Magnetic Resonance Guided Focused Ultrasound^[#] for Fibroid Treatment – Results of the Second Radiological Gynecological Expert Meeting

Preamble

Treating myoma using MR-guided focused ultrasound surgery (MRgFUS; synonym: MR HIFU = high-intensity focused ultrasound) is a thermoablative procedure in which focused ultrasound, under constant MR tomographic monitoring, heats the treated tissue in individual small volume increments (sonications) until the planned fibroid volume has been completely denatured. Upon completion of thermoablation, the control (contrast-enhanced MRI) indicates an absence of contrast enhancement in the treated tissue (i.e. NPV = non-perfused volume).

The MRgFUS procedure is organ-preserving, non-invasive and can be performed on an outpatient basis.

This treatment method is provided by only a few specialized facilities.

The aim of MRgFUS therapy is the reduction or elimination of myoma-based symptoms among affected women. Ultrasonic treatment can achieve shrinking of a fibroid. Complete remission of the fibroid should not be expected and is not the goal of treatment.

There is a consensus between the disciplines of gynecology and radiology that determination of required treatment of uterine fibroids should be based on an examination and advice by a gynecologist. Comprehensive advice regarding treatment options for symptomatic uterine fibroids encompasses not only medication-based and surgical options, but also non-surgical therapy options including uterine artery embolization (UAE) and MRgFUS. The decision for or against an alternative therapy should be made taking into account the patientʼs desire for, and knowledge of, therapeutic alternatives, their chances of success and limitations, as well as typical side effects and possible complications (informed decision).

In Germany, Austria and Switzerland, the option of MRgFUS treatment offers the possibility of a therapeutic procedure for patients with myoma-related symptoms which provides further individualization of therapy in cases of uterine fibroids.

^# To be distinguished from non-MR-guided methods for the application of focused ultrasound.

^* On behalf of the participants of the Consensus Meeting.