the median TLV and ELV were 263.74 cm 3 (30.45–689.56 cm 3 ) and 210.13 cm 3 (14.43–689.53 cm 3 ), respectively. The 6-month follow-up demonstrated a reduction of TLV in 21 patients (87.5%) with a median TLV of 171.7 cm 3 (8.5–791.2 cm 3 ; P < .0001). TLV remained stable with significant differences compared to baseline ( P < .001 and P = .047 after 12 and 24 months). A reduction of ELV was apparent in 16 patients (66.6%) with a median ELV of 158.91 cm 3 (8.55–779.61 cm 3 ) after 6 months ( P = .065). Three-dimensional quantification and manual measurements showed strong intermethod agreement for fibroid volumes ( R 2 = .889 and .917) but greater discrepancy for enhancement calculations ( R 2 = .659 and .419) at baseline and 6 months. No significant differences in TLV or ELV were observed between clinical R ( n = 15) and NR ( n = 3).

Conclusions

The 3D assessment has proven feasible and accurate in the quantification of fibroid response to MRgHIFU. Contrary to ELV, changes in TLV may be representative of the clinical outcome.

Uterine fibroids (UF) represent one of the most common benign tumors that predominantly occur in the perimenopausal years . Location, size, and multiplicity of UF are varying, resulting in a diversity of clinical presentations that range from asymptomatic to symptoms which highly interfere with the patient’s quality of life . As for the treatment of UF, surgical removal (myomectomy or hysterectomy) remains the gold standard, and UF represents the major indication for hysterectomy . However, there are minimal invasive treatment options including radiofrequency ablation and catheter-based approaches, such as uterine artery (UAE), which have become well-accepted alternatives to surgery over the last decades .

Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) represents another approach and is the only fully noninvasive alternative in the treatment of UF. MRgHIFU uses targeted energy deposition from focused ultrasound under MR guidance to ablate the tissue by thermal coagulation and acoustic cavitation . MRgHIFU has proved as safe, feasible, and effective in reducing clinical symptoms .

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Materials and methods

Study Cohort

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Clinical Evaluation

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MRgHIFU Procedure and Follow-up Imaging

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Imaging Data Evaluation—3D Quantification of Lesion Response

Lesion Segmentation

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3D-RESQU Technique

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Figure 1, Quantification of the total lesion volume and enhancing lesion volume. The graph (median and standard error) demonstrates the (a) total lesion volume (TLV) and the (b) enhancing lesion volume (ELV) assessed by three-dimensional response quantification in uterine fibroids on contrast-enhanced MRI (ceMRI) scans at baseline, 24 hours, 6, 12, and 24 months after magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU). A TLV decrease of statistical significance compared to baseline was observed after 6, 12, and 24 months. A significant decrease of ELV was apparent after 12 months.* P < .05, ** P < .01, *** P < .001.

Figure 2, Three-dimensional quantitative assessment of uterine fibroids. The graph illustrates representative changes in the total lesion volume (TLV) and the enhancing lesion volume (ELV) of a uterine fibroid after magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) in a 44-year-old patient. In the vertical, the contrast-enhanced MRI (ceMRI) scans are arranged according to the time of acquisition. (a,b) The ceMRI scans at 0 and 20 seconds, respectively. (c) The volume rendering for the segmented lesion on a ceMRI scan. (d) The color map of the lesion using three-dimensional response quantification in uterine fibroids; the color coding varies from red representing maximum enhancement to blue representing no enhancement.

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Manual Image Analysis

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Statistical Analysis

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Results

Study Population

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Table 1

Patient Characteristics

Parameter Study Population, n Age ( n = 24) 46.13 ∗ years (range, 37–53) Race African American 9 White 13 Other 2 Clinical symptoms at presentation (n = 19) Menorrhagia 13 (68%) Bulk-related symptoms 16 (84%) Number of uterine fibroids 1 9 2 9 >2 6 Baseline TLV ( n = 24) 263.74 ∗ cm 3 (range, 30.45–689.56)

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Imaging Results

Volumetric Assessment I—TLV

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Volumetric Assessment II—ELV

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Manual and Visual Image Analysis

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Figure 3, Correlation analysis: uterine fibroid volume. The graphs illustrate the interreader agreement for manual volume measurements (a,b) and the intermethod correlation between manual assessment and three-dimensional response quantification of the total lesion volume (TLV) in uterine fibroids (3D-RESQU) on contrast-enhanced MRI scans (c,d). Uterine fibroid volumes were assessed at baseline and 6 months after magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU). According to the linear regression model and the calculation of the Pearson correlation coefficient ( R 2 ), volumes measured manually by both readers demonstrate good agreement and the strong correlation of both attempts validates volumetric calculations by the semiautomatic 3D-RESQU technique in this setting.

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Figure 4, Correlation analysis: uterine fibroid enhancement. The graphs illustrate the interreader agreement for visual enhancement assessments (a,b) and the intermethod correlation between visual measurement and three-dimensional response quantification of the enhancing lesion volume (ELV) in uterine fibroids (3D-RESQU) on contrast-enhanced MRI scans (c,d). Uterine Fibroid enhancement was analyzed at baseline and 6 months after magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU). According to the linear regression model and the calculation of the Pearson correlation coefficient ( R 2 ), visually estimated enhancements only show slight agreement and thereby demonstrate limited reproducibility. The correlation analysis of both attempts reveals strong discrepancy, particularly at the 6-month follow-up, suggesting a benefit of the semiautomatic 3D-RESQU technique over a planar visual approach.

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Clinical Results

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Discussion

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Academic Radiology, Volume 22, Issue 9
Journals General Radiology
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