Quantitative serial MRI of the treated fibroid uterus

dc.contributor.authorMunro, Kirsty I.
dc.contributor.authorThrippleton, Michael J.
dc.contributor.authorWilliams, Alistair R.W.
dc.contributor.authorMcKillop, Graham
dc.contributor.authorWalker, Jane B.
dc.contributor.authorHorne, Andrew W.
dc.contributor.authorNewby, David E.
dc.contributor.authorAnderson, Richard A.
dc.contributor.authorSemple, Scott I.
dc.contributor.authorMarshall, Ian
dc.contributor.authorLewis, Steff C.
dc.contributor.authorMillar, Robert P.
dc.contributor.authorBastin, Mark E.
dc.contributor.authorCritchley, Hilary O.D.
dc.date.accessioned2014-08-21T11:36:50Z
dc.date.available2014-08-21T11:36:50Z
dc.date.issued2014-03-07
dc.description.abstractOBJECTIVE: There are no long-term medical treatments for uterine fibroids, and non-invasive biomarkers are needed to evaluate novel therapeutic interventions. The aim of this study was to determine whether serial dynamic contrast-enhanced MRI (DCE-MRI) and magnetization transfer MRI (MT-MRI) are able to detect changes that accompany volume reduction in patients administered GnRH analogue drugs, a treatment which is known to reduce fibroid volume and perfusion. Our secondary aim was to determine whether rapid suppression of ovarian activity by combining GnRH agonist and antagonist therapies results in faster volume reduction. METHODS: Forty women were assessed for eligibility at gynaecology clinics in the region, of whom thirty premenopausal women scheduled for hysterectomy due to symptomatic fibroids were randomized to three groups, receiving (1) GnRH agonist (Goserelin), (2) GnRH agonist+GnRH antagonist (Goserelin and Cetrorelix) or (3) no treatment. Patients were monitored by serial structural, DCE-MRI and MT-MRI, as well as by ultrasound and serum oestradiol concentration measurements from enrolment to hysterectomy (approximately 3 months). RESULTS: A volumetric treatment effect assessed by structural MRI occurred by day 14 of treatment (9% median reduction versus 9% increase in untreated women; P = 0.022) and persisted throughout. Reduced fibroid perfusion and permeability assessed by DCE-MRI occurred later and was demonstrable by 2–3 months (43% median reduction versus 20% increase respectively; P = 0.0093). There was no apparent treatment effect by MT-MRI. Effective suppression of oestradiol was associated with early volume reduction at days 14 (P = 0.041) and 28 (P = 0.0061). CONCLUSION: DCE-MRI is sensitive to the vascular changes thought to accompany successful GnRH analogue treatment of uterine fibroids and should be considered for use in future mechanism/efficacy studies of proposed fibroid drug therapies. GnRH antagonist administration does not appear to accelerate volume reduction, though our data do support the role of oestradiol suppression in GnRH analogue treatment of fibroids.en_US
dc.description.librarianam2014en_US
dc.description.sponsorshipThe Translational Medicine Research Collaboration (WHMSB-EU-131) and The University of Edinburgh.en_US
dc.description.uriwww.plosone.orgen_US
dc.identifier.citationMunro KI, Thrippleton MJ, Williams ARW, McKillop G, Walker J, et al. (2014) Quantitative Serial MRI of the Treated Fibroid Uterus. PLoS ONE 9(3): e89809. DOI: 10.1371/journal.pone.0089809.en_US
dc.identifier.issn1932-6203
dc.identifier.other10.1371/journal.pone.0089809
dc.identifier.urihttp://hdl.handle.net/2263/41492
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.rights© 2014 Munro et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.en_US
dc.subjectMedical treatmentsen_US
dc.subjectUterine fibroidsen_US
dc.subjectPatientsen_US
dc.subjectDynamic contrast-enhanced MRI (DCE-MRI)en_US
dc.subjectMagnetization transfer MRI (MT-MRI)en_US
dc.subjectVolume reductionen_US
dc.subjectGnRH analogue drugsen_US
dc.titleQuantitative serial MRI of the treated fibroid uterusen_US
dc.typeArticleen_US

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