PMC4864147_01
Sagittal T1 weighted survey prior to vaginal pessary placement with multiple bowel loops between the abdominal wall (black arrow) and uterus (white arrow) in the path of the ultrasound beam.
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F1
On the day of magnetic resonance-guided high-intensity focused ultrasound treatment as part of a clinical trial to undergo leiomyoma ablation followed by hysterectomy (clinical trials.gov identifier: NCT00837161), multiple loops of small bowel were observed between the abdominal wall and uterus on MRI, in the ultrasound beam path (Figure 1).
Sagittal T2 weighted images following vaginal pessary placement (white arrow). Pessary anteverts uterus (black arrow), displaces anterior bowel loops and facilitates safe HIFU.
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F2
Uterine repositioning was eventually accomplished with a 76 mm donut rubber vaginal pessary (Figure 2) which anteverted the fundus and successfully displaced bowel.
Sagittal T1 weighted image post contrast shows area of necrosis (black arrow) achieved (immediately post HIFU) with pessary in place (white arrow).
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F3
No adverse events were observed during MR-HIFU treatment (Figure 3).