By Ed Susman
CHICAGO -- December 1, 2008 -- Approximately 73% of women who present with uterine fibroid symptomatology are eligible candidates for treatment using magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS), researchers reported here at the Radiological Society of North America (RSNA) 94th Annual Meeting.
The most frequent reason for disqualification from the procedure was a finding of adenomyosis, a condition that is not amenable to current ablation procedures.
"The ability for physicians to be able to advise patients of their suitability for magnetic resonance focus ultrasound is critical to the success of the procedure," said Suzanne LeBlang, MD, University MRI & Diagnostic Imaging, affiliated with Florida Atlantic University, Boca Raton, Florida.
In her oral presentation on November 30, Dr. LeBlang noted that MRI "can also identify other pelvic pathology that was not seen on screening ultrasounds and [that was] obscured by the symptoms attributed to the fibroids, such as uterine sarcoma, endometrial cancer, adenomyosis, and polyps."
Dr. LeBlang and colleagues reviewed data on 200 women who were assessed in her outpatient clinic for treatment with focus ultrasound.
Their findings showed that 12 women had significant adenomyosis unknown to the patients and not spotted in initial screening examinations.
The researchers also found that 11 women had more than 5 fibroids and 8 women had nonenhancing fibroids on MRI, indicating calcified, haemorrhagic, or necrotic masses. Seven women were found to have endometrial polyps. Seven women had suspicious examinations, 2 of which proved to be malignancies.
Six women had fibroids that were large enough to be partially ablated with the procedure. Four women were found to have fibroids that were deemed too vascular in nature.
Three women had metal clips in the beam path, which could reflect the beam and cause damage elsewhere. One woman had a fibroid positioned more than 12 cm from the surface, an area hard to reach effectively with the focused ultrasound beam. One woman had a pendiculated fibroid for which the treatment is contraindicated.
According to Dr. LeBlang, 131 (73%) of the 179 women presenting for possible MRgFUS treatment were suitable candidates who could achieve a desired nonperfused volume of at least 50% for symptomatic relief."
She suggested that in some cases women had more than one concern that made treatment with focused ultrasound ill advised.
"The wrong diagnosis by ultrasound stresses the importance of magnetic resonance imaging to determine a correct diagnosis and to direct proper treatment," Dr. LeBlang said.
[Presentation title: Factors Influencing Patient Candidacy for Magnetic Resonance Guided Focused Ultrasound Treatment (MRgFUS) of Uterine Fibroids. Abstract SSA11-07]
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