MR-guided high-intensity focused ultrasound treatment of uterine fibroids

Abstract

Uterine fibroids are benign, encapsulated uterine tumors, representing the most common reason for hysterectomy in premenopausal women. High-intensity focused ultrasound (HIFU; also known as focused ultrasound surgery) is a noninvasive technique leading to tissue heating in a centered focus, inducing a thermal tissue necrosis. Magnetic resonance-guided HIFU (MR-HIFU; also know as MR-guided focused ultrasound surgery) allows to allocate the uterine fibroids as well as to evaluate whether these are accessible for HIFU treatment. Further advantages are MR-based real-time temperature mapping and immediate evaluation of postprocedure therapeutic success by MR imaging. These advantages minimize the patient risk and make the treatment more effective. MR-HIFU is a uterus conserving, low pain-to-painless, and noninvasive treatment option. Here, we review its medical and economic advance to surgical procedures due to the low complication rates combined with proven symptom relief and the enhancement of the quality of life.

Effectiveness of a Hysteroscopic Tissue Removal System Device for Hysteroscopic Myomectomy on Patients’ Quality of Life: A Randomized Clinical Trial

“…Studies have shown that quality of life after hysteroscopic myomectomy was signi cantly better than after laparoscopic myomectomy due to shorter operative duration, less intraoperative bleeding, and shorter hospitalization [18]. Other uterine sparing minimally invasive techniques available for treating submucosal broids include uterine artery embolization (UAE) [19], hysteroscopic myomectomy after UAE [20], and transvaginal radio-frequency myolysis [21,22] and magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) [23,24]. UAE showed improvement in symptom score and quality of life score outcomes when associated with heavy bleeding and submucosal leiomyoma location [25].…”

Adenomyosis - Is a new treatment solution available?

“…HIFU ablation is, however, not suitable in some situations such as (a) Bowel adhesions found in the acoustic pathway, which will increase the risk of bowel injury [19,26]. (b) The lesion of adenomyosis is too small, because adenomyoma is without a pseudocapsule, and the ablation heat may diffuse and spread to the uterine serosa or endometrium, causing damage to bowel, bladder or endometrium.…”

“…Therefore if the lesion is too small, i.e., with the lesions in the uterine wall together measured less than 3 cm, HIFU ablation might not be applicable [19]. (c) Severe abdominal keloid scars which can affect ultrasound penetration and lead to skin or keloid burn [19,26].…”