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Uterine Fibroids: Diffusion-weighted MR Imaging for Monitoring Therapy with Focused Ultrasound Surgery—Preliminary Study¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science (M.A.J., H.S.K.) and Department of Vascular and Interventional Radiology (H.S.K.), the Johns Hopkins University School of Medicine, Traylor Bldg, Room 217, 712 Rutland Ave, Baltimore, MD 21205; and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (E.H.H.). Received February 17, 2004; revision requested April 23; revision received August 24; accepted October 20. M.A.J. supported in part by National Institutes of Health grants P50 CA09630 and 1R01CA100184. Address correspondence to M.A.J. (e-mail: mikej{at}mri.jhu.edu).

PURPOSE: To prospectively determine the feasibility of using diffusion-weighted (DW) imaging and apparent diffusion coefficient (ADC) mapping before (baseline) and after treatment and at 6-month follow-up to monitor magnetic resonance (MR) image–guided focused ultrasound surgical ablation of uterine fibroids.

MATERIALS AND METHODS: Informed consent was obtained from patients before treatment with our study protocol, as approved by the institutional review board, and the study complied with the Health Insurance Portability and Accountability Act. Fourteen patients (mean age, 46 years ± 5 [standard deviation]) who underwent DW imaging were enrolled in this study, and 12 of 14 completed the inclusive MR examination with DW imaging at 6-month follow-up. Treatment was performed by one radiologist with a modified MR image–guided focused ultrasound surgical system coupled with a 1.5-T MR imager. Pre- and posttreatment and 6-month follow-up MR images were obtained by using phase-sensitive T1-weighted fast spoiled gradient-recalled acquisition, T1-weighted contrast material–enhanced, and DW imaging sequences. Total treatment time was 1–3 hours. Trace ADC maps were constructed for quantitative analysis. Regions of interest localized to areas of hyperintensity on DW images were drawn on postcontrast images, and quantitative statistics were obtained from treated and nontreated uterine tissue before and after treatment and at 6-month follow-up. Statistical analysis was performed with analysis of variance. Differences with P < .05 were considered statistically significant.

RESULTS: T1-weighted contrast-enhancing fibroids selected for treatment had no hyperintense or hypointense signal intensity changes on the DW images or ADC maps before treatment. Considerably increased signal intensity changes that were localized within the treated areas were noted on DW images. Mean baseline ADC value in fibroids was 1504 mm^–6/sec² ± 290. Posttreatment ADC values for nontreated fibroid tissue (1685 mm^–6/sec² ± 468) differed from posttreatment ADC values for fibroid tissue (1078 mm^–6/sec² ± 293) (P = .001). A significant difference (P < .001) between ADC values for treated (1905 mm^–6/sec² ± 446) and nontreated (1437 mm^–6/sec² ± 270) fibroid tissue at 6-month follow-up was observed.

CONCLUSION: DW imaging and ADC mapping are feasible for identification of ablated tissue after focused ultrasound treatment of uterine fibroids.

© RSNA, 2005

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