Scripties UMCG - Rijksuniversiteit Groningen
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Multiparametrische MRI-sequenties geven inzicht in de morfologische karaktereigenschappen van myomen

(2017) Anneveldt, K. (Kimberley)

Introduction: Uterus myomatosus is the most common benign tumor of the pelvic area among women. Symptoms can be divided in heavy bleeding, bulk symptoms or fertility problems. Treatment starts in most cases with oral hormone intake, but a lot of woman are advised to undergo a hysterectomy. The Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU) is the most recent and the only non-invasive treatment option. However, not all myomas are suitable. This has to do with the location of the myoma, but the morphologic characteristics of myomas may play a role as well. Because of this, accurate screening is necessary. In current practice the ordinal Funaki classification is used as
Stage wetenschap “Onderzoek morfologische eigenschappen van myomen”. 2
screening tool, but this classification is not specific enough. A more recent developed screening tool, de Scaled Signal Intensity (SSI) score, is rarely used yet, but seems a better classification because of its numeric character. To optimize screening, the knowledge of morphologic myoma characteristic most extends first.
Goal: Extending the knowledge of morphologic myoma tissue characteristics, using new multiparametric MRI-sequences, which can potentially be used as new screening parameters for MR-HIFU treatment of myomas. To be able to implement these parameters in the future, the MR-HIFU treatment potential should be known based on current screening.
Methods: A new MRI protocol was implemented including de new multiparametric MRI-sequences T2-relaxometry and different Diffusion Weighted Intensity (DWI) sequences. By using conventional MRI-sequences, Funaki classification and SSI score was calculated.
Symptoms were measured using the Uterine Fibroid Symptom Quality of Life questionnaire. By medical file screening, an estimate of the annual potential was done.
Results: In one and a half years, 87 patients were analyzed by these new MRI-sequences. A significant correlation was found between Funaki and the SSI score, although a more accurate screening was seen using the SSI because of its numeric character. By using DWI a difference in diffusion of the myoma- and myometriumtissue could be found. There was no correlation between the symptom questionnaire and the MRI-sequences. Annually at least 70 patients can be treated by MR-HIFU is Isala.
Conclusion: These MRI-sequences are able to stratify morphologic characteristics and may have the potential of being used in a new screening tool for MR-HIFU treatment.

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