Magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroids in an outpatient practice can yield significantly greater non-perfused volume (NPV) and shrinkage than other methods, according to study data presented on Sunday at the 2008 meeting of the Radiological Society of North America (RSNA). "The greater the non-perfused volume, the greater the shrinkage. Specifically, for non-perfused volumes of 0 to 50% their was average shrinkage of 14%, but for non-perfused volumes of 75% to 100% there was average shrinkage at 6 months of 51%," reported Suzanne LeBlang, MD, Neuroradiologist at University MRI & Diagnostic Imaging Center, who presented the study. (Read the abstract here.) "Our results of increased tumor shrinkage with increased non-perfused volume ratios exceeded that shown in previous studies due to more relaxed treatment guidelines and improved operator experience. The average shrinkage from the initial pivotal study was 15%, whereas in our study the average shrinkage was 33%."

In two subsequent presentations, safety and candidacy issues for MRgFUS were discussed. "We determined that 75% of women screened with MRI scans with and without contrast are candidates for MRgFUS," Dr. LeBlang said in an interview with MedicExchange. "The other patients that do not seem to be good candidates for the MRgFUS procedure had multiple and varied exclusion criteria, the most significant of which were alternative diagnoses such as adenomyosis, endometrial lesions, and cancer. Another potential exclusion criterion is an enlarged subcutaneous fat and muscle layer."

Dr. LeBlang noted that patients who had thicker subcutaneous muscle layers were at a slightly higher risk for developing fat and muscle necrosis during the procedure. This necrosis can lead to focal self-limiting pain in the region, but did not result in any serious complications in the study population. "Patients with a thicker fat and muscle layer tended to have a lower non-perfused volume in the fibroid, possibly because the thicker fat layer was preventing the intensity of the beam from reaching the fibroid tissue and generating the focused heat needed to kill the fibroid," Dr. LeBlang told MedicExchange. She added, "Other clinical applications for MRgFUS are treating bone pain from metastatic bone cancer and breast cancer, while MRgFUS research is currently investigating its use for prostate cancer and targeted drug delivery systems."

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