Post treatment and 3 month contrast enhanced MRI findings following HIFU of submucosal fibroids: a retrospective study

Figures & data

Table 1. Baseline characteristics of the patients.

Variable	Type 1 (n = 33)	Type 2 (n = 29)	Type2- 5 (n = 19)	p Value
Age (y)	36.6 (6.6)	37.3 (4.9)	36.7 (1.5)	0.986
T2WI				0.152
1	14 (42.4%)	9 (31.0%)	3 (15.8%)
2	9 (27.3%)	16 (55.2%)	11 (57.9%)
3	10 (30.3%)	4 (13.8%)	5 (26.3%)
Position of the uterus				0.647
Anteposition	15 (45.5%)	22 (75.9%)	11 (57.9%)
midposition	7 (21.2%)	4 (13.8%)	5 (26.3%)
Retroposition	11 (33.3%)	3 (10.3%)	3 (15.8%)
Localization of uterine fibroid				0.603
Anterior wall	15 (45.5%)	8 (27.6%)	3 (15.8%)
Posterior wall	10 (30.3%)	13 (44.8%)	2 (10.5%)
Other	8 (24.2%)	8 (27.6%)	14 (73.7%)

Figure 1. Pre-HIFU, post-HIFU and follow-up MRI images obtained from a patient with type 1 submucosal fibroids. (A) The fibroids were located in the submucosa of the posterior wall of the uterus, with slightly high signal intensity on T2WI(Funaki III); (B) Moderate enhancement on T1WI; (C) 95% of the fibroids were ablated after HIFU, and there was no enhancement in the ablation area; Endometrium impairment grade 3(arrow); (D) Three months after HIFU, FVSR was 50%. Endometrium impairment grade 0(arrow).

Figure 2. Pre-HIFU, post- HIFU and follow up HIFU MRI images obtained from a patient with type 2 submucosal fibroid. (A) The fibroids were located under the mucosa of the anterior wall of the uterus, with low signal intensity on T2WI(Funaki II); (B) Significant enhancement on T1WI; (C) 100% of the fibroids were ablated after HIFU, there is no enhancement in the mucosa of the fibroids; Endometrium impairmen grade 3(arrow); (D) 3 months after HIFU, FVSR was 90%, 100% enhancement of mucosa in fibroids. Endometrium impairmen grade 0(arrow).

Figure 3. Pre-HIFU, post-HIFU and follow-up MRI images obtained from a patient with type 2–5 submucosal fibroids. (A) The fibroids were located under the mucosa of the anterior wall of the uterus, with low signal intensity on T2WI(Funaki I); (B) Slight to moderate enhancement after T1WI; (C) 100% of the fibroids were ablated after HIFU, there was no enhancement in the mucosa of the fibroids; Endometrium impairmen grade 3(arrow). (D) Three months after HIFU, FVSR was 50%. Excreted fibroid tissue was observed in the cervical canal. On the same day, the patient had abdominal pain and fibroid tissue was discharged through the vagina. Endometrium impairmen grade 3(arrow).

Table 2. Comparison of treatment efficacy.

	Type 1 (n = 33)	Type2 (n = 29)	Type 2–5 (n = 19)	p Value
treatment time (s)	972 (490)	961 (506)	996 (679)	0.251
treatment energy (kj)	410 (235)	398 (192)	470 (284)	0.178
treatment power (w)	383 (54.6)	395 (17.5)	396 (6.7)	0.591
Immediate NPVR (%)	86.4 (19.3)	90.0 (13.3)	90.3 (7.2)	0.758
Immediate endomentrium impairment				0.104
0	12 (36.4%)	13 (44.8%)	6 (31.6%)
1	3 (9.1%)	5 (17.2%)	5 (26.3%)
2	3 (9.1%)	7 (24.1%)	2 (10.5%)
3	15 (45.4%)	4 (13.9%)	6 (31.6%)
3 months after HIFU NPVR (%)	68.0 (36.4)	74.3 (27.7)	85.0 (16.1)	0.065
endometrium impairment (3 months after)				0.305
0	22 (66.7%)	20 (69%)	10 (52.6%)
1	6 (18.2%)	8 (27.6%)	5 (26.3%)
2	5 (15.1%)	1 (3.4%)	2 (10.5%)
3	0	0	2 (10.5%)
Volume before HIFU (cm3)	57.2 (15.6)	67.8 (19.8)	85.4 (22.3)	0.403
3 months after HIFU Volume (cm3)	24.3 (17.4)	45 (11.7)	51.2 (13.6)	0.036
FVSR (%)	49.0 (1.3)	39.6 (1.7)	37.2 (2.1)	0.041

Table 3. Analysis of submucosal fibroids type (FIGO) in FVSR, NPVR and endometrium impairment at three months after HIFU.

	Type of submucosal fibroids (FIGO)	β	SE	t	OR	95% CI	p Value
FVSR	Type2^a	1.42	0.54	2.6	4.12	1.45–12.35	0.006**
	Type2–5^a	1.26	0.58	2.16	3.51	1.14–11.32	0.017*
	Type2–5^b	−0.16	0.60	−0.27	0.85	0.26–2.77	0.395
NPVR	Type2^a	−0.61	0.55	−1.10	0.545	0.18–1.58	0.137
	Type2–5^a	−1.25	0.66	−1.89	0.286	0.07–0.98	0.031*
	Type2–5^b	−0.64	0.71	−0.91	0.526	0.12–2.03	0.183
Endometrium impairment	Type2^a	−0.23	0.57	−0.41	0.792	0.25–2.39	0.341
	Type2–5^a	0.37	0.60	0.62	1.451	0.44–4.75	0.269
	Type2–5^b	0.61	0.63	0.96	1.832	0.528–6.47	0.171

FIGO: International Federation of Gynecology and Obstetrics; FVSR: fibroid volume shrinkage rate; NPVR: non-perfused volume ratio; a: compared with Type 1; b: compared with Type 2; *Indicates p < 0.05; **Indicates p < 0.01.