This scientific article hopes to provide a general understanding of the patients who are suitable for magnetic wave therapy.
Disease selection
First of all, in obstetrics and gynecology, magnetic wave therapy is mainly suitable for the treatment of benign diseases of the uterus, while malignant diseases such as uterine sarcoma or endometrial cancer are still mainly surgical. Uterine fibroids and myometriosis are the two main diseases that are currently treated.
In the treatment of fibroids and myometriosis, we still recommend to choose those patients who have indications for surgery and need to be treated. Any treatment requires a comprehensive assessment of the risks and benefits of the treatment. Magnetic wave therapy is very safe, much safer than surgery, but statistically there is still a 5 per cent chance of complications, and if side effects occur, then it is not worth it.
Fortunately, fibroids are benign diseases, and only one in 6,000 cases of fibroids is seen as a problem of uterine sarcoma, and I am currently trying to perform fine needle aspiration biopsy to rule out sarcoma in some patients who cannot be reassured of the possibility of sarcoma.
If myometrium is combined with the presence of ovarian coeliacs, myometrium can be treated with magnetic waves, but coeliacs cannot be treated with magnetic waves at the same time, so a clinical evaluation is then needed to determine an appropriate treatment plan for the patient.
1. What kind of tests need to be done in advance to determine
For all patients to undergo magnetic wave therapy, we need to perform an MRI scan (scan + enhancement of the uterus, please reply to “magnetic wave” to understand the process) before the procedure, and in order to correspond to the position in the treatment, we usually need to have the patient empty the urine and do the treatment lying down. After the treatment, you will get the data in Dicom format. For an MRI scan, no metal should be present in the body, so if there are metal rings, internal fixation plates or pacemakers in the body, it is necessary to confirm with a specialist whether an MRI can be done.
In addition to MRI, some basic blood tests (routine blood, liver and kidney electrolytes, coagulation function) and ECG need to be completed before the treatment because intravenous analgesia is needed during the treatment.
2.What kind of images are suitable for magnetic wave therapy
The interpretation of MRI is key to determine whether magnetic wave therapy can be done. Although there are films available, but because of the different standards around the world, sometimes the film is too small or the resolution is not enough to determine whether it is suitable for magnetic wave, so it is best to get the CD or Dicom data.
The following aspects need to be understood on the film.
Figure 1. Uterine fibroids suitable for magnetic wave therapy
Figure 2. the presence of bowel in front of the posteriorly inclined uterus, which affects the penetration of ultrasound
(1) Whether there are intestinal tubes before the target area of treatment, which affect the ultrasound penetration. Ultrasound is easily reflected and refracted by cavity organs, so if there are intestinal tubes in front of the uterus, ultrasound cannot penetrate. Of course there are times when the bowel can be emptied by gluing or pushing the bladder in the rectum, and a posteriorly tilted and retroflexed uterus is often less likely to succeed. In Figure 1, the target area of treatment, where the uterus is close to the abdominal wall and ultrasound energy can easily pass through, is a situation suitable for magnetic wave therapy. In Figure 2, the uterus is posteriorly tilted and there is a lot of intestinal tissue in front of it, and the intestinal tube will affect the penetration of ultrasound, so it is not particularly suitable for magnetic wave therapy.
(2) The size of the lesion to be treated. Generally speaking, lesions larger than 2 cm in the anterior wall and lesions larger than 4 cm in the posterior wall are convenient for ultrasound treatment to form a focal point in the target area.
Figure 3: Submucosal leiomyosarcoma with multiple lesions and fertility requirements are not suitable for magnetic wave therapy
(3) If the number of fibroids is particularly large, it is difficult to ablate all the lesions with magnetic wave therapy, and the chance of recurrence is high.
(4) Distance of the treatment lesion from the abdominal wall: if the depth of the treatment target is more than 14 cm from the abdominal wall, it may easily lead to infertility.
Figure 4. T2 high signal myoma
(5) Signal of the lesion, fibroids with different water content inside the fibroid will have different performance in T2 imaging of MRI. Short T2 fibroids usually look black shaded on the image, which contain less water inside the tumor, and ultrasonic energy can easily accumulate, causing a rapid rise of heat inside the fibroid; while fibroids with long T2 signal look white in color on the image, which have higher water content and are less likely to The treatment is successful (somewhat like a wet firewood is less easy to light).
(6) Whether the original surgical scar has an effect on ultrasound, the surgical scar will affect the passage of ultrasound. If the scar is located in front of the treatment target area and affects the passage of ultrasound, the treatment with focused ultrasound cannot be chosen.