A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa

Figures & data

Figure 1. Real-time ultrasound monitoring images from a 42 years old patient. (A). An ultrasound image obtained before HIFU. A degassed water balloon (arrow) was used to push bowel away, the small loops of bowel (arrow) was detected outside the acoustic field. (B). A significant grey scale change was observed in the fibroid (arrow).

Figure 2. Contrast-enhanced MR images from a 36 years old patient with multiple uterine fibroids. (A). A sagittal view image obtained before HIFU treatment showed the size of uterus was 9.6 × 7.6 × 7.0 cm³, multiple uterine fibroids were detected (arrows). (B). A sagittal view image obtained one day after HIFU showed the fibroids were completely ablated (arrows). (C). A sagittal view image obtained 6 months after HIFU showed the size of uterus was 8.0 × 7.3 × 6.4 cm³, the rate of fibroid volume reduction was 89.6% (arrows).

Table 1. Baseline characteristics of patients with multiple uterine fibroids.

Variable	Data
No. of patients	81
Total number of fibroids	346
Age (years)	35.3 ± 5.9 (range: 19–46)
Average weight (kg)	68.4 ± 11.4 (range: 43–99)
Abdominal subcutaneous fat thickness (mm)	38.0 ± 11.4 (range: 7.5–65)
BMI	26.3 ± 4.6 (range: 15.8–39.3)
Median fibroid number of patients	6 (range: 3–9)
Locations (anterior/posterior/lateral/fundal	127/72/67/80
Median volume of fibroids (cm^3)	36.0 (range: 1.8–1220.1)
Largest diameter of fibroid (cm)	4.8 (range: 1.5–14.4)
Signal intensity on T2WI (hypo/iso/hyper)	213/69/64
Types (submucosal/intramural/subserosal)	38/166/142

Table 2. USgHIFU treatment results of patients with multiple uterine fibroids.

Variable	Data
Sonication power (w)	386.6 ± 24.1 (range: 300–400)
Overall treatment time (min)	97.3 ± 61.3 (range: 40–240)
Sonication time (s)	549.2 ± 454.2 (range: 280–2020)
Treatment intensity (s/h)	411.0 ± 137.1 (range: 134.0–863.6)
Non-perfused volume ratio (%)	85.2 (range: 60.1–100)
Treatment energy (KJ)	275.9 ± 284.6 (range: 60.0–2222.3)
Treatment efficiency (mm^3/s)	76.0 (range: 39.7–176.1)

Table 3. Side effects and complications during or after the procedure.

Side effects	No. of cases	Percentage
Transient leg pain	11	13.6%
Sciatic/buttock pain	35	43.2%
Skin “burning” sensation	50	61.7%
Lower abdominal pain	49	60.5%
Abnormal vaginal discharge	5	6.2%

Table 4. Comparison of UFS and QOL pre-HIFU and post-HIFU.

Evaluation time points	UFS (n = 21)	QOL (n = 21)
Pre-HIFU	56.3 ± 16.7	41.3 ± 21.2
1 months after HIFU	40.5 ± 17.2	60.6 ± 19.7
3 months after HIFU	31.0 ± 15.1	72.3 ± 18.1
6 months after HIFU	20.6 ± 14.2	73.4 ± 19.2

Table 5. Shrinkage rate of 120 fibroids in 21 followed to 6 months during follow-up interval.

Variable	1 month	3 months	6 months
Hypointense (n = 75)	30.8 ± 23.2%	47.4 ± 25.6%	54.6 ± 35.3%
Isointense (n = 25)	38.9 ± 22.8%	43.9 + 27.0%	52.3 ± 25.8%
Hyperintense (n = 20)	29.9 ± 24.5%	37.5 ± 21.3%	47.1 ± 31.7%
Overall (n = 120)	32.5 ± 24.0%	42.3 ± 32.2%	52.5 ± 36.3%