Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids

• Main Authors: WEI Qing, CHEN Jinyu, LIU Yinuo
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2019-06-01
• Series: Di-san junyi daxue xuebao
• Subjects: high-intensity focused ultrasound; uterine fibroids; injury; safety; magnetic resonance imaging
• Online Access: http://aammt.tmmu.edu.cn/Upload/rhtml/201812060.htm

Objective To investigate the magnetic resonance imaging (MRI) features of uterine seromuscular layer injuries early after ultrasound ablation of uterine fibroids. Methods Between 2013 and 2017, a total of 671 women received high-intensity focused ultrasound (HIFU) ablation of uterine fibroids in the First Affiliated Hospital of Chongqing Medical University and underwent MRI examinations both before and after the ablation. After screening for eligibility, 400 patients were enrolled in this study. Uterine seromuscular layer injuries following HIFU were defined as the presence of non-perfused area within 120 s after contrast medium injection on enhanced MRI images within 3 d after HIFU. The morphological features and extension of the injuries were analyzed in these patients. Results The uterine seromuscular layer without injuries showed intact circular enhancement on MRI, and injuries were manifested as local enhancement deficits. Of the 400 cases included in this analysis, 90 (22.50%) showed seromuscular layer injuries following HIFU, and the lesions ranged from 3.9 mm to 66.3 mm in size (mean 25.92±14.84 mm); the valume ablation rate was significantly higher in cases with seromuscular layer injuries than in cases without injuries [(86.91±17.78)% vs (80.93±16.25)%, P < 0.05]. The seromuscular layer injuries occurred most frequently in the anterior field of the acoustic pathway and occasionally in the proximal sacrum. The incidence of seromuscular layer injuries was significantly higher in cases of subserosal fibroids than in cases of intramural myoma (43.09% vs 14.18%, P < 0.05), and the size of lesions was greater in the former cases (26.8±15.5 vs 24.6±14.0 mm). No major complications occurred in these patients following the ablation. None of the 90 patients with seromuscular layer injuries had persistent vaginal bleeding, hematuria, or hematoplegia, and follow-up MRI at 3 and 6 months after HIFU showed complete enhancement of the seromuscular layer in all these cases. Conclusion Seromuscular layer injuries visible on MRI can occur early after ultrasound ablation of uterine fibroids, and the injury sites locate often in the anterior field of the acoustic pathway but do not cause significant clinical adverse reactions.