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Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids: Impact of Technology Advancement on Ablation Volumes in 115 Patients

Trumm, Christoph G. MD*; Stahl, Robert MD*; Clevert, Dirk-André MD*; Herzog, Peter MD; Mindjuk, Irene MD; Kornprobst, Sabine; Schwarz, Christina; Hoffmann, Ralf-Thorsten MD; Reiser, Maximilian F. MD*; Matzko, Matthias MD

doi: 10.1097/RLI.0b013e3182806904
Original Articles

Objectives The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)–guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio.

Materials and Methods This is a retrospective analysis of 115 women (mean age, 42 years; range, 27–54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm3 and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio.

Results Magnetic resonance imaging–guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio.

Conclusions With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

From the *Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, München; †Department of Diagnostic and Interventional Radiology, Klinikum Dachau, Dachau; and ‡Department and Policlinics of Diagnostic Radiology, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany.

Received for publication May 15, 2012; and accepted for publication, after revision November 28, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Christoph G. Trumm, MD, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany. E-mail:

© 2013 by Lippincott Williams & Wilkins