Dynamic contrast-enhanced magnetic resonance imaging predicts immediate therapeutic response of magnetic resonance-guided high-intensity focused ultrasound ablation of symptomatic uterine fibroids

Invest Radiol. 2011 Oct;46(10):639-47. doi: 10.1097/RLI.0b013e318220785c.


Objectives: : To evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in the prediction of the immediate therapeutic response of MR-guided high-intensity focused ultrasound (HIFU) therapy in the treatment of symptomatic uterine fibroids

Materials and methods: : Institutional review board approved this study, and informed consent was obtained from all participants. A total of 10 symptomatic uterine fibroids (diameter: mean, 8.9 cm; range, 4.7-12 cm) in 10 female patients (mean age, 42.2 years) were treated with MR-HIFU therapy using the volumetric ablation technique. DCE-MRI and conventional contrast-enhanced MRI were obtained as a baseline and as an immediate follow-up study, respectively. After regions of interest of each treatment cell were properly registered to both MRI studies, DCE-MRI parameters (K, ve, vp) and operator-controllable therapy parameters (power, treatment cell size, sonication depth) were investigated on a cell-by-cell basis to reflect tissue inhomogeneity. Two types of ablation efficacy indices (volume of 240 equivalent minutes at 43°C/treatment-cell volume, nonperfused volume/treatment-cell volume) were then correlated with those parameters using multiple linear regression analysis to determine which factors were significant predictors for ablation efficacy.

Results: : We used 293 treatment cells (4 mm, n = 12; 8 mm, n = 115; 12 mm, n = 149; 16 mm, n = 17), and all of them were analyzable. Ablation efficacies were 1.06 ± 0.58 and 0.67 ± 0.39. K (B = -12.035, P < 0.001 and B = -11.516, P < 0.001, respectively) among DCE-MRI parameters and acoustic power (B = 0.008, P < 0.001; B = 0.010, P < 0.001, respectively) among therapy parameters were revealed to be independently significant predictors for both types of ablation efficacy.

Conclusions: : A higher K value at baseline DCE-MRI suggested a poor ablation efficacy of MR-HIFU therapy for symptomatic uterine fibroids.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Contrast Media*
  • Female
  • Heterocyclic Compounds*
  • High-Intensity Focused Ultrasound Ablation*
  • Humans
  • Least-Squares Analysis
  • Leiomyoma / pathology
  • Leiomyoma / therapy*
  • Linear Models
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Imaging, Interventional / methods*
  • Middle Aged
  • Organometallic Compounds*
  • Predictive Value of Tests
  • Prospective Studies
  • Treatment Outcome
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / therapy*


  • Contrast Media
  • Heterocyclic Compounds
  • Organometallic Compounds
  • gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate