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Table of Contents
CLINICAL IMAGE
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 178-180

Single-phase focused ultrasound surgery for 15-leiomyoma and huge leiomyoma patients


Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam

Date of Web Publication26-Sep-2018

Correspondence Address:
Dr. Minh Duc Nguyen
Department of Radiology, Pham Ngoc Thach University of Medicine, 86/2 Thanh Thai Ward 12 District 11 HO Chi Minh City
Vietnam
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_52_18

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  Abstract 


Focused ultrasound surgery is a potential noninvasive surgery for eliminating leiomyoma. In this clinical image, we introduced an alternative role of this method for cases of multiple leiomyomas and huge leiomyoma with effective outcomes.

Keywords: Focused ultrasound surgery, leiomyoma, noninvasive treatment


How to cite this article:
Nguyen MD. Single-phase focused ultrasound surgery for 15-leiomyoma and huge leiomyoma patients. Gynecol Minim Invasive Ther 2018;7:178-80

How to cite this URL:
Nguyen MD. Single-phase focused ultrasound surgery for 15-leiomyoma and huge leiomyoma patients. Gynecol Minim Invasive Ther [serial online] 2018 [cited 2018 Dec 11];7:178-80. Available from: http://www.e-gmit.com/text.asp?2018/7/4/178/240467




  Introduction Top


A nulliparous 30-year-old patient with a history of uterine leiomyoma complained bulk effect of pelvis admitted to the Department of Gynecology. Magnetic resonance imaging examination revealed that there were 15 uterine leiomyomas affected almost areas of anteflexed uterus considered as all Type II uterine leiomyomas (the signal intensity of leiomyoma was greater than that of skeletal muscle and less than that of myometrium) [Figure 1]a.[1] The perfusion classification of uterine leiomyomas was regarded as Type A uterine leiomyoma (the time signal intensity curve of uterine leiomyoma was less than that of myometrium) [Figure 1]b.[2] The patient was indicated single-phase focused ultrasound surgery (FUS) under the guidance of magnetic resonance imaging. After 144 min of treatment duration, nonperfused volume ratio of this case was 98% [Figure 1]c. At 24-h posttreatment, the patient was discharged without adverse events. At 6 months of follow-up, all leiomyomas were shrinked with total mean volume reduction ratio of 52% and the pelvic tension symptom was resolved entirely [Figure 1]d. In addition, anti-Müllerian hormone level before ablation and after 6 months of follow-up was preserved comprehensively.[3]
Figure 1: (a) Sagittal T2-weighted image at screening phase shows multiple uterine leiomyomas. (b) Axial perfusion-weighted image at screening phase shows the time signal intensity curve of uterine leiomyoma lower than that of myometrium. (c) Coronal contrast-enhanced T1-weighted image after treatment shows near-complete ablation of all uterine leiomyomas. (d) Sagittal T2-weighted image at 6-month follow-up shows significant shrinkage of all uterine leiomyomas

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A nulliparous 28-year-old patient with a history of leiomyoma suffered from urinary retention and pelvic pressure admitted to the Department of Gynecology. On the physical examination, clinician found a big palpable mass on the pelvis. On T2-weighted image, there was an intramural leiomyoma located on the anterior wall of retroflexed uterus with diameter of 151 mm considered as a Type II leiomyoma (the signal intensity of leiomyoma was higher than that of skeletal muscle and lower than that of myometrium) [Figure 2]a.[1] On perfusion-weighted image, leiomyoma was regarded as a Type A leiomyoma (the time signal intensity curve of leiomyoma was lower than that of myometrium) [Figure 2]b.[2] The patient desired to undergo FUS instead of open surgery. The FUS under the guidance of magnetic resonance imaging yielded a nonperfused volume ratio of 91% [Figure 2]c. At 12 h postablation, the patient was discharged without side effects. At 6-month follow-up, the diameter of leiomyoma was reduced to 82 mm, and the complaint symptoms were resolved completely [Figure 2]d. In addition, serum anti-Müllerian concentration of this case before ablation and after 6 months of treatment was preserved entirely.[3]
Figure 2: (a) Sagittal T2-weighted image at screening phase shows a huge uterine leiomyoma. (b) Axial perfusion-weighted image at screening phase shows the time signal intensity curve of uterine leiomyoma lower than that of myometrium. (c) Coronal contrast-enhanced T1-weighted image after treatment shows near-complete ablation of uterine leiomyoma. (d) Sagittal T2-weighted image at 6-month follow-up shows significant shrinkage of uterine leiomyoma

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Leiomyoma is one of most common gynecological benign diseases that influence adversely on the health of the reproductive age patients. The prevalence of leiomyoma is approximate 70%–80%. FUS was based on the biological thermal effect of high-intensity focused ultrasound on the convergent tissue to elevate the tissue's temperature up to the threshold of coagulative necrosis and protein denaturation.[1],[2],[3],[4],[5],[6] In this clinical image article, we displayed a case of 15 leiomyomas and a case of huge leiomyoma treated in single phase FUS successfully without any side effects. These results were fully agreement with some previous studies;[4],[5],[6] therefore, FUS treatment should be considered as an alternative therapeutic method for patients with multiple leiomyomas and huge leiomyoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Funaki K, Fukunishi H, Funaki T, Sawada K, Kaji Y, Maruo T, et al. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: Relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol 2007;196:184.e1-6.  Back to cited text no. 1
    
2.
Keserci B, Duc NM. The role of T1 perfusion-based classification in magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids. Eur Radiol 2017;27:5299-308.  Back to cited text no. 2
    
3.
Lee JS, Hong GY, Lee KH, Kim TE. Changes in anti-müllerian hormone levels as a biomarker for ovarian reserve after ultrasound-guided high-intensity focused ultrasound treatment of adenomyosis and uterine fibroid. BJOG 2017;124 Suppl 3:18-22.  Back to cited text no. 3
    
4.
He M, Jacobson H, Zhang C, Setzen R, Zhang L. A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa. Int J Hyperthermia 2018;1-7.[Ahead of Print]. Doi: 10.1080/02656736.2017.1421323.  Back to cited text no. 4
    
5.
Kim YS, Kim JH, Rhim H, Lim HK, Keserci B, Bae DS, et al. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: Initial clinical outcomes. Radiology 2012;263:600-9.  Back to cited text no. 5
    
6.
Hou R, Wang L, Li S, Rong F, Wang Y, Qin X, et al. Pilot study: Safety and effectiveness of simple ultrasound-guided high-intensity focused ultrasound ablating uterine leiomyoma with a diameter greater than 10 cm. Br J Radiol 2018;91:20160950.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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