Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids

Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids

“…Indication for MRgFUS treatment was regularly confirmed by a multidisciplinary team of interventional radiologists and gynecologists in accordance with selection criteria published elsewhere. 13,14 Pregnant women and those with a contraindication to MRI were excluded. Women with the desire for future pregnancy were counseled with respect to the limited data for pregnancy after MRgFUS treatment.…”

“…Treating fibroids near the sacrum may be painful because of far-field heating of the neighboring sacral nerves. 13,14 In case of patient movement, the entire treatment plan has to be adapted, increasing the overall patient time on the treatment table. Large fibroids require large sonication spot sizes to cover their volume and avoid 2 sonication layers.…”

“…In addition, patient management techniques were optimized to reduce the preparation time, patient pain, and movement. 14 In this article, we report the NPV and safety results of, to the best of our knowledge, the first 115 patients who were treated with the new ExAblate 2100 system in a single center.…”

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

“…We therefore also consider pretreatment of patients with highly cellular fibroids (hyperintense SI on T2 WI) with a GnRHa, as it has been reported that MRgFUS of T2 hyperintense fibroids results in lower non-perfused volumes compared to iso-or hypointense fibroids [22]. GnRHa's potentiate the thermal effects of MRgFUS [23], and may have an important role in treating fibroids which otherwise have been found to respond poorly to MRgFUS [24]. It has also been noted (in a case report) that dynamic contrastenhanced MR may be used to select a subpopulation of uterine fibroid patients suitable for MRgFUS despite high signal on T2 WIs [25].…”

“…The first results of the initial phase I/II trial of the ExAblate 2000 device, (treating a subvolume of a fibroid prior to hysterectomy), demonstrated MRgFUS to be a safe and feasible treatment through pathological correlation [23]. Subsequent multicenter phase III clinical trials demonstrated a majority (71 %) of patients to have reached the targeted symptom improvement at 6 months post-therapy, maintained in 51 % by 12 months post-therapy [27].…”