Proton, diffusion-weighted imaging, and sodium (23Na) MRI of uterine leiomyomata after MR-guided high-intensity focused ultrasound: a preliminary study
Michael A Jacobs, Ronald Ouwerkerk, Ihab Kamel, Paul A Bottomley, David A Bluemke, Hyun S Kim, Michael A Jacobs, Ronald Ouwerkerk, Ihab Kamel, Paul A Bottomley, David A Bluemke, Hyun S Kim
Abstract
Purpose: To determine the feasibility of using combined proton (1H), diffusion-weighted imaging (DWI), and sodium (23Na) magnetic resonance imaging (MRI) to monitor the treatment of uterine leiomyomata (fibroids).
Materials and methods: Eight patients with uterine leiomyomata were enrolled and treated using MRI-guided high-intensity frequency ultrasound surgery (MRg-HIFUS). MRI scans collected at baseline and posttreatment consisted of T2-, T1-, and 1H DWI, as well as posttreatment 23Na MRI. The 23Na and 1H MRi were coregistered using a replacement phantom method. Regions of interest in treated and untreated uterine leiomyoma tissue were drawn on 1H MRI and DWI, wherein the tissue apparent diffusion coefficient of water (ADC) and absolute sodium concentrations were measured.
Results: Regions of treated uterine tissue were clearly identified on both DWI and 23Na images. The sodium concentrations in normal myometrium tissue were 35.8+/-2.1 mmol (mM), in the fundus; 43.4+/-3.8 mM, and in the bladder; 65.3+/-0.8 mM with ADC in normal myometrium of 2.2+/-0.3x10(-3) mm2/sec. Sodium concentration in untreated leiomyomata were 28+/-5 mM, and were significantly elevated (41.6+/-7.6 mM, P<0.05) after treatment. Apparent diffusion coefficient values in the treated leiomyomata (1.30+/-0.38x10(-3) mm2/sec) were decreased compared to areas of untreated leiomyomata (1.75+/--4048micro-4050micro36x10(-3) mm2/sec; P=0.04).
Conclusion: Multiparametric imaging permits identification of uterine leiomyomata, revealing altered 23Na MRI and DWI levels following noninvasive treatment that provides a mechanism to explore the molecular and metabolic pathways after treatment.
Copyright (c) 2009 Wiley-Liss, Inc.
Figures
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Figure 7
Bar graphs of sodium concentration…
Figure 7
Bar graphs of sodium concentration in millimolar (mM) in uterine fatty, leiomyoma tissue…
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- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Aged
- Aged, 80 and over
- Biomarkers
- Diffusion Magnetic Resonance Imaging / methods*
- Feasibility Studies
- Female
- Humans
- Image Processing, Computer-Assisted / methods
- Leiomyoma / diagnosis
- Leiomyoma / pathology*
- Leiomyoma / therapy*
- Middle Aged
- Phantoms, Imaging
- Prospective Studies
- Protons
- Sodium Isotopes
- Treatment Outcome
- Ultrasonic Therapy*
- Uterine Neoplasms / diagnosis
- Uterine Neoplasms / pathology*
- Uterine Neoplasms / therapy*
- Biomarkers
- Protons
- Sodium Isotopes
- 1R01CA100184/CA/NCI NIH HHS/United States
- ZIA CL090019-01/ImNIH/Intramural NIH HHS/United States
- P30 CA006973/CA/NCI NIH HHS/United States
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- R01 CA100184-03/CA/NCI NIH HHS/United States
- P50CA103175/CA/NCI NIH HHS/United States
- ZIA EB000072-01/ImNIH/Intramural NIH HHS/United States
- R01 CA100184-04/CA/NCI NIH HHS/United States
- P50 CA103175/CA/NCI NIH HHS/United States
- R01 CA100184/CA/NCI NIH HHS/United States
- R01 CA100184-02/CA/NCI NIH HHS/United States
- 5R01EB007829/EB/NIBIB NIH HHS/United States
- R01 EB007829/EB/NIBIB NIH HHS/United States
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Source: PubMed