1. Brigham and Women’s Hospital, Department of Radiology
Evaluation of the Efficacy of Uterine Artery Embolization for Focused Ultrasound Surgery Therapeutic Failures
Alisa Suzuki, MD
Brigham and Women’s Hospital,
Department of Radiology

2. Basic Fibroid Treatment Algorithm
asymptomatic
symptomatic
operation
hormone therapy
Watch carefully
MRgFUS
laparotomy
laparoscopy
hysteroscopy
UAE
hysterectomy
TCR
stable
myomectomy
progression
T V Hysterectomy
L Hysterectomy
observation
LAVHysterectomy
L Myomectomy
LA Myomectomy

3. We evaluate the effect of UAE in patients who are unsatisfied with FUS treatment.

4. New treatment option from radiology for SYMPTOMATIC FIBROIDS
MR guided Focused Ultrasound Surgery = since 2001
MRgFUS = a new method of non-invasive thermal(heat) ablation for symptomatic fibroids.
73% to 91 % of the women who have been treated reported a significant improvement in their uterine fibroid symptoms.
MRgFUS is an FDA-approved treatment for symptomatic uterine fibroids

5. UAE
Procedure
POST Procedure

6. UAE
PRE
3 month POST

7. MRgFUS
POST
PRE

8. UAE and MRgFUS - similarities
Less or non- invasive compared to conventional gynecological surgeries.
= short hospital stay, short recovery
= smaller incision, or no incision
= No general anesthesia (intravenous conscious sedation)
Similar or lower serious adverse event %
= High patient satisfaction
Performed by a radiologist

9. UAE vs. MRgFUS - differences
procedure
UAE
MRgFUS
Type
Minimally invasive
Non-invasive
Hospital stay
Overnight
10 min - 2hours
Pain control
Narcotics
OTC pain killers
Procedure time
20 min - 90 min
180 min
Feasible numbers
1– innumerable/
one session
1 – 3/
Feasible size
0.5cm – 10 cm
4 – 10cm
Access for the patient
Most IR doctors will perform
Not all hospital can provide

10. ?
% of women who have been treated with FUS reported a significant improvement in their uterine fibroid symptoms.
% of women did not report clinically satisfactory outcome.
10 patients underwent UAE subsequently at BWH.
options : myomectomy, hysterectomy, UAE, re-FUS
Patients were allowed to select their treatment.

11. Study design: FUS performed in BWH from March 2002 and June 2004.
7 patients were reviewed.
Pre and post FUS and UAE uterine size.
Pre and post FUS and UAE fibroid size.
Clinical symptoms

12. Result 1 Size of Fibroid The mean volume of pre-FUS fibroid 279cc
12 month post-FUS fibroid 316cc, -13.0%
post-UAE fibroid 163cc, -49%
Significant decrease in size between post-FUS 12 month size and post-UAE fibroid size. (p=0.02)

13. Result 2 Size of Uterus The mean volume of pre-FUS uterus 617 cc
Post-FUS 12 month uterus 682 cc, +10.0%
post-UAE uterus was 475cc, - 31%
Significant decrease in uterine size between pre-FUS and post UAE. (p=0.03)
Significant decrease in size between 12 month post-FUS fibroid size and post-UAE fibroid size. (p=0.002)

14. Result 3 Clinical symptoms
Clinical symptoms including heavy bleeding, bulk, and pelvic pressure were improved in all patients (as reported by patient)

15. These two fibroids were targeted.
@ FUS Nov-2003
These two fibroids were targeted.
Post FUS Gd Image

16. Post FUS 6 & 13 months May- 04, 6 month follow up.
Uterus size 12.1 x 11.7 x 9.8 cm,
721cc
Jan -05, 13 month follow up.
Uterus size 14.4 x 12.4 x 7.8 cm, 738cc

17. @ UAE, Post FUS 23 months
Dec-05 UAE.

18. Post UAE 13 months, Post FUS 36 month
Jan -05,
Post FUS 13 month follow up.
Uterus size 14.4 x 12.4 x 7.8 cm, 738cc
Nov-06
Post FUS 36 m, post UAE 13 m
follow up. Uterine size
11.4 x 9.6 x 8.4 cm, 487.2cc

19. UAE can be therapeutic after unsatisfactory outcomes of FUS.
MRg FUS is a new, exciting technique which can ‘zap’ fibroids in 3 hours while the patient is sleeping on the MRI table.
Patients who develop clinical failure after FUS treatment could subsequently receive full benefit from Uterine Artery Embolization.
Now we can comfortably inform patients that an FUS treatment failure does not require subsequent highly invasive surgery procedure as a minimally invasive procedure (like UAE) may resolve the patient's symptoms.

20. There are many areas where our experience with FUS is limited.
Due to the newness of FUS, there is limited long-term follow up data on patients.