Expulsion of Fibroids to the Endometrial Cavity after Magnetic Resonance Imaging-guided High Intensity Focused Ultrasound Surgery (MRgFUS) Treatment of Intramural Uterine Fibroids

다국어 초록 (Multilingual Abstract)

Objectives: This report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy. Methods: Of the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system.Results: The volume of fibroids ranged from 26.0 cm3 to 199.5 cm3, averaging 95.6 cm3. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy.Conclusions: In some cases, after an intramural uterine fibroid is treated with MRgFUS,, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution. (J Menopausal Med 2016;22:139-145)

참고문헌 (Reference)

1 윤상욱, "자궁근종이 있는 한국여성에서 자기공명영상 유도하 고집적 초음파수술: 초기 임상경험" 대한산부인과학회 51 (51): 982-987, 2008

2 김용욱, "배꼽만을 통한 단일공법 복강경하 전자궁절제술: 한국최초 임상보고" 대한산부인과학회 52 (52): 480-486, 2009

3 Yao-long L, "Therapeutic effect of HIFU treatment for benign and malignant solid tumor" 15 : 106-112, 2007

4 Choi SJ, "The effects of hormonal therapy on uterine leiomyomas in perimenopausal women" 10 : 269-276, 2004

5 Spies JB, "The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata" 99 : 290-300, 2002

6 Yoon BS, "Single-port laparoscopic salpingectomy for the surgical treatment of ectopic pregnancy" 17 : 26-29, 2010

7 Quinn SD, "Safety and five-year re-intervention following magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids" 182 : 247-251, 2014

8 이희숙, "Risk Factors Associated with Premalignant and Malignant Endometrial Polyps" 대한폐경학회 19 (19): 74-80, 2013

9 Morita Y, "Non-invasive magnetic resonance imagingguided focused ultrasound treatment for uterine fibroids - early experience" 139 : 199-203, 2008

10 Thiburce AC, "Magnetic resonance-guided high-intensity focused ultrasound for uterine fibroids: Mid-term outcomes of 36 patients treated with the Sonalleve system" 31 : 764-770, 2015

11 Funaki K, "Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images" 196 : 184.e1-184.e6, 2007

12 Venkatesan AM, "Magnetic resonance imaging-guided volumetric ablation of symptomatic leiomyomata: correlation of imaging with histology" 23 : 786-794.e4, 2012

13 Hindley J, "MRI guidance of focused ultrasound therapy of uterine fibroids: early results" 183 : 1713-1719, 2004

14 National Institute of Food and Drug Safety Evaluation, "High intensity focused type ultrasound operator (HIFU) assessment guideline" National Institute of Food and Drug Safety Evaluation 2009

15 Stewart EA, "Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique" 189 : 48-54, 2003

16 McDannold N, "Evaluation of referenceless thermometry in MRI-guided focused ultrasound surgery of uterine fibroids" 28 : 1026-1032, 2008

17 Funaki K, "Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up" 34 : 584-589, 2009

18 Stewart EA, "Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids" 85 : 22-29, 2006

19 Uy K, "Clinical applications of hysteroscopic surgery in postmenopausal women" 16 : 46-51, 2010