Comparison between diffusion-weighted imaging, T1-weighted, and postcontrast T1-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

Michael A. Jacobs; David H. Gultekin; Hyun S. Kim

doi:10.1118/1.3475940

Comparison between diffusion-weighted imaging, T₁-weighted, and postcontrast T₁-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results

Michael A. Jacobs, David H. Gultekin, Hyun S. Kim

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Purpose: To investigate the comparison between diffusion-weighted imaging (DWI), T₂ -weighted imaging, (T₂ WI) and contrast T ₁ -weighted imaging (cT₁ WI) in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery (MRg-HIFUS). Methods: Twenty one patients (45±5 yrs) with clinical symptoms of uterine leiomyoma (fibroids) were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T₂ WI, and T₁ -weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT₁ WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the "eigenimage filter," using both cT₁ WI and DWI. Signal-to-noise ratios were determined for the T₂ WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated. Results: All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT ₁ WI defined area. The mean pretreatment T₂ WI signal intensity ratios were T₂ WI/muscle=1.8±0.7 and T₂ WI/myometrium=0.7±0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT₁ WI and DWI segmented treatment volumes were found to be significantly correlated (r² =0.94, p<0.05) with the linear equation, (cT₁ WI) =1.1 (DWI) -0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots. Conclusions: Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT₁ WI -defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.

Original language	English (US)
Pages (from-to)	4768-4776
Number of pages	9
Journal	Medical physics
Volume	37
Issue number	9
DOIs	https://doi.org/10.1118/1.3475940
State	Published - Sep 2010
Externally published	Yes

Keywords

ADC map
diffusion-weighted imaging
high intensity focused ultrasound surgery
leiomyoma
leiomyomata
thermotherapy
uterine fibroids

ASJC Scopus subject areas

Biophysics
Radiology Nuclear Medicine and imaging

Access to Document

10.1118/1.3475940

Cite this

Comparison between diffusion-weighted imaging, T₁-weighted, and postcontrast T₁-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results. / Jacobs, Michael A.; Gultekin, David H.; Kim, Hyun S.
In: Medical physics, Vol. 37, No. 9, 09.2010, p. 4768-4776.

Research output: Contribution to journal › Article › peer-review

@article{67cdbe2e6b6f48f19242717aaf367bde,

title = "Comparison between diffusion-weighted imaging, T1-weighted, and postcontrast T1-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata: Preliminary results",

abstract = "Purpose: To investigate the comparison between diffusion-weighted imaging (DWI), T2 -weighted imaging, (T2 WI) and contrast T 1 -weighted imaging (cT1 WI) in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery (MRg-HIFUS). Methods: Twenty one patients (45±5 yrs) with clinical symptoms of uterine leiomyoma (fibroids) were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T2 WI, and T1 -weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT1 WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the {"}eigenimage filter,{"} using both cT1 WI and DWI. Signal-to-noise ratios were determined for the T2 WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated. Results: All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT 1 WI defined area. The mean pretreatment T2 WI signal intensity ratios were T2 WI/muscle=1.8±0.7 and T2 WI/myometrium=0.7±0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT1 WI and DWI segmented treatment volumes were found to be significantly correlated (r2 =0.94, p<0.05) with the linear equation, (cT1 WI) =1.1 (DWI) -0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots. Conclusions: Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT1 WI -defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.",

keywords = "ADC map, diffusion-weighted imaging, high intensity focused ultrasound surgery, leiomyoma, leiomyomata, thermotherapy, uterine fibroids",

author = "Jacobs, {Michael A.} and Gultekin, {David H.} and Kim, {Hyun S.}",

note = "Funding Information: We are grateful for the help of Mary McAllister, MA. Lucie Bower, Dr. Donald Peck, and Dr. Hamid Soltanian-Zadeh, Henry Ford Hospital, Detroit, MI for the Eigentool image analysis software used for image processing. This work was supported in part by NIH Grant Nos. 1R01CA100184, P50CA103175, 5P30CA06973, Breast SPORE: P50CA88843, Avon:01-2009-031, and U01CA070095 ",

year = "2010",

month = sep,

doi = "10.1118/1.3475940",

language = "English (US)",

volume = "37",

pages = "4768--4776",

journal = "Medical physics",

issn = "0094-2405",

publisher = "AAPM - American Association of Physicists in Medicine",

number = "9",

}

TY - JOUR

T1 - Comparison between diffusion-weighted imaging, T1-weighted, and postcontrast T1-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata

T2 - Preliminary results

AU - Jacobs, Michael A.

AU - Gultekin, David H.

AU - Kim, Hyun S.

N1 - Funding Information: We are grateful for the help of Mary McAllister, MA. Lucie Bower, Dr. Donald Peck, and Dr. Hamid Soltanian-Zadeh, Henry Ford Hospital, Detroit, MI for the Eigentool image analysis software used for image processing. This work was supported in part by NIH Grant Nos. 1R01CA100184, P50CA103175, 5P30CA06973, Breast SPORE: P50CA88843, Avon:01-2009-031, and U01CA070095

PY - 2010/9

Y1 - 2010/9

N2 - Purpose: To investigate the comparison between diffusion-weighted imaging (DWI), T2 -weighted imaging, (T2 WI) and contrast T 1 -weighted imaging (cT1 WI) in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery (MRg-HIFUS). Methods: Twenty one patients (45±5 yrs) with clinical symptoms of uterine leiomyoma (fibroids) were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T2 WI, and T1 -weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT1 WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the "eigenimage filter," using both cT1 WI and DWI. Signal-to-noise ratios were determined for the T2 WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated. Results: All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT 1 WI defined area. The mean pretreatment T2 WI signal intensity ratios were T2 WI/muscle=1.8±0.7 and T2 WI/myometrium=0.7±0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT1 WI and DWI segmented treatment volumes were found to be significantly correlated (r2 =0.94, p<0.05) with the linear equation, (cT1 WI) =1.1 (DWI) -0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots. Conclusions: Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT1 WI -defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.

AB - Purpose: To investigate the comparison between diffusion-weighted imaging (DWI), T2 -weighted imaging, (T2 WI) and contrast T 1 -weighted imaging (cT1 WI) in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery (MRg-HIFUS). Methods: Twenty one patients (45±5 yrs) with clinical symptoms of uterine leiomyoma (fibroids) were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T2 WI, and T1 -weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT1 WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the "eigenimage filter," using both cT1 WI and DWI. Signal-to-noise ratios were determined for the T2 WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated. Results: All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT 1 WI defined area. The mean pretreatment T2 WI signal intensity ratios were T2 WI/muscle=1.8±0.7 and T2 WI/myometrium=0.7±0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT1 WI and DWI segmented treatment volumes were found to be significantly correlated (r2 =0.94, p<0.05) with the linear equation, (cT1 WI) =1.1 (DWI) -0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots. Conclusions: Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT1 WI -defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.

KW - ADC map

KW - diffusion-weighted imaging

KW - high intensity focused ultrasound surgery

KW - leiomyoma

KW - leiomyomata

KW - thermotherapy

KW - uterine fibroids

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DO - 10.1118/1.3475940

M3 - Article

C2 - 20964196

AN - SCOPUS:77956326055

SN - 0094-2405

VL - 37

SP - 4768

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JO - Medical physics

JF - Medical physics

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