MRI Guidance of Focused Ultrasound Therapy of Uterine Fibroids: Early Results
Jonathan Hindley1,
Wladyslaw M. Gedroyc1,
Lesley Regan1,
Elizabeth Stewart2,
Clare Tempany2,
Kullervo Hynnen2,
Nathan Macdanold2,
Yael Inbar3,
Yacov Itzchak3,
Jaron Rabinovici3,
Kevin Kim4,
Jean-François Geschwind4,
Gina Hesley5,
Brian Gostout5,
Tillman Ehrenstein6,
Sylvia Hengst6,
Miri Sklair-Levy7,
Asher Shushan7 and
Ferenc Jolesz2
1 Departments of Magnetic Resonance Imaging and Academic Obstetrics and
Gynaecology, Interventional MR Unit, St Mary's Hospital London and Imperial
College School of Medicine, Praed St., London W2 1NY, England.
2 Departments of Obstetrics and Gynaecology and Reproductive Biology and
Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
02115.
3 Department of Radiology and Obstetrics and Gynaecology, Sheba Medical Centre,
Tel-Hashomer 91120, Israel.
4 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD
21287.
5 Department of Radiology and Obstetrics and Gynaecology, Mayo Clinic,
Rochester, MN 55905.
6 Department of Radiology, Charité Medical Centre and Humboldt
University, Virchow Clinic Campus, Berlin D-13353, Germany.
7 Department of Radiology, Hadassah Medical Centre, Jerusalem 52621,
Israel.
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Fig. 1. —Schematic representation of patient lying on ExAblate 2000
(InSightec) focused ultrasound system ready to be placed into MRI unit.
Ultrasound transducer found in sealed water bath within MR table.
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Fig. 2. —T2-weighted image of 38-year-old woman with symptomatic
fibroids ready for MRI-guided focused ultrasound therapy. She is lying prone
on gel pad, which is above focused ultrasound therapy transducer. Sonication
pathway is superimposed on image and has been angled craniocaudally to avoid
small bowel close to uterus. Spot where irreversible thermal damage is
expected is also superimposed onto this image. Figure is screen capture from
ExAblate 2000 system (InSightec) at time of treatment.
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Fig. 3. —Phase-shift image taken 22.2 sec after onset of sonication in
38-year-old woman with symptomatic fibroids. High-signal area is visible due
to rise in temperature and can be seen along sonication pathway. Signal is
greatest within target spot and it is this area that has been heated
sufficiently to cause irreversible damage. Heating of anterior pathway will be
dissipated by perfusion during cooling period between sonications. Figure is
screen capture from ExAblate 2000 system (InSightec) during treatment.
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Fig. 4. —Graph of temperature against sonication time. Green
represents average temperature within target volume; red represents absolute
temperature at specified point. This sonication has resulted in maximum
temperature of 91.8°C. This is higher than is necessary for irreversible
damage so this information can be used to shorten sonication time or reduce
acoustic power for subsequent sonications. Figure is screen capture from
Ex-Ablate 2000 system (InSightec) during treatment.
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Fig. 5A. —41-year-old woman with symptomatic uterine fibroids.
T2-weighted sagittal image shows fibroid before treatment.
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Fig. 5B. —41-year-old woman with symptomatic uterine fibroids.
T1-weighted gadolinium-enhanced sagittal image with fat saturation of same
fibroid obtained immediately after MRI-guided focused ultrasound therapy shows
area of reduced enhancement corresponding to area of ablation.
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Copyright © 2004 by the American Roentgen Ray Society.
