Semin intervent Radiol 2013; 30(04): 347-353
DOI: 10.1055/s-0033-1359728
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical and Technical Aspects of MR-Guided High Intensity Focused Ultrasound for Treatment of Symptomatic Uterine Fibroids

Laura E. Rueff
1   Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
,
Steven S. Raman
2   Department of Radiology, Cross Sectional Interventional Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
20 November 2013 (online)

Abstract

Although many women undergo hysterectomy for treatment of uterine fibroids, there are more options than ever before for fibroid treatment. A combination of objective criteria, including clinical parameters, anatomic factors, fibroid characteristics, and patient desires influence the choice of optimal therapeutic modality for a woman with symptomatic uterine fibroids. Magnetic resonance imaging-guided high intensity focused ultrasound (MR-HIFU) is the only noninvasive treatment option for women with symptomatic uterine fibroids unresponsive to medical treatment. The procedure has been shown to be safe and effective. MR-HIFU couples the three-dimensional multiplanar anatomic imaging and thermal monitoring capability of MR imaging with the therapeutic thermal-based coagulative necrosis mechanism of HIFU to safely and effectively ablate limited volume classical fibroids. In the author's experience, a multidisciplinary fibroid clinic facilitates a unified approach between gynecologists, radiologists, and others to individualize the most appropriate fibroid treatment options for each woman. This article describes the MR-HIFU technique and outcomes, as well as patient selection and treatment assessment.

 
  • References

  • 1 Hindley J, Gedroyc WM, Regan L , et al. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol 2004; 183 (6) 1713-1719
  • 2 Hesley GK, Felmlee JP, Gebhart JB , et al. Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging-guided focused ultrasound. Mayo Clin Proc 2006; 81 (7) 936-942
  • 3 Hesley GK, Gorny KR, Woodrum DA. MR-guided focused ultrasound for the treatment of uterine fibroids. Cardiovasc Intervent Radiol 2013; 36 (1) 5-13
  • 4 Stewart EA, Rabinovici J, Tempany CM , et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 2006; 85 (1) 22-29
  • 5 Stewart EA, Gostout B, Rabinovici J, Kim HS, Regan L, Tempany CM. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007; 110 (2 Pt 1): 279-287
  • 6 Funaki K, Sawada K, Maeda F, Nagai S. Subjective effect of magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res 2007; 33 (6) 834-839
  • 7 Funaki K, Fukunishi H, Funaki T, Kawakami C. Mid-term outcome of magnetic resonance-guided focused ultrasound surgery for uterine myomas: from six to twelve months after volume reduction. J Minim Invasive Gynecol 2007; 14 (5) 616-621
  • 8 Funaki K, Fukunishi H, Funaki T, Sawada K, Kaji Y, Maruo T. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol 2007; 196 (2) e1-e6
  • 9 Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol 2008; 15 (5) 571-579
  • 10 Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 2009; 34 (5) 584-589
  • 11 Fennessy FM, Tempany CM, McDannold NJ , et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery—results of different treatment protocols. Radiology 2007; 243 (3) 885-893
  • 12 Mikami K, Murakami T, Okada A, Osuga K, Tomoda K, Nakamura H. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience. Radiat Med 2008; 26 (4) 198-205
  • 13 Morita Y, Ito N, Hikida H, Takeuchi S, Nakamura K, Ohashi H. Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids - early experience. Eur J Obstet Gynecol Reprod Biol 2008; 139 (2) 199-203
  • 14 LeBlang SD, Hoctor K, Steinberg FL. Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 2010; 194 (1) 274-280
  • 15 Gorny KR, Woodrum DA, Brown DL , et al. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol 2011; 22 (6) 857-864
  • 16 Kim HS, Baik JH, Pham LD, Jacobs MA. MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol 2011; 18 (8) 970-976
  • 17 Harding G, Coyne KS, Thompson CL, Spies JB. The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes 2008; 6: 99
  • 18 Tan N, McClure T, Tarnay C, Johnson M, Lu D, Raman S. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. Presented at: Radiological Society of North America Annual Meeting; December, 2012; Chicago, IL
  • 19 Rabinovici J, Inbar Y, Eylon SC, Schiff E, Hananel A, Freundlich D. Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report. Hum Reprod 2006; 21 (5) 1255-1259
  • 20 Hanstede MM, Tempany CM, Stewart EA. Focused ultrasound surgery of intramural leiomyomas may facilitate fertility: a case report. Fertil Steril 2007; 88 (2) e5-e7
  • 21 Gavrilova-Jordan LP, Rose CH, Traynor KD, Brost BC, Gostout BS. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma. J Perinatol 2007; 27 (1) 59-61
  • 22 Morita Y, Ito N, Ohashi H. Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynaecol Obstet 2007; 99 (1) 56-57
  • 23 Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA ; MRgFUS Study Group. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 2010; 93 (1) 199-209
  • 24 Yoon SW, Kim KA, Kim SH , et al. Pregnancy and natural delivery following magnetic resonance imaging-guided focused ultrasound surgery of uterine myomas. Yonsei Med J 2010; 51 (3) 451-453
  • 25 Zaher S, Lyons D, Regan L. Successful in vitro fertilization pregnancy following magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res 2011; 37 (4) 370-373
  • 26 Bouwsma EV, Gorny KR, Hesley GK, Jensen JR, Peterson LG, Stewart EA. Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility. Fertil Steril 2011; 96 (1) e9-e12
  • 27 Samuel A, Fennessy FM, Tempany CMC, Stewart EA. Avoiding treatment of leiomyosarcomas: the role of magnetic resonance in focused ultrasound surgery. Fertil Steril 2008; 90 (3) e9-e12
  • 28 Polina L, Nyapathy V, Mishra A, Yellamanthili H, Vallabhaneni MP. Noninvasive treatment of focal adenomyosis with MR-guided focused ultrasound in two patients. Indian J Radiol Imaging 2012; 22 (2) 93-97
  • 29 Yoon SW, Kim KA, Cha SH , et al. Successful use of magnetic resonance-guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis. Fertil Steril 2008; 90 (5) e13-e15
  • 30 Park H, Yoon SW, Kim KA, Jung Kim D, Jung SG. Magnetic resonance imaging-guided focused ultrasound treatment of pedunculated subserosal uterine fibroids: a preliminary report. J Vasc Interv Radiol 2012; 23 (12) 1589-1593
  • 31 Arleo EK, Khilnani NM, Ng A, Min RJ. Features influencing patient selection for fibroid treatment with magnetic resonance-guided focused ultrasound. J Vasc Interv Radiol 2007; 18 (5) 681-685
  • 32 Jung SG, Yoon SW, Park H, Lee C. Potential exploratory use of MR-guided focused ultrasound for disconnection of symptomatic intracavitary submucosal uterine myoma. J Vasc Interv Radiol 2011; 22 (11) 1635-1637
  • 33 Smart OC, Hindley JT, Regan L, Gedroyc WG. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol 2006; 108 (1) 49-54
  • 34 Smart OC, Hindley JT, Regan L, Gedroyc WMW. Magnetic resonance guided focused ultrasound surgery of uterine fibroids—the tissue effects of GnRH agonist pre-treatment. Eur J Radiol 2006; 59 (2) 163-167
  • 35 Kim YS, Lim HK, Kim JH , et al. Dynamic contrast-enhanced magnetic resonance imaging predicts immediate therapeutic response of magnetic resonance-guided high-intensity focused ultrasound ablation of symptomatic uterine fibroids. Invest Radiol 2011; 46 (10) 639-647
  • 36 Kim YS, Keserci B, Partanen A , et al. Volumetric MR-HIFU ablation of uterine fibroids: role of treatment cell size in the improvement of energy efficiency. Eur J Radiol 2012; 81 (11) 3652-3659
  • 37 Venkatesan AM, Partanen A, Pulanic TK , et al. Magnetic resonance imaging-guided volumetric ablation of symptomatic leiomyomata: correlation of imaging with histology. J Vasc Interv Radiol 2012; 23 (6) 786-794 , e4
  • 38 Voogt MJ, Trillaud H, Kim YS , et al. Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol 2012; 22 (2) 411-417
  • 39 Lénárd ZM, McDannold NJ, Fennessy FM , et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery—imaging predictors of success. Radiology 2008; 249 (1) 187-194
  • 40 Yoon SW, Lee C, Cha SH , et al. Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI. Eur Radiol 2008; 18 (12) 2997-3006
  • 41 Pond JB. The role of heat in the production of ultrasonic focal lesions. J Acoust Soc Am 1970; 47 (6) 1607-1611
  • 42 Salomir R, Palussière J, Vimeux FC , et al. Local hyperthermia with MR-guided focused ultrasound: spiral trajectory of the focal point optimized for temperature uniformity in the target region. J Magn Reson Imaging 2000; 12 (4) 571-583
  • 43 Vanne A, Hynynen K. MRI feedback temperature control for focused ultrasound surgery. Phys Med Biol 2003; 48 (1) 31-43
  • 44 Mougenot C, Salomir R, Palussière J, Grenier N, Moonen CT. Automatic spatial and temporal temperature control for MR-guided focused ultrasound using fast 3D MR thermometry and multispiral trajectory of the focal point. Magn Reson Med 2004; 52 (5) 1005-1015
  • 45 Arora D, Minor MA, Skliar M, Roemer RB. Control of thermal therapies with moving power deposition field. Phys Med Biol 2006; 51 (5) 1201-1219
  • 46 Mougenot C, Quesson B, de Senneville BD , et al. Three-dimensional spatial and temporal temperature control with MR thermometry-guided focused ultrasound (MRgHIFU). Magn Reson Med 2009; 61 (3) 603-614
  • 47 Hynynen K, Damianou C, Darkazanli A, Unger E, Schenck JF. The feasibility of using MRI to monitor and guide noninvasive ultrasound surgery. Ultrasound Med Biol 1993; 19 (1) 91-92
  • 48 Hynynen K, Freund WR, Cline HE , et al. A clinical, noninvasive, MR imaging-monitored ultrasound surgery method. Radiographics 1996; 16 (1) 185-195
  • 49 Stewart EA, Gedroyc WMW, Tempany CMC , et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol 2003; 189 (1) 48-54
  • 50 Tempany CMC, Stewart EA, McDannold N, Quade BJ, Jolesz FA, Hynynen K. MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology 2003; 226 (3) 897-905