Development and clinical evaluation of a 3-step modified manipulation protocol for MRI-guided high-intensity focused ultrasound of uterine fibroids.

Autor: Verpalen IM; Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. i.m.verpalen@isala.nl., van 't Veer-Ten Kate M; Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., de Boer E; Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., van den Hoed RD; Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands., Schutte JM; Department of Gynecology, Isala, Zwolle, The Netherlands., Dijkstra JR; Department of Gynecology, Isala, Zwolle, The Netherlands., Franx A; Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands., Bartels LW; Image Sciences Institute, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands., Moonen CTW; Image Sciences Institute, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands., Boomsma MF; Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2020 Jul; Vol. 30 (7), pp. 3869-3878. Date of Electronic Publication: 2020 Mar 12.
DOI: 10.1007/s00330-020-06780-2
Abstrakt: Objectives: The clinical applicability of magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids is often limited due to inaccessible fibroids or bowel interference. The aim of this study was to implement a newly developed 3-step modified manipulation protocol and to evaluate its influence on the number of eligible women and treatment failure rate.
Methods: From June 2016 to June 2018, 165 women underwent a screening MRI examination, 67 women of whom were consecutively treated with MR-HIFU at our institution. Group 1 (n = 20) was treated with the BRB manipulation protocol which consisted of sequential applications of urinary bladder filling, rectal filling, and urinary bladder emptying. Group 2 (n = 47) was treated using the 3-step modified manipulation protocol which included (1) the BRB maneuver with adjusted rectal filling by adding psyllium fibers to the solution; (2) Trendelenburg position combined with bowel massage; (3) the manual uterine manipulation (MUM) method for uterine repositioning. A comparison was made between the two manipulation protocols to evaluate differences in safety, the eligibility percentage, and treatment failure rate due to unsuccessful manipulation.
Results: After implementing the 3-step modified manipulation protocol, our ineligibility rate due to bowel interference or inaccessible fibroids decreased from 18% (16/88) to 0% (0/77). Our treatment failure rate due to unsuccessful manipulation decreased from 20% (4/20) to 2% (1/47). There were no thermal complications to the bowel or uterus.
Conclusions: Implementation of the 3-step modified manipulation protocol during MR-HIFU therapy of uterine fibroids improved the eligibility percentage and reduced the treatment failure rate.
Trial Registration: Registry number NL56182.075.16 KEY POINTS: • A newly developed 3-step modified manipulation protocol was successfully implemented without the occurrence of thermal complication to the bowel or uterus. • The 3-step modified manipulation protocol increased our eligibility percentage for MR-HIFU treatment of uterine fibroids. • The 3-step modified manipulation protocol reduced our treatment failure rate for MR-HIFU treatment of uterine fibroids.
Databáze: MEDLINE
Externí odkaz: