Patient history

Findings

• A 49-year-old woman presented with complains of menorrhagia and

metrorrhagia

• She was a multiparous woman

• Her symptom severity score (on the score of 0–100 scale of the UFS –

QoL, questionnaire) was 48 points

A screening ultrasound was undertaken that showed a fundal and anterior

wall intramural fibroid. MRI showed an anterior wall and fundal intramural

fibroid measuring 5.6 x 5.1 x 5.7 cm (volume 76 cc). The fibroid was

hypointense to myometrium on T2W images (Fig. 1 A & B). Post-gadolinium

contrast images showed moderate heterogeneous enhancement (Fig. 1 C).

Utility of MRgFUS in Gynecology - Case Study 1

GE Healthcare

MR guided focused ultrasound

(MRgFUS) is the first and only

commercially approved focused

ultrasound system used for more than

a decade in treating uterine fibroids. It

is commercially approved for treating

uterine fibroids, adenomyosis and

pain alleviation of bone metastases in

Europe. This technique locally targets

the tissue while sparing the

surrounding healthy tissue. MRgFUS is

a non-invasive procedure that does

not require general anesthesia and

helps in speedy recovery. It provides

continuous real-time monitoring of

treatment.

The procedure is very safe and has

lesser side effects and complications.

The patient can resume back to work

or carry out day-to-day activities

within a day or two.

MRgFUS is a very convenient

technique for the operating physician

as there is no need for sterilization

and requires less hours of standing. It

can help in performing wide range of

procedures using a single system.

MR guided focused

ultrasound (MRgFUS)

© 2013 General Electric Company

Fig. 1 A & B: T2WI saggital (A) & coronal (B) sequences showing fundal and

anterior wall intramural fibroid measuring 5.6 × 5.1 × 5.7 cms (arrows). The

fibroid was hypointense to myometrium

A B

Dr. Vinay Nyapathy, MD

Professor of Radiology

Director, Lucid Medical Diagnostics

Bangalore(This case study is courtesy of GSL Medical

Trust, Rajahmundry, Andhra Pradesh)

"MRgFUS is an excellent tool for treatment of

gynecologic conditions"

Technique

On the day of treatment, the patient was administered conscious sedation (one ampoule of Fentanyl) to reduce

motion during the procedure. A urinary catheter was inserted and bowels were mitigated using a rectal balloon

(Fig. 1 D). The fibroid was treated using a total number of 28 sonication spots and the treatment duration was 50 min

(from first to last sonication) (Fig. 1 E-H). The mean energy was 2045 J and frequency of sonication waves was 1.15

M. The temperature was in the range of 60–85°C. Post treatment contrast enhanced SPGR sequences were acquired

which showed a non-perfused volume of 72 cc (Fig. 1 I & J) achieving an NPV ratio of 95%. Immediate post treatment

period was uneventful and patient was discharged after removal of urinary catheter and rectal balloon. The patient

was comfortable and returned to her daily routine the next day.

On follow-up after 6 months, there was significant alleviation of symptoms and her symptom severity score was

reduced to 20. Follow- up MRI showed a decrease in dimensions of the fibroid in all 3 planes. It measured 4.5 x 4.2 x

4.7 cms (Fig. 1 K & L).

Fig. 1 C: Post gadolinium T1WI sagittal image showing moderate heterogenous contrast enhancement (arrow)

Fig. 1 D: T2WI sagittal image obtained during treatment planning. The empty urinary bladder with Foley’s bulb in situ

(arrow head), inflated rectal balloon (long arrow), is seen pushing the fibroid (short arrow) and bringing it close to the

anterior abdominal wall

C

D

Fig.1 (E, F, G, H): Sagittal (E) and coronal (F) T2WI images obtained during treatment show sonication spots (red arrow,

ultrasound beam path (*) Red line: skin surface; dotted line: pubic bone; blue line: far field bone; Arrow head: bowel.

Fig. F: Post sonication image showing sonicated spot (yellow arrow), previously ablated area (pink arrow) (Protocol:

1.5T MRI+ ExAblate 2000, TR: 4200ms, TE: 86.8ms). Fig. G: Temperature graph shows the temperature attained at the

sonication spot during treatment (arrow). Fig. H: The system allows changes to the energy, frequency, spot

parameters depending on the patient comfort and the response of the fibroids to the sonications. The system also

displays the spot length, diameter of the sonication spot along with the angulations of the beam (roll and pitch)

Fig.1 I & J: Contrast enhanced spoiled gradient recalled acquisition in the steady state (SPGR) sagittal (I) & coronal (J)

MR of the pelvis after MRgFUS treatment showing non enhancing area (arrows) corresponding to non-perfused

volume of 95%

E F

G H

I J

Image courtesy of GSL Medical Trust

“This article has been published by GE Healthcare with consent of the authors/institutions concerned in academic interest. The views expressed in the

case study are solely those of the Author. For circulation within India only”

To learn more about GE MR Systems SMS GEHC to 56677 or call our toll free number at 1800 209 9003 or email to dhrumil.sorathia@ge.com

Fig.1 (K & L): Sagittal (K) and coronal (L) T2WI images obtained 6 months after MRgFUS treatment shows regression of

the fibroid in all 3 planes. The fibroid measures 4.5 x 4.2 x 4.7cms

The fibroid which was measuring pretreatment 5.6 x 5.1 x 5.7 cms showed 55% regression in T2 weighted MR

imaging done after 6 months and it measured at 4.5 x 4.2 x 4.7cms.

K L