Magnetic Resonance-Guided Focused Ultrasound for Uterine Fibroids

ABSTRACT

Uterine fibroids are an important problem for women of reproductive age. Although hysterectomy has been the traditional treatment for fibroids, many women are interested in a less invasive therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) is a new technique for treating a variety of solid tumors. It has been tested and approved by the U.S. Food & Drug Administration (FDA) for the treatment of uterine fibroids. The procedure is completely noninvasive. It is performed as an outpatient procedure and the patient can resume her normal activities the day following the procedure. Techniques of treatment of uterine fibroids are still being refined, but significant progress has been made in understanding some of the challenges for this new technology. Some fibroids are more responsive to the focused ultrasound; some fibroids are more resistant. Not all women are candidates for this procedure. Absolute contraindications include bowel that is in the path of the ultrasound beam, or surgical scars in the beam pathway. The procedure of MRgFUS is feasible, safe and becoming increasingly popular. Questions still remain particularly the use of this technique for patients desiring fertility, and what will be the long-term results.

KEYWORDS

Focused ultrasound - fibroids - uterine leiomyoma - MR-guided - magnetic resonance imaging - ablation

REFERENCES

• 1 Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States.  Am J Obstet Gynecol. 2006;  195(4) 955-964
• 2 Hynynen K. Fundamental principles of therapeutic ultrasound. In: Jolesz F, Hynyen K MRI-Guided Focused Ultrasound Surgery. New York; Informa Healthcare 2008: 5-23
• 3 Tempany C M. From the RSNA refresher courses: image-guided thermal therapy of uterine fibroids.  Radiographics. 2007;  27(6) 1819-1826
• 4 McDannold N, Tempany C M, Fennessy F M et al.. Uterine leiomyomas: MR imaging-based thermometry and thermal dosimetry during focused ultrasound thermal ablation.  Radiology. 2006;  240(1) 263-272
• 5 Smart O C, Hindley J T, Regan L, Gedroyc W G. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata.  Obstet Gynecol. 2006;  108(1) 49-54
• 6 Catane R, Beck A, Inbar Y et al.. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases–preliminary clinical experience.  Ann Oncol. 2007;  18(1) 163-167
• 7 Chapman A, Ter Haar G. Thermal ablation of uterine fibroids using MR-guided focused ultrasound-a truly non-invasive treatment modality.  Eur Radiol. 2007;  17(10) 2505-2511
• 8 Arleo E K, Khilnani N M, Ng A, Min R J. Features influencing patient selection for fibroid treatment with magnetic resonance-guided focused ultrasound.  J Vasc Interv Radiol. 2007;  18(5) 681-685
• 9 Stafford R J, Hazle J D. Fundamental principles of magnetic resonance temperature imaging. In: Jolesz F, Hynyen K MRI-Guided Focused Ultrasound Surgery. New York; Informa Healthcare 2008: 25-42
• 10 Gedroyc W M, Anstee A. MR-guided focused ultrasound.  Expert Rev Med Devices. 2007;  4(4) 539-547
• 11 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
• 12 Rabinovici J, Inbar Y, Eylon S C et al.. Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report.  Hum Reprod. 2006;  21(5) 1255-1259
• 13 Rabinovici J, Inbar Y, Revel A et al.. Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance-guided focused ultrasound surgery.  Ultrasound Obstet Gynecol. 2007;  30(5) 771-777
• 14 Mikami K, Murakami T, Okada A et al.. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience.  Radiat Med. 2008;  26(4) 198-205
• 15 Fennessy F M, Tempany C M, McDannold N J et al.. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery—results of different treatment protocols.  Radiology. 2007;  243 885-893
• 16 Hudson S B, Stewart E A. Magnetic resonance-guided focused ultrasound surgery.  Clin Obstet Gynecol. 2008;  51(1) 159-166
• 17 Hesley G K, Felmlee J P, Gebhart J B 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
• 18 Olive D L. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery.  Obstet Gynecol. 2008;  111(3) 775 author reply 775-776
• 19 Spies J B, Coyne K, Guaou Guaou N et al.. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.  Obstet Gynecol. 2002;  99(2) 290-300
• 20 Spies J B. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery.  Obstet Gynecol. 2007;  110(6) 1427-1428 author reply 1428-1429
• 21 Goodwin S C, Spies J B, Worthington-Kirsch R et al.. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry.  Obstet Gynecol. 2008;  111(1) 22-33
• 22 Pelage J P, Guaou N G, Jha R C, Ascher S M, Spies J B. Uterine fibroid tumors: long-term MR imaging outcome after embolization.  Radiology. 2004;  230(3) 803-809
• 23 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
• 24 Parker W H. Uterine myomas: management.  Fertil Steril. 2007;  88(2) 255-271
• 25 Insightec .Information for Prescribers, ExAblate 2000. Version 2.46. 2004: 9
• 26 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
• 27 Hanstede M M, Tempany C M, Stewart E A. Focused ultrasound surgery of intramural leiomyomas may facilitate fertility: a case report.  Fertil Steril. 2007;  88(2) e495-e497
• 28 Gavrilova-Jordan L P, Rose C H, Traynor K D, Brost B C, Gostout B S. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma.  J Perinatol. 2007;  27(1) 59-61
• 29 Goldberg J, Pereira L. Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy.  Curr Opin Obstet Gynecol. 2006;  18(4) 402-406
• 30 InSightec .InSightec home page. Available at: http://www.extranet.insightec.com Click Presentations and register Accessed Nov. 11, 2008

1 CE marking is a declaration by the manufacturer that the product meets all the appropriate provisions of the relevant legislation on implementing certain European Directives. Available at: http://www.berr.gov.uk/whatwedo/sectors/sustainability/regulations/cemark/page/1646.html.