Volumetric treatment of uterine fibroids using ultrasound-guided, power- and pathway-controlled, pulsed-type high-intensity focused ultrasound

Abstract

Background and Objectives : Non-invasive high-intensity focused ultrasound (HIFU) treatments are used widely to relieve uterine fibroids (UF)-related symptoms without general anesthesia and long hospitalization. This study evaluated the effectiveness and safety of power, pathway-controlled, cumulative, pulsed-type HIFU treatments for symptomatic UF lesions. Materials and Methods : A total of 633 UF lesions in 300 patients were treated with a single HIFU session. Reductions in the UF size and volume were evaluated at 1, 3, 6, and 12 months after the HIFU treatments. Results : Hypoenhancing ultrasonographic findings were obtained by treating UF lesions with HIFU at an average HIFU power of 389.1 ± 81.6 W, an energy/ therapeutic point of 49.5 ± 2.6 J/pulse, a total of 2.8 ± 1.1 therapeutic pathways, and a total sonication energy of 28,016.4 ± 10,622.2 J. The volume of the overall UFs decreased significantly to 72.1% of their original volume during the 12-month follow-up. Among four different UF size groups, significant differences were found in the final HIFU settings, including power, total number of therapeutic pathways, total sonication energy, and sonication time, but not energy/therapeutic point. Linear mixed model analysis revealed significant interactions between the group and time for post-HIFU reductions in the maximum diameter of UFs and UF volume and rate of UF volume reductions. Conclusion : Ultrasound-guided, power- and pathway-controlled, pulsed-type HIFU treatment can be used as an effective uterus-sparing treatment modality for symptomatic UFs in patients of childbearing age or perimenopausal period.