Volume transfer constant (Ktrans) maps from dynamic contrast enhanced MRI as potential guidance for MR-guided high intensity focused ultrasound treatment of hypervascular uterine fibroids

Higher perfusion of uterine fibroids at baseline is recognized as cause for poor efficacy of MR-guided high intensity focused ultrasound (HIFU) ablation, and higher acoustic power has been suggested for the treatment of high-perfused areas inside uterine fibroids. However, considering the heterogeneously vascular distribution inside the uterine fibroids especially with hyper vascularity, it is not easy to choose the correct therapy acoustic power for every part inside fibroids. In our study, we presented two cases of fibroids with hyper vascularity, to show the differences between them with different outcomes. Selecting higher therapy acoustic powers to ablate high-perfused areas efficiently inside fibroids might help achieving good ablation results. Volume transfer constant (Ktrans) maps from dynamic contrast-enhanced (DCE) imaging at baseline helps visualizing perfusion state inside the fibroids and locating areas with higher-perfusion. In addition, with the help of Ktrans maps, appropriate therapy acoustic power could be selected by the result of initial test and therapy sonications at different areas with significantly different perfusion state inside fibroids.