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

Figures & data

Figure 1 MR-HIFU treatment planning with superimposed MRI in three planes, such as coronal (A), sagittal (B), and transversal (C); pretreatment T2-weighted planning MR images show a uterine fibroid with low signal intensity. Red circles indicate the target volume for HIFU treatment as defined by the borders of the UF with a safety margin; green ellipsoids indicate the anticipated volumes of sonication.

Abbreviations: HIFU, high-intensity focused ultrasound; MR, magnetic resonance; MRI, magnetic resonance imaging; PTV, planned treatment volume.

Figure 2 Sagittal T2-weighted MRI for planning purposes (A) shows a homogeneously hypointense UF in the anterior wall. Sagittal T1-weighted, fat-saturated and contrast-enhanced MRI immediately (B) as well as 1 month (C) after the MR-HIFU procedure with a satisfying NPV.

Abbreviations: HIFU, high-intensity focused ultrasound; MR, magnetic resonance; MRI, magnetic resonance imaging; NPV, nonperfused volume; UF, uterine fibroid.

Table 1 Indications for MR-HIFU therapy of UFs

UF-associated symptoms

Safe access window or the ultrasound beam to the UF UF size 3–10 cm Number of UFs <5

Note: Data from Beck et al.⁴⁸

Abbreviations: HIFU, high-intensity focused ultrasound; MR, magnetic resonance; UF, uterine fibroid.

Table 2 Contraindications for MR-HIFU treatment of UFs

Suspicion of an uterine malignancy (absolute)

Pregnancy (absolute)

Acute lower pelvic inflammation (absolute)

UF size >10 cm (relative)

UF size <3 cm (relative)

Number of UFs >5 (relative, decision on a case-by-case basis)

UFs not safely accessible by the ultrasound beam (eg, interposed intestine, huge abdominal wall scarring, and dorsal allocation of the UF) (relative)

Pedunculated subserosal UF (relative)

Close allocation of the UF to the os sacrum or UF allocated to the posterior uterine wall (relative)

Contraindications for MRI contrast agents (relative)

General MRI contraindications

Note: Data from Beck et al.⁴⁸

Abbreviations: HIFU, high-intensity focused ultrasound; MR, magnetic resonance; MRI, magnetic resonance imaging; UF, uterine fibroid.

Table 3 Adverse effects and complications after MR-HIFU therapy of UFs

Pain during the MR-HIFU treatment procedure (slight and only short- termed in most cases)

(Slight) skin burns

(Slight) inflammation of the abdominal subepidermal fat and muscle tissue

Leg paresthesia due to nerve irritation or damage Deep leg or pelvic vein thrombosis (very rare) Intestinal perforation (extremely rare)

Note: Data from Beck et al.⁴⁸

Abbreviations: HIFU, high-intensity focused ultrasound; MR, magnetic resonance; UF, uterine fibroid.