Magnetic Resonance-Guided Focused Ultrasound for Treatment of Myomas – Results of the First Radiology-Gynaecology Experts Meeting

Preamble

The treatment of myomas using the technique of magnetic resonance-guided focused ultrasound (MRgFUS; syn.: HIFU = high-intensity focused ultrasound) represents a thermoablative procedure by which the tissue to be treated is heated in small volume steps by focused ultrasound under continuous MR imaging control until complete denaturation of the planned myoma volume has been achieved (so-called sonifications, syn.: sonications). After successful thermoablation control scans reveal the absence of contrast medium uptake in the treated tissue (correspondingly: npv = non-perfused volume).

The MRgFUS procedure is organ-conserving, non-invasive and can be performed in an outpatient setting.

This treatment option is relatively new and is currently only available in a few specialised centres.

The objective of MRgFUS therapy is the reduction or elimination of complaints caused by myomas in the afflicted women. The ultrasound treatment leads to a shrinking of the myoma. A complete remission of the myoma is however not to be expected.

There is agreement between the specialties gynaecology and interventional radiology that an indication for the required therapy in cases of uterus myomatosus is only given after expert examination by and consultation with a gynaecologist. A complete and comprehensive consultation on treatment options for symptomatic uterus myomatosus explicitly includes, besides the drug and surgical treatment options, also the non-surgical treatment options such as uterine artery embolisation (UAE) and MRgUS. The decision for or against a therapeutic option should be made in consideration of the individual patientʼs wishes and with a full knowledge of alternative strategies, their chances of success, their limitations as well as their typical side effects and possible complications (informed consent).

In Germany, Austria and Switzerland, MRgFUS constitutes a treatment option for women with complaints due to myomas that enables a further individualisation of the therapy for uterus myomatosus.