MRI guided high-focused ultrasound (MRgFUS) as treatment for symptomatic uterine fibroids – experiences of 339 cases

Background MRgFUS is an established alternative to endocrine treatment, surgery and uterine artery embolization in the management of uterine fibroids in selected patients. Clinical data including large populations are needed because today, selection scores are based on rather small populations. We are reporting our experiences after treatment of 339 patients.

Methods We included patients with symptomatic uterine fibroids who qualified for and were treated with MRgFUS using the ExAblate 2100 UF V2 between 2012 and 2017. Associations of patient-related characteristics and primary success (defined as non-perfused volume (NPV) above 80 %) and association of NPV and symptom control were analyzed.

Results 339 patients were included in this analysis, 39 of these patients had taken ulipristal acetate (UPA) prior to the procedure. Side effects were rare and occurred in 4.3 % of patients. Median FU was 18 months (range 1-63 months). Age, number of fibroids, subcutaneous fat layer and abdominal scars showed no significant association to primary success rates, whereas the fibroid volume (below 20ml: 40.5 %, 20-99ml: 30.5 %, above 100ml: 18.9 %), distance of the skin to posterior fibroid border (cut off: 79.5mm) and localization of the fibroid close to the os sacrum (no versus yes) were positively associated with an NPV above 80 %. Prior medication with UPA did not influence the results. NPV was significantly associated with symptom control (p = 0.001).

Conclusion A careful selection process is key for successful treatment of uterine fibroids with MRgFUS. Although our results are important for daily practice, prospective studies are needed to develop more robust selection scores.

Publication History

Article published online:
07 October 2020