Title:MR Diffusion-Weighted Imaging in Evaluating Immediate HIFU Treatment
Response of Uterine Fibroids
Volume: 20
Author(s): Yunneng Cui, Jing Zhang, Jiaming RAO, Minqing Feng, Liangfeng Yao, Weibin Liao, Cuishan Liang and Yanping Huang*
Affiliation:
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong, China
Keywords:
Uterine fibroid, Magnetic resonance imaging, Diffusion-weighted imaging, Contrast enhanced imaging, Ablation quality grading, Nonperfusion volume.
Abstract:
Background:
Nowadays, High Intensity Focused Ultrasound (HIFU) is a common surgery option for the treatment of uterine fibroids in China, the immediate
response of which is clinically evaluated using Contrast Enhanced (CE) imaging. However, the injection of gadolinium with its potential adverse
effect is of concern in CE and therefore, it deserves efforts to find a better imaging method without the need for contrast agent injection for this
task.
Objective:
To assess the role of Diffusion-weighted Imaging (DWI) in evaluating the immediate therapeutic response of HIFU treatment for uterine fibroids in
comparison with CE.
Methods:
68 patients with 74 uterine fibroids receiving HIFU treatment were enrolled, and immediate treatment response was assessed using post-surgical
DWI images. Semi-quantitative ordinal ablation quality grading and quantitative nonperfusion volume (NPV) measurement based on DWI and CE
imaging were determined by two experienced radiologists. Agreement of ablation quality grading between DWI and CE was assessed using the
weighted kappa coefficient, while intraobserver, interobserver and interprotocol agreements of NPV measurements within and between DWI and
CE were evaluated using the intraclass correlation (ICC) and Bland-Altman analysis.
Results:
Grading of immediate HIFU treatment response showed a moderate agreement between DWI and CE (weighted kappa = 0.446, p < 0.001). NPV
measured in 65 fibroids with DWI of Grade 3~5 showed very high ICCs for the intraobserver and interobserver agreement within DWI and CE (all
ICC > 0.980, p < 0.001) and also for the interprotocol agreement between DWI and CE (ICC = 0.976, p < 0.001).
Conclusion:
DWI could provide satisfactory ablation quality grading, and reliable NPV quantification results to assess immediate therapeutic responses of
HIFU treatment for uterine fibroids in most cases, which suggests that non-contrast enhanced DWI might be potentially used as a more costeffective
and convenient method in a large proportion of patients for this task replacing CE imaging.
