CLINICAL CHARACTERISTICS, IMAGING EFFICACY, AND SAFETY OF MRI-GUIDED FOCUSED ULTRASOUND ABLATION (FUS-MRI) IN THE...

Uterine fibroids remain one of the most common benign tumors of the female reproductive system and a significant cause of menorrhagia, pain, symptoms of pelvic organ compression, and a reduced quality of life. Due to the limitations of surgical methods, organ-preserving and minimally invasive technologies are attracting increasing interest, including MRI-guided focused ultrasound ablation (FUS-MRI).

To evaluate the immediate imaging efficacy, early morphological response, and safety of FUS-MRI in the treatment of uterine fibroids based on the non-perfused volume ratio (NPVR) and 3-month changes in fibroid volume.

A prospective, single-center study was conducted involving 120 female patients with symptomatic uterine fibroids who underwent FUS-MRI ablation between December 20, 2019, and October 7, 2024. We analyzed clinical characteristics, morphological and MRI parameters of the target lesion, technical characteristics of the procedure, immediate post-procedural effects, and safety indicators. Efficacy was assessed based on contrast-enhanced MRI data immediately after the procedure, with determination of NPVR (%), as well as by changes in the volume of the target lesion at 3 months. Safety was assessed based on data from the registry and medical records.

The mean age of the patients was 47.3±6.1 years. The most common complaints were bladder pressure (49.2%), dysmenorrhea (24.2%), and menorrhagia (20.8%). The median NPVR was 80% (IQR 48-90), and the mean was 68.2±29.2%. An NPVR threshold of ≥60% was reached in 71.7% of patients, ≥70% in 61.7%, ≥80% in 54.2%, ≥90% in 38.3%. Median NPVR values were numerically higher in hypointense and isointense nodules than in hyperintense nodules; however, the overall between-group comparison did not reach statistical significance (Kruskal-Wallis test, p=0.532). After 3 months, the median reduction in the volume of the index nodule was 2.32% (IQR 1.29-3.69), with a mean of 2.96±2.80%. No serious complications requiring invasive intervention, emergency hospitalization, or referral for surgical treatment were reported.

In a single-center setting, FUS-MRI demonstrated high immediate post-procedural imaging efficacy and a favorable safety profile. T2-weighted MRI characteristics of the lesion showed a numerical association with NPVR in the present cohort, although the between-group differences were not statistically significant and should be interpreted cautiously.