New approaches, better data enhance palatability of MR-guided US fibroid ablation

Results from papers released Sunday at the 2008 RSNA suggest that a less rigid approach to treatment, coupled with knowledgeable practitioners and judicious patient selection can improve the commercial prospects of outpatient MRI-guided focused ultrasound ablation of uterine fibroids. There are caveats, though.

Dr. Suzanne D. LeBlang, medical director of the University Image Guided Therapy Center in Boca Raton, FL, opened her marathon delivery by releasing results of a study on 80 patients who underwent MRgFUS fibroid ablation at her private outpatient clinic.

According to LeBlang, higher post-treatment nonperfused volumes correlate with increased leimyoma shrinkage, which results in improved patient symptoms. Practitioners should strive for treatment NPVs of at least 50% in order to attain better clinical outcomes, she said. This can be achieved by relaxing the treatment guidelines used by most clinical trials and engaging experienced MR operators.

Results from another study presented by LeBlang showed that patients with pelvic-abdominal wall fat deposits of 2.5 cm or larger are at higher risk of failing treatment. This also includes the chances of suffering muscle necrosis from MRgFUS burn. The researcher speculated that fibroids adhering to the muscle wall may transmit heat at higher temperatures when this is surrounded by heavy fat. Careful selection of patients is a must to avoid complications, she said.

MRgFUS use has expanded beyond fibroid ablation nowadays. It's also being used to treat prostate, breast, and bone cancers. Though reimbursement is still not available, the procedure is becoming increasingly popular among nonradiologists. Turf issues are on the horizon, LeBlang said.