Utility of MRgFUS - gehealthcare.in/media/Downloads/in/Products/MR Case Stu… · The patient can...
Transcript of Utility of MRgFUS - gehealthcare.in/media/Downloads/in/Products/MR Case Stu… · The patient can...
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 [email protected]
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