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Neumann B, Singh B, Brennan J, Blanck J, Segars JH. The impact of fibroid treatments on quality of life and mental health: a systematic review. Fertil Steril 2024; 121:400-425. [PMID: 38246400 PMCID: PMC11140829 DOI: 10.1016/j.fertnstert.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Fibroids significantly impact the quality of life (QOL) and mental health of affected women. However, there are limited comparative data on QOL measures after medical, surgical, and radiologic interventions in women with fibroids. This study aimed to assess the current literature evaluating the impact of fibroids on QOL measures using several validated questionnaires for radiologic, medical, or surgical interventions or a combination of interventions before and after treatment. PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library were searched from January 1990 to October 2023 to evaluate the available evidence, and the risk of bias was assessed using Cochrane RoB 2.0 or the Newcastle-Ottawa Scale. The review criteria included randomized controlled trials (RCTs) and observational cohort studies that included premenopausal women with symptomatic uterine fibroids, confirmed by imaging, who underwent an intervention to target fibroid disease. Only reports using validated questionnaires with a numerical baseline (pretreatment) and posttreatment scores were included. The exclusion criteria included perimenopausal or postmenopausal patients, conditions in addition to uterine fibroids that share similar symptoms, or studies that did not focus on QOL assessment. Abstracts were screened, and full texts were reviewed to determine whether studies met the inclusion criteria. A total of 67 studies were included after final review: 18 RCTs and 49 observational studies. All interventions were associated with a significant improvement in uterine fibroid-specific QOL measures, mental health metrics, and a reduction in symptom severity scores after treatment. These data reveal a substantial impact of uterine fibroids on the QOL and mental health of women with fibroids and indicate the metrics that can be used to compare the effectiveness of fibroid treatment options.
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Affiliation(s)
- Brooke Neumann
- Department of Obstetrics and Gynecology, Inspira, Vineland, New Jersey
| | - Bhuchitra Singh
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joshua Brennan
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James H Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Yu J, Jiang L, Su X, Yang M, Yang C, Chen J. Comparison efficacy of ultrasound-guided HIFU for adenomyosis-associated dysmenorrhea with different signal intensity on T2-weighted MR imaging. J Obstet Gynaecol Res 2023; 49:1189-1197. [PMID: 36733261 DOI: 10.1111/jog.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
AIM To compare the therapeutic efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) in the treatment of adenomyosis with different signal intensity (SI) on T2-weighted images (T2WI). METHODS A total of 299 adenomyosis patients who underwent HIFU and completed a one-year follow-up were retrospectively reviewed. Based on the SI values of adenomyosis relative to myometrium and endometrium on T2WI MRI, the patients were classified into three groups: the hypointense adenomyosis (Hypo-AM) group, the isointense adenomyosis (Iso-AM) group, and the hyperintense adenomyosis (Hyper-AM) group. The non-perfused volume ratio (NPVr) and relief of dysmenorrhea were used to assess the therapeutic efficacy. Optimal cutpoints (CPs) of NPVr were determined using the postoperative dysmenorrhea score as an anchor. Logistic regression analysis was used to test the relationship between the NPVr and SI. RESULTS The clinical effectiveness rate was significantly lower in the Hyper-AM group than in the Hypo-AM and Iso-AM groups (P < 0.05 for both). The NPVr in the Hypo-AM and Iso-AM groups were significantly higher than that in the Hyper-AM group (P < 0.05 for both). The optimal CP was 54.0% for NPVr. Logistic regression analysis showed that the SI on T2WI was an effect factor for NPVr (P < 0.05), and the probability of NPVr ≥54.0% decreased continuously as the SI of adenomyosis increased. CONCLUSIONS The NPVr of 54.0% has a clinically significant impact on dysmenorrhea scores in patients. The efficiency of the Hypo-AM and Iso-AM was better than that of the Hyper-AM.
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Affiliation(s)
- Jingwen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xueyao Su
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Meijie Yang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Chao Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Ultrasound Ablation Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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3
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Li F, Chen J, Yin L, Zeng D, Wang L, Tao H, Wu X, Wei F, Xu F, Shi Q, Lin Z, Wang Z. HIFU as an alternative modality for patients with uterine fibroids who require fertility-sparing treatment. Int J Hyperthermia 2023; 40:2155077. [PMID: 36603842 DOI: 10.1080/02656736.2022.2155077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To compare pregnancy outcomes after high-intensity focused ultrasound ablation (HIFU), myomectomy and uterine artery embolization (UAE) for fertility-sparing patients with uterine fibroids and to investigate the possible mechanism of improving pregnancy by HIFU. MATERIALS AND METHODS A meta-analysis of 54 studies containing 12,367 patients was conducted to compare the pregnancy outcomes of three fertility-sparing therapies. And a retrospective self-control study of 26 patients with uterine fibroids from May 2019 to December 2020 was performed to assess the blood flow impedance of bilateral uterine arteries before and after HIFU. RESULTS In the analysis by treatment option, the pregnancy rate after myomectomy was 0.43 (95% CI 0.36-0.49), which was higher than 0.18 (95% CI 0.10-0.26) after HIFU, the latter was significantly higher than that after UAE (ratio 0.08, 95% CI 0.06-0.10). The miscarriage rate after HIFU was 0.08 (95% CI 0.04-0.12), which was similar to 0.15 (95% CI 0.09-0.21) after myomectomy and also similar to 0.16 after UAE (95% CI 0.01-0.30). In the subgroup analysis, women who received ultrasound guided HIFU (USgHIFU) were more likely to have ideal pregnancy outcomes than that after magnetic resonance imaging-guided HIFU. The pulsatility index and resistance index on the right side were significantly higher 3 months after HIFU than before (1.637 ± 0.435 vs. 1.845 ± 0.469; p = 0.033; 0.729 ± 0.141 vs. 0.784 ± 0.081, p = 0.039). CONCLUSIONS HIFU, especially USgHIFU, may be an alternative fertility-sparing modality for patients with uterine fibroids over 40 years old. HIFU may contribute to improving pregnancy rates by elevating uterine blood flow impedance.
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Affiliation(s)
- Fang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Jing Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Yin
- Xiamen Maluan Bay Hospital, Xiamen, China
| | - Dingyuan Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Wang
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Hua Tao
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Xiajuan Wu
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Feng Wei
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Fan Xu
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound Engineering in Medicine, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhong Lin
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Liao L, Xu YH, Bai J, Zhan P, Zhou J, Li MX, Zhang Y. MRI parameters for predicting the effect of ultrasound-guided high-intensity focused ultrasound in the ablation of uterine fibroids. Clin Radiol 2023; 78:61-69. [PMID: 36241567 DOI: 10.1016/j.crad.2022.09.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 06/01/2022] [Accepted: 09/03/2022] [Indexed: 01/07/2023]
Abstract
AIM To study the value of magnetic resonance imaging (MRI) parameters in predicting the efficacy of ultrasonic ablation of fibroids. MATERIALS AND METHODS A total of 91 patients were divided into groups based on non-perfused volume (NPV) ratio and blood supply type. The preoperative MRI parameters were measured and analysed. A correlation analysis between the MRI parameters and the NPV ratio was performed. Receiver operating characteristic (ROC) curves were used to analyse and determine the cut-off value of MRI parameters to predict the ablation rate of fibroids. RESULTS The uterine fibroids group with an NPV ratio <80% and the group with an NPV ratio of ≥80% had significant differences in signal intensity (SI) at MRI T2-weighted imaging (WI), fibroid-to-rectus abdominis SI ratio (SIR) at T2WI, and blood supply type (p<0.05). There were no significant differences in fibroid volume, T2WI signal uniformity, and apparent diffusion coefficient (ADC) values. The ADC value and SI and SIR at MRI T2WI in the group with poor blood supply were lower than those in the group with a rich blood supply (p<0.05). SI at MRI T2WI correlated negatively with the NPV ratio. The cut-off values for SI and SIR at MRI T2WI of fibroids whose NPV ratio exceeds 80% were 220.58 and 1.315, respectively. CONCLUSION SI at MRI T2WI and blood supply type could be predictors of the efficacy of ablation. Ultrasonic ablation of fibroids with MRI T2WI hyperintensity and a rich blood supply had poor efficacy.
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Affiliation(s)
- L Liao
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
| | - Y H Xu
- Department of Medical Imaging, Zhongshan Hospital, Fudan University (Xuhui Branch), Shanghai 200000, China
| | - J Bai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - P Zhan
- Department of Gynaecology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - J Zhou
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - M X Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Y Zhang
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Wang Y, Gong C, He M, Lin Z, Xu F, Peng S, Zhang L. Therapeutic dose and long-term efficacy of high-intensity focused ultrasound ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images. Int J Hyperthermia 2023; 40:2194594. [PMID: 37011910 DOI: 10.1080/02656736.2023.2194594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE To investigate the therapeutic dose and long-term efficacy of high-intensity focused ultrasound (HIFU) ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images (T2WI). MATERIALS AND METHODS Four hundred and one patients with a solitary uterine fibroid treated with HIFU were classified into four groups consisting of extremely hypointense, hypointense, isointense and hyperintense fibroids. Each group was further classified into two subtypes: homogeneous and heterogeneous, based on signal homogeneity of fibroids. The therapeutic dose and long-term follow-up results were compared. RESULTS There were significant differences in treatment time, sonication time, treatment intensity, total treatment dosage, treatment efficiency, energy-efficiency factor (EEF) and non-perfused volume (NPV) ratio among the four groups (p<.05). The average NPV ratio achieved in patients with extremely hypointense, hypointense, isointense and hyperintense fibroids was 75.2 ± 14.6%, 71.1 ± 15.6%, 68.2 ± 17.3% and 67.8 ± 16.6%, respectively; the re-intervention rates at 36 months after HIFU were 8.4%, 10.3%, 12.5% and 6.1%, respectively. Sonication time, treatment intensity and total energy for heterogeneous fibroids were greater than that for homogeneous fibroids in patients with extremely hypointense fibroids (p<.05). The treatment time for heterogeneous fibroids was significantly longer than that for homogeneous fibroids in patients with isointense fibroids (p<.05). Multivariate ordered logistic regression analysis showed that the ablation volume of fibroids and treatment time were related to NPV ratio (p<.05). CONCLUSION Every group of patients obtained satisfactory long-term results. Hyperintense fibroids are difficult to treat by HIFU. Heterogeneous fibroids are more difficult to treat with HIFU than homogeneity fibroids.
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Affiliation(s)
- Yangyang Wang
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Chunmei Gong
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Haifu Hospital, Chongqing, China
| | - Min He
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Zhenjiang Lin
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Department of Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Feng Xu
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Department of Gynecology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Song Peng
- Department of Radiology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- College of Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Haifu Hospital, Chongqing, China
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Cheng LC, Li HY, Gong QQ, Huang CY, Zhang C, Yan JZ. Global, regional, and national burden of uterine fibroids in the last 30 years: Estimates from the 1990 to 2019 Global Burden of Disease Study. Front Med (Lausanne) 2022; 9:1003605. [PMID: 36419793 PMCID: PMC9676237 DOI: 10.3389/fmed.2022.1003605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To study specific information on trends in incidence, mortality, disability-adjusted life years (DALY) and the corresponding trends among five sociodemographic index regions, 21 regions, and 204 countries for decision-making, which would enable policymakers to distribute limited resources and devise policies more rationally. METHODS Data on uterine fibroids (UNs) from 1990 to 2019, including incidence, mortality, and DALYs, were obtained from the 2019 Global Burden of Disease Study. An estimated annual percentage change (EAPC) was calculated to assess morbidity, mortality, and DALY trends. RESULTS The incident cases of UFs increased from 5,769,658 (95%UI, 7,634,3995-4,274,824) incidences in 1990 to 9,643,336 (95%UI, 7,178,053-12,714,741) incidences in 2017, and the age-standardized incidence rate was steady at 225.67/100,000 persons (95%UI, 167.33-298.87) in 1990 to 241.18/100,000 persons (95%UI, 179,45-318.02) in 2019. The incidence ratio in the high sociodemographic index (SDI) region showed a unimodal distribution, with peaks in 2005. Between 2009 and 2017, the age-standardized death rate of UFs declined globally, especially in low-SDI and low-middle SDI regions. In contrast with 860,619 DALYs (95%UI, 473,067-1,505,289) in 1990, the number of DALYs was 1,378,497 (95%UI, 710,915-2,475,244) in 2019, which had increased significantly, whereas the age-standardized DALY rate decreased expressively with an EAPC of -1.93 (95%CI, from -2.16 to -1.71). CONCLUSION The global burden of UFs increased between 1990 and 2019, and the incidences and DALYs increased prominently worldwide, while the deaths from UFs had no evident growth. Lower SDI regions carried an incremental burden of UFs, while disease reduction was observed in higher SDI regions. It is high time we paid attention to the underprivileged regional quality of life and health protection.
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Affiliation(s)
- Lin-Can Cheng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hao-Yang Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qin-Qin Gong
- Center for Gynecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Cheng-Yang Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jin-Zhu Yan
- Center for Gynecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Zhong Q, Yang MJ, Hu Y, Jiang L, Yu JW, Chen JY, Chen WZ. Factors influencing treatment decisions in HIFU treatment of adenomyosis: A retrospective study. Front Surg 2022; 9:941368. [PMID: 36311935 PMCID: PMC9597082 DOI: 10.3389/fsurg.2022.941368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To explore the influencing factors of decision-making in patients with adenomyosis, who are receiving high-intensity focused ultrasound (HIFU) treatment. Methods A total of 776 patients with adenomyosis were enrolled into HIFU group (241 cases) and hysterectomy group (535 cases) according to the treatment methods. The general data, clinical symptoms, marital and childbearing history, and economic status were compared between the two groups, and factors with P < 0.05 were introduced into multivariate logistic regression analysis to determine the determinants of patients choosing HIFU. Results The average age of the patients in the HIFU group was 39.1 ± 5.2 years, which was lower than that in the hysterectomy group, which was 45.1 ± 3.9 years (P < 0.05). The basic medical insurance for urban workers in the HIFU group was more than the hysterectomy group (P < 0.05). 95.9% of the hysterectomy group had no desire to have children, compared to 60.6% of the HIFU group, the difference was significant (P < 0.05). The treatment costs of HIFU group were significantly lower than that of hysterectomy group (P < 0.05). The main symptoms of the two groups were dysmenorrhea, menorrhagia, and secondary anemia. The results of multivariate logistic regression analysis showed that 31–40 years old, fertility desire, dysmenorrhea, menorrhagia, anemia and dizziness and fatigue were the influencing factors for the decision-making of HIFU for patients with adenomyosis. Conclusion 31–40 years old, fertility desire, dysmenorrhea, menorrhagia, anemia and dizziness and fatigue were the influencing factors for patients to choose HIFU treatment. HIFU therapy has emerged as a new option for patients with adenomyosis as an alternative to hysterectomy.
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Affiliation(s)
- Qiao Zhong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mei-Jie Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China,College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yan Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jing-Wen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China,Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Correspondence: Jin-Yun Chen
| | - Wen-Zhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Jiang L, Yu JW, Yang MJ, Zhong Q, Chen JY. Ultrasound-guided HIFU for uterine fibroids of hyperintense on T2-weighted MR imaging with or without GnRH-analogue-pretreated: A propensity score matched cohort study. Front Surg 2022; 9:975839. [PMID: 35990089 PMCID: PMC9386137 DOI: 10.3389/fsurg.2022.975839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the therapeutic effect of high-intensity focused ultrasound (HIFU) ablation and HIFU pretreated with gonadotropin-releasing hormone analogue (GnRH-a) in the treatment of hyperintense uterine fibroids on T2-weighted magnetic resonance imaging (T2WI) by using propensity score matching. Materials and methods 339 women with 368 hyperintense uterine fibroids on T2WI who underwent single-session HIFU ablation were enrolled, including 283 patients with 303 fibroids in the single-session HIFU (sHIFU) group and 56 patients with 65 fibroids in the HIFU pretreated with GnRH-a (Gn-HIFU) group. The signal intensity (SI) value and standard deviation (SD) value were measured based on T2WI, and the fibroids were further subdivided into heterogeneous hyperintense fibroids, slightly homogeneous hyperintense fibroids and markedly homogeneous hyperintense fibroids as 3 subgroups (HHF, sHHF and mHHF group respectively). Treatment time, sonication time, dose, non-perfused volume (NPV), NPV per sonication time, non-perfused volume ratio (NPVR), energy effect ratio (EEF) and adverse events were recorded. Results Out of 339 patients, the median NPVR was 75.2% (interquartile range,31.5%). After propensity score matching, the matched cohort included 91 (64.5%) patients in the sHIFU group and 48 (34.5%) patients in the Gn-HIFU group. The NPVR of sHHF in the Gn-HIFU group had significantly smaller than that in the sHIFU group (60.2% versus 74.9%, p = 0.005), and the NPVR of HHF in the Gn-HIFU group was higher than those in the sHIFU group (87.4% versus 72.9%, p = 0.002). Conclusions Compared with HIFU alone, the therapeutic efficacy of the heterogeneous hyperintense fibroids may be enhanced by GnRH-a pretreated with HIFU, however it is important to rule out the slightly homogeneous hyperintense fibroids.
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Affiliation(s)
- Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jing-Wen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mei-Jie Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Qiao Zhong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Jin-Yun Chen
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Ng VWY, Cheung VYT. Successful Control of Heavy Menstrual Bleeding Using High-Intensity Focused Ultrasound Ablation of Fibroid Uterus in a Woman With Eisenmenger Syndrome. Cureus 2022; 14:e27165. [PMID: 36017286 PMCID: PMC9393315 DOI: 10.7759/cureus.27165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 12/01/2022] Open
Abstract
Uterine fibroid causes heavy menstrual bleeding and can be difficult to manage particularly in patients with complicated medical history. We present a woman with Eisenmenger syndrome, who presented with heavy menses due to fibroid uterus. She was advised against having hormonal therapy or major surgery under general anesthesia. We successfully controlled her heavy menses and avoided surgery using high-intensity focused ultrasound ablation of her fibroid.
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Lorton O, Guillemin PC, M’Rad Y, Peloso A, Boudabbous S, Charbonnier C, Holman R, Crowe LA, Gui L, Poletti PA, Ricoeur A, Terraz S, Salomir R. A Novel Concept of a Phased-Array HIFU Transducer Optimized for MR-Guided Hepatic Ablation: Embodiment and First In-Vivo Studies. Front Oncol 2022; 12:899440. [PMID: 35769711 PMCID: PMC9235567 DOI: 10.3389/fonc.2022.899440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose High-intensity focused ultrasound (HIFU) is challenging in the liver due to the respiratory motion and risks of near-/far-field burns, particularly on the ribs. We implemented a novel design of a HIFU phased-array transducer, dedicated to transcostal hepatic thermo-ablation. Due to its large acoustic window and strong focusing, the transducer should perform safely for this application. Material and Methods The new HIFU transducer is composed of 256 elements distributed on 5 concentric segments of a specific radius (either 100, 111, or 125 mm). It has been optimally shaped to fit the abdominal wall. The shape and size of the acoustic elements were optimized for the largest emitting surface and the lowest symmetry. Calibration tests have been conducted on tissue-mimicking gels under 3-T magnetic resonance (MR) guidance. In-vivo MR-guided HIFU treatment was conducted in two pigs, aiming to create thermal ablation deep in the liver without significant side effects. Imaging follow-up was performed at D0 and D7. Sacrifice and post-mortem macroscopic examination occurred at D7, with the ablated tissue being fixed for pathology. Results The device showed −3-dB focusing capacities in a volume of 27 × 46 × 50 mm3 as compared with the numerical simulation volume of 18 × 48 × 60 mm3. The shape of the focal area was in millimeter-range agreement with the numerical simulations. No interference was detected between the HIFU sonication and the MR acquisition. In vivo, the temperature elevation in perivascular liver parenchyma reached 28°C above physiological temperature, within one breath-hold. The lesion was visible on Gd contrast-enhanced MRI sequences and post-mortem examination. The non-perfused volume was found in pig #1 and pig #2 of 8/11, 6/8, and 7/7 mm along the LR, AP, and HF directions, respectively. No rib burns or other near-field side effects were visually observed on post-mortem gross examination. High-resolution contrast-enhanced 3D MRI indicated a minor lesion on the sternum. Conclusion The performance of this new HIFU transducer has been demonstrated in vitro and in vivo. The transducer meets the requirement to perform thermal lesions in deep tissues, without the need for rib-sparing means.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Orane Lorton,
| | - Pauline C. Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yacine M’Rad
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Peloso
- Visceral Surgery Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Caecilia Charbonnier
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Research Department, Artanim Foundation, Geneva, Switzerland
| | - Ryan Holman
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lindsey A. Crowe
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Alexis Ricoeur
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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11
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Gong X, Zhang X, Liu D, Yang C, Zhang R, Xiao Z, Chen W, Chen J. Evaluation of physician experience in achieving non-perfused volume ratio of high-intensity focused ultrasound ablation for uterine fibroids: a multicentre study. J Int Med Res 2022; 50:3000605221102087. [PMID: 35634930 PMCID: PMC9158416 DOI: 10.1177/03000605221102087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training. Methods This prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician’s level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated. Results A total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve. Conclusions NPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.
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Affiliation(s)
- Xue Gong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinyue Zhang
- Department of Ultrasound Medicine, Mianyang Central Hospital, Mianyang, Sichuan Province, China
| | - Dang Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chao Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Rong Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhibo Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Centre, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Guan X, Huang X, Ye M, Huang G, Xiao X, Chen J. Treatment of Placenta Increta With High-Intensity Focused Ultrasound Ablation and Leaving the Placenta in situ: A Multicenter Comparative Study. Front Med (Lausanne) 2022; 9:871528. [PMID: 35463039 PMCID: PMC9021530 DOI: 10.3389/fmed.2022.871528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the feasibility of simple high-intensity focused ultrasound (HIFU) ablation for placenta increta. Methods Ninety-five patients after a vaginal delivery were enrolled in this retrospective cohort study, 53 patients were treated with simple HIFU ablation, and 42 patients were treated with HIFU followed by uterine curettage. Results All 95 patients were successfully treated with a single-session HIFU procedure, and in the control group, the necrotic placental tissue was removed with curettage. Vaginal hemorrhage did not occur in either group. The duration of bloody lochia was 25.9 ± 8.6 days in the sHIFU group and 24.2 ± 8.8 days in the control group (P > 0.05). The median serum human chorionic gonadotropin (HCG) level was 3,222 mIU/mL and 2,838 mIU/mL in the sHIFU and control groups, respectively, which decreased and returned to normal within 30 days, and the differences were not significantly on comparing the blood HCG level in the two groups at 7, 15, and 30 days after HIFU (all P > 0.05). Decreased menstrual volume occurred in 85.71% of patients in the control group, which was higher than that in the sHIFU group (23.08%) (χ2 = 6.839, P < 0.001). During 2–8 years of follow-up, six pregnancies occurred in the sHIFU group without any recurrence of placenta increta, three pregnancies occurred in the control group, and one patient developed a repeat placenta increta. Conclusion Simple HIFU treatment is safe and effective for postpartum placenta increta and leaving the placenta in situ. It is a promising option for patients who wish to preserve their fertility and conceive.
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Affiliation(s)
- Xiaoping Guan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Gynecology, Neijiang First People's Hospital, Neijiang, China
| | - Xiaoqin Huang
- Department of Gynecology, Neijiang First People's Hospital, Neijiang, China
| | - Min Ye
- Department of Gynecology, Neijiang First People's Hospital, Neijiang, China
| | - Guohua Huang
- Department of Gynecology, Suining Central Hospital, Suining, China
| | - Xiao Xiao
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
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13
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Keserci B, Duc NM, Nadarajan C, Huy HQ, Saizan A, Wan Ahmed WA, Osman K, Abdullah MS. Volumetric MRI-guided, high-intensity focused ultrasound ablation of uterine leiomyomas: ASEAN preliminary experience. ACTA ACUST UNITED AC 2021; 26:207-215. [PMID: 32209511 DOI: 10.5152/dir.2019.19157] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We sought to present our preliminary experience on the effectiveness and safety of magnetic resonance imaging (MRI)-guided, high-intensity focused ultrasound (HIFU) therapy using a volumetric ablation technique in the treatment of Association of Asian Nations (ASEAN) patients with symptomatic uterine leiomyomas. METHODS This study included 33 women who underwent HIFU treatment. Tissue characteristics of leiomyomas were assessed based on T2- and T1-weighted MRI. The immediate nonperfused volume (NPV) ratio and the treatment effectiveness of MRI-guided HIFU on the basis of the degrees of volume reduction and improvement in transformed symptom severity score (SSS) were assessed. RESULTS The median immediate NPV ratio was 89.8%. Additionally, the median acoustic sonication power and HIFU treatment durations were 150 W and 125 min, respectively. At six-month follow-up, the median leiomyoma volume had decreased from 139 mL at baseline to 84 mL and the median transformed SSS had decreased from 56.2 at baseline to 18.8. No major adverse events were observed. CONCLUSION The preliminary results demonstrated that volumetric MRI-guided HIFU therapy for the treatment of symptomatic leiomyomas in ASEAN patients appears to be clinically acceptable with regard to treatment effectiveness and safety.
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Affiliation(s)
- Bilgin Keserci
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University School of Medicine, Ho Chi Minh City, Vietnam
| | - Chandran Nadarajan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
| | - Huynh Quang Huy
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Aishah Saizan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Aireene Wan Ahmed
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
| | - Khalid Osman
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Shafie Abdullah
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;Department of Radiology, Hospital Universiti Sains Malaysia, USM 16150 Kubang Kerian, Kelantan, Malaysia
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14
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Imseeh G, Giles SL, Taylor A, Brown MRD, Rivens I, Gordon-Williams R, Ter Haar G, deSouza NM. Feasibility of palliating recurrent gynecological tumors with MRGHIFU: comparison of symptom, quality-of-life, and imaging response in intra and extra-pelvic disease. Int J Hyperthermia 2021; 38:623-632. [PMID: 33882792 DOI: 10.1080/02656736.2021.1904154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To document longitudinal symptom, quality-of-life and imaging response in patients with recurrent gynecological tumors treated with magnetic resonance guided high intensity focused ultrasound (MRgHIFU), and compare changes in patients with intra- versus extra-pelvic lesions. METHODS Eleven symptomatic patients with painful recurrent gynecological tumors were treated with MRgHIFU (Profound Sonalleve) in a prospective single center study (NCT02714621). Pain scores, analgesic intake and quality-of-life metrics, whole tumor volume, and perfused tumor volume from Gadolinium-enhanced T1W imaging documented before and up to 90 days after treatment were compared between patients with intra- and extra-pelvic tumors. RESULTS Two of five patients with intra-pelvic and three of six patients with extra-pelvic tumors were classified as responders (>2 point reduction in NRS pain score without analgesia increase or a > 25% reduction in analgesic use). Cohort reductions in worst pain scores were not significant for either group. Emotional functioning for the whole cohort improved, although physical functioning did not. Ablative thermal temperatures were achieved in three patients with extra-pelvic tumors, but in none whose tumors were intra-pelvic. Pain response did not correlate with thermal dose. Tumor volume increased by 18% immediately post-treatment in the extra-pelvic but not in the intra-pelvic group. Ratio of perfused to whole lesion volume decreased by >20% by day 30 in extra-pelvic, but not intra-pelvic tumors although at day 30 both extra-pelvic and intra-pelvic tumors increased in volume. CONCLUSION MRgHIFU treatments can be delivered safely to patients with recurrent gynecological tumors. Extra-pelvic tumors responded better than intra-pelvic tumors and showed immediate swelling and reduction in perfused volume by day 30.
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Affiliation(s)
- Georgios Imseeh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
- Department of Gynecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Sharon L Giles
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alexandra Taylor
- Department of Gynecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R D Brown
- Pain Medicine Department, The Royal Marsden Hospital, London, UK
- Targeted Approaches to Cancer Pain, The Institute of Cancer Research, London, UK
| | - Ian Rivens
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
| | | | - Gail Ter Haar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
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15
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A systematic review of the psychosocial impact of fibroids before and after treatment. Am J Obstet Gynecol 2020; 223:674-708.e8. [PMID: 32474012 DOI: 10.1016/j.ajog.2020.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Despite the high prevalence of uterine fibroids, the psychosocial impact of fibroids has not been evaluated across different quality of life indicators and compared with other chronic conditions. Here, we rigorously analyzed available evidence pertaining to the psychosocial burden of uterine fibroids in premenopausal women and compared validated quality of life and symptom scores before and after treatment. DATA SOURCES We searched PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library for publications from January 1990 to January 2020. STUDY ELIGIBILITY CRITERIA We considered English-language publications that evaluated the association between uterine fibroids diagnosed by imaging studies in premenopausal women and quality of life by standardized and validated questionnaires at baseline and after treatment. We used a detailed list of terms related to quality of life, questionnaires, and uterine fibroids to conduct the search. METHODS Three reviewers screened titles and abstracts and then obtained full-text articles for further analysis. The reviewers assessed risk of bias using established Cochrane and Newcastle-Ottawa Scale guidelines. The quality of life scores of premenopausal women with fibroids were reviewed at baseline and compared with those of published quality of life scores in other disease populations in addition to after fibroid treatment. RESULTS A total of 57 studies were included in the review: 18 randomized controlled trials and 39 observational studies. Of note, the 36-Item Short Form Survey and European Quality of Life Five-Dimension Scale questionnaires both indicated a diagnosis of uterine fibroids to have a disability score that was similar to or exceeded (was a greater psychosocial stressor) a diagnosis of heart disease, diabetes mellitus, or breast cancer. Quality of life scores were lower at baseline than after treatment in all instruments measuring these variables in women with uterine fibroids, indicating significantly impaired psychosocial functioning. Uterine fibroids were associated with significant patient-reported health disabilities related to bodily pain, mental health, social functioning, and satisfaction with sex life. CONCLUSION A diagnosis of uterine fibroids was a significant psychosocial stressor among women at baseline and relative to other diseases. Validated quality of life instruments indicated therapeutic success and the improvement of both physical and emotional symptoms after treatment.
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Sinha V, Mehta S, Kalantzis G, Steinberg F, LeBlang SD. Artifact from myomectomy/C-Section on MRI images - what does this mean for MR-guided focused ultrasound candidacy for uterine fibroids? Int J Hyperthermia 2019; 36:1079-1083. [PMID: 31709842 DOI: 10.1080/02656736.2019.1682689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Magnetic resonance-guided focused ultrasound (MRgFUS) is used for non-surgical treatment of uterine fibroids, often in patients who have had prior myomectomy or Cesarean section. The presence of post-surgical MRI artifacts along the beam path are a common contraindication to MRgFUS treatment. While potential problems arising from superficial cutaneous scars can be circumvented through scar patching and other techniques, deeper artifacts are difficult to bypass. Consequently, many patients with deeper artifacts are often excluded from treatment because of the assumption that these artifacts could deflect the ultrasound beam resulting in off target heating or perturb accurate MR thermometry. We sought to determine if these deep artifacts affect MRgFUS treatment efficacy or safety.Materials and Methods: A search of a MRgFUS center patient database yielded 19 patients with prior uterine surgery who had artifacts along the FUS beam path visible on MRI. Charts, operative reports (when available), screening MRI scans, and MRgFUS treatment scans were reviewed by an experienced MRgFUS treatment physician and artifacts were graded as mild, moderate, or severe.Results: One-way ANOVA showed no significant correlation between artifact severity and percent non-perfused volume (%NPV) (p = .41) or between fibroid size and % NPV (p = .49). There were no adverse events in this patient population except for one case of endometritis that occurred months after the operation, unlikely to be related to the MRgFUS treatments.Conclusion: Patients with uterine fibroids with post-operative susceptibility artifacts in the near-field can be successfully treated with MRgFUS.
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Affiliation(s)
- Vikash Sinha
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Shahil Mehta
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Suzanne D LeBlang
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.,University of Miami Miller School of Medicine, Miami, FL, USA.,University MRI, Boca Raton, FL, USA
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Verpalen IM, Anneveldt KJ, Nijholt IM, Schutte JM, Dijkstra JR, Franx A, Bartels LW, Moonen CT, Edens MA, Boomsma MF. Magnetic resonance-high intensity focused ultrasound (MR-HIFU) therapy of symptomatic uterine fibroids with unrestrictive treatment protocols: A systematic review and meta-analysis. Eur J Radiol 2019; 120:108700. [DOI: 10.1016/j.ejrad.2019.108700] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022]
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18
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Duc NM, Keserci B. Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids. ACTA ACUST UNITED AC 2019; 24:283-291. [PMID: 30211682 DOI: 10.5152/dir.2018.18111] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) is an effective noninvasive treatment option for symptomatic uterine fibroids. However, tissue characteristics of uterine fibroids and technical limitations can limit the patient population that can benefit from this therapy. In this article, we present our literature review focusing on the influential clinical factors that might reduce the risk of an unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids.
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Affiliation(s)
- Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Viet Nam
| | - Bilgin Keserci
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Viet Nam
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