Myomectomy and MRI-Directed Cryotherapy

The purpose of this study was to identify alternatives to hysterectomy by transabdominal interventional magnetic resonance imaging-guided cryoablation. This represents a report of a prospective institutional review board-approved protocol to study interventional magnetic resonance imaging-guided cryoablation of uterine fibroid tumors. Women were selected on the basis of symptoms that were related to uterine fibroid tumors (bleeding, uterine pain, pelvic congestion, compression symptoms) and the absence of any desire for childbearing. Magnetic resonance imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow-up magnetic resonance imaging determined the reduction of the lesion. Ten patients were originally included, and nine were treated and had substantial reduction in the uterine size (average, 65% volume reduction). The primary symptoms have either improved or resolved in eight of the nine women. This is the first reported review of interventional magnetic resonance imaging-directed cryotherapy of uterine fibroid tumors. This minimally invasive therapy produced shrinkage of the tumor in nine of our first ten patients.

KEYWORDS

Fibroids - magnetic resonance imaging cryoablation - uterus

REFERENCES

• 1 Wilcox L S, Loonin L M, Pokras R, Strauss L T, Xia Z, Peterson H B. Hysterectomy in the United States, 1988-1990.  Obstet Gynecol. 1994;  83 549-555
• 2 Sewell P E, Arriola R M, Robinette L, Cowan B D. Real-time I-MR-Imaging-guided cryoablation of uterine fibroids.  J Vasc Interv Radiol. 2001;  12 891-893
• 3 Nowak R A. Fibroids: pathophysiology and current medical treatment.  Baillieres Best Pract Res Clin Obstet Gynaecol. 1999;  13 223-238
• 4 Goldfarb H A. Combining myoma coagulation with endometrial ablation/resection reduces subsequent surgery rates.  JSLS. 1999;  3 253-260
• 5 Anderson J. Factors in fibroid growth.  Baillieres Clin Obstet Gynaecol. 1998;  12 225-243
• 6 Tallini G, Vanni R, Manfioletti G et al.. HMGI-C and HMGI(Y) immunoreactivity correlates with cytogenetic abnormalities in lipomas, pulmonary chondroid hamartomas, endometrial polyps, and uterine leiomyomas and is compatible with rearrangement of the HMGI-C and MHGI(Y) genes.  Lab Invest. 2000;  80 359-369
• 7 Law P, Gedroyc W MW, Regan L. Magnetic resonance-guided percutaneous laser ablation of uterine fibroids.  Lancet. 1999;  354 2049-2050
• 8 Hindley J T, Law P A, Hickey M et al.. Clinical outcomes following percutaneous magnetic resonance image guided laser ablation of symptomatic uterine fibroids.  Hum Reprod. 2002;  17 2737-2741
• 9 Zreik T G, Rutherford T J, Palter S F et al.. Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids.  J Am Assoc Gynecol Laparosc. 1998;  5 33-38
• 10 Lufkin R B, Gronemeyer D H, Seibel R M. Interventional MRI: update.  Eur Radiol. 1997;  7(Suppl) 187-200
• 11 Bischof J C, Fahssi W M, Smtih D, Nagel T, Swanlund D J. A parametric study of freezing injury in ELT-3 uterine leiomyoma tumour cells.  Hum Reprod. 2001;  16 340-348
• 12 Ryu R K, Moary R A, Sichlau M J et al.. Comparison of pain after uterine artery embolization using tris-acrul gelatin microspheres versus polyvinyl alcohol particles.  Cardiovasc Intervent Radiol. 2003;  26 375-378