PMC3100577_01
Pretreatment screening axial T2 weighted screening MR images (a, b) and axial T2 weighted images on the day of treatment (c, d). On screening images, the ostomy is evident in the right lower quadrant (grey arrows), and longitudinal abdominal scarring is seen in the subcutaneous tissue in the midline (black arrows) which overlies the uterine fibroid (F). The ostomy bag can also be seen to overlie the anterior abdominal wall (white thick arrows). On the day of treatment, the ostomy bag was placed off to the side and was no longer visible on the images. The skin of the anterior abdominal wall was pulled off to the right side such that the ostomy and scar are now out of the treatment window and the fibroid (F) is accessible for treatment.
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fig1
After review of the screening MR images (Figures 1(a) and 1(b)) and consultation with the hospital ostomy service, a plan was made to attach the ostomy bag off-center, cut back the wafer/base plate, and rotate the bag off to the side such that it lay away from the center of the abdomen. The skin of the anterior abdominal wall was pulled towards the ostomy, such that the midline longitudinal scars were also out of the treatment field, increasing the size of the acoustic or treatment window and subsequently allowing treatment of a greater fibroid volume (Figures 1(c) and 1(d)). 
T1 spoiled gradient recalled (SPGR) echo sequences in the axial (a, c) and sagittal (b, d) planes, post administration of intravenous gadolinium gadopentate. Imaging acquired pretreatment (a, b) demonstrates homogenous enhancement of the fibroid (F), and post treatment (c, d) there is a large area of nonenhancement within the fibroid (outlined in white), consistent with a treatment effect. There is no evidence for enhancement in the scar tissues of the anterior abdominal wall. (P): Pubic bone; (S): spine.
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fig2
No abnormal areas of enhancement within the subcutaneous tissue or the regions of the scar were identified (Figures 2(a)-2(d)). 