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Chapter 17 - MRI-Guided Ultrasound Lysis of Fibroids

Published online by Cambridge University Press:  10 October 2020

By
Jessica Gelman  and
Charles E. Miller
Edited by
Mostafa Metwally  and
Tin-Chiu Li
Mostafa Metwally
Affiliation:
University of Sheffield
Tin-Chiu Li
Affiliation:
The Chinese University of Hong Kong
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Summary

Magnetic-resonance-guided focused ultrasound surgery (MRgFUS) is the only truly non-invasive procedure for the treatment of uterine fibroids. In MRgFUS, high-frequency ultrasound beams target specific tissue, in this case fibroids, causing increased temperatures leading to destruction of the tissue by coagulative necrosis. The resultant fibroid shrinkage occurs under the guidance of real-time magnetic resonance imaging (MRI) for accuracy and preservation of healthy surrounding myometrium [1]. This chapter will begin with an overview of the history of MRgFUS, then examine the technical parameters of the procedure and measurement of success, discuss patient eligibility and selection, preparation for the procedure, recovery, potential complications, and finally, outlooks for fertility and other outcomes.

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Chapter
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Modern Management of Uterine Fibroids , pp. 165 - 172
Publisher: Cambridge University Press
Print publication year: 2020

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References

Carranza-Mamane, B, Havelock, J, Hemmings, R. The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can 2015;37(3):277–85.Google Scholar
Quinn, SD, Gedroyc, WM. Thermal ablative treatment of uterine fibroids. Int J Hyperthermia 2015;31(3):272–9.CrossRefGoogle ScholarPubMed
Silberzweig, JE, Powell, DK, Matsumoto, AH, Spies, JB. Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology 2016;280(3):675–92.CrossRefGoogle ScholarPubMed
Clark, NA, Mumford, SL, Segars, JH. Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr Opin Obstet Gynecol 2014;26(3):151–61.Google Scholar
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.Google Scholar
Kim, YS, Bae, DS, Park, MJ, et al. Techniques to expand patient selection for MRI-guided high-intensity focused ultrasound ablation of uterine fibroids. AJR Am J Roentgenol 2014;202(2):443–51.Google Scholar
Goldberg, SN, Gazelle, GS, Halpern, EF, et al. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996;3(3):212–18.CrossRefGoogle ScholarPubMed
Solbiati, L, Ierace, T, Goldberg, SN, et al. Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients. Radiology 1997;202(1):195–203.Google Scholar
Goldberg, SN, Gazelle, GS, Mueller, PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000;174(2):323–31.Google Scholar
Lenard, ZM, McDannold, NJ, Fennessy, FM, et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery – imaging predictors of success. Radiology 2008;249(1):187–94.Google Scholar
Stewart, EA, Gostout, B, Rabinovici, J, et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007;110(2 Pt 1):279–87.Google Scholar
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):274–80.CrossRefGoogle ScholarPubMed
Froling, V, Kröncke, TJ, Schreiter, NF, et al. Technical eligibility for treatment of magnetic resonance-guided focused ultrasound surgery. Cardiovasc Intervent Radiol 2014;37(2):445–50.Google Scholar
Fennessy, FM, Tempany, CM. A review of magnetic resonance imaging-guided focused ultrasound surgery of uterine fibroids. Top Magn Reson Imaging 2006;17(3):173–9.CrossRefGoogle ScholarPubMed
Zhao, WP, Chen, JY, Zhang, L, et al. Feasibility of ultrasound-guided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging. Eur J Radiol 2013;82(1):e43–9.Google Scholar
Machtinger, R, Fennessy, FM, Stewart, EA, et al. MR-guided focused ultrasound (MRgFUS) is effective for the distinct pattern of uterine fibroids seen in African-American women: data from phase III/IV, non-randomized, multicenter clinical trials. J Ther Ultrasound 2013;1:23.Google Scholar
Howlader, N, Noone, AM, Yu, M, Cronin, KA. Use of imputed population-based cancer registry data as a method of accounting for missing information: application to oestrogen receptor status for breast cancer. Am J Epidemiol 2012;176(4):347–56.CrossRefGoogle Scholar
Masciocchi, C, Arrigoni, F, Ferrari, F, et al. Uterine fibroid therapy using interventional radiology mini-invasive treatments: current perspective. Med Oncol 2017;34(4):52.Google Scholar
Yoon, SW, Seong, SJ, Jung, SG, et al. Mitigation of abdominal scars during MR-guided focused ultrasound treatment of uterine leiomyomas with the use of an energy-blocking scar patch. J Vasc Interv Radiol 2011;22(12):1747–50.Google Scholar
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):885–93.Google Scholar
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.CrossRefGoogle ScholarPubMed
Cura, M, Cura, A, Bugnone, A. Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol 2006;47(10):1105–14.CrossRefGoogle ScholarPubMed
Quinn, SD, Vedelago, J, Gedroyc, W, Regan, L. Safety and five-year re-intervention following magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2014;182:247–51.Google Scholar
Deligdisch, L, Hirschmann, S, Altchek, A. Pathologic changes in gonadotropin releasing hormone agonist analogue treated uterine leiomyomata. Fertil Steril 1997;67(5):837–41.Google Scholar
Huang, X, He, M, Liu, YJ, Zhang, L, Wang, ZB. [Effect of oxytocin on uterine fibroids treated by ultrasound ablation]. Zhonghua Fu Chan Ke Za Zhi 2011;46(6):412–15.Google ScholarPubMed
Fischer, K, McDannold, NJ, Tempany, CM, Jolesz, FA, Fennessy, FM. Potential of minimally invasive procedures in the treatment of uterine fibroids: a focus on magnetic resonance-guided focused ultrasound therapy. Int J Womens Health 2015;7:901–12.Google Scholar
Pérez-López, FR, Ornat, L, Ceausu, I, et al. EMAS position statement: management of uterine fibroids. Maturitas 2014;79(1):106–16.Google Scholar
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):22–9.Google Scholar
Chudnoff, SG, Berman, JM, Levine, DJ, et al. Outpatient procedure for the treatment and relief of symptomatic uterine myomas. Obstet Gynecol 2013;121(5):1075–82.Google Scholar
Rabinovici, J, David, M, Fukunishi, H, et al. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 2010;93(1):199–209.Google Scholar
Bouwsma, EV, Gorny, KR, Hesley, GK, et al. Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility. Fertil Steril 2011;96(1):e9–12.Google Scholar
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):370–3.Google Scholar
Gizzo, S, Saccardi, C, Patrelli, TS, et al. Magnetic resonance-guided focused ultrasound myomectomy: safety, efficacy, subsequent fertility and quality-of-life improvements, a systematic review. Reprod Sci 2014;21(4):465–76.Google Scholar
Smart, OC, Hindley, JT, Regan, L, Gedroyc, WM. Magnetic resonance guided focused ultrasound surgery of uterine fibroids – the tissue effects of GnRH agonist pre-treatment. Eur J Radiol 2006;59(2):163–7.Google Scholar
Taran, FA, Tempany, CM, Regan, L, et al. Magnetic resonance-guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas. Ultrasound Obstet Gynecol 2009;34(5):572–8.Google Scholar
Froeling, V, Meckelburg, K, Schreiter, NF, et al. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: long-term results. Eur J Radiol 2013;82(12):2265–9.Google Scholar
Borah, BJ, Nicholson, WK, Bradley, L, Stewart, EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol 2013;209(4):319 e1–319 e20.Google Scholar
Zhao, WP, Chen, JY, Chen, WZ. Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images. Exp Ther Med 2016;11(1):328–34.Google Scholar
Machtinger, R, Inbar, Y, Cohen-Eylon, S, et al. MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success. Hum Reprod 2012;27(12):3425–31.Google Scholar

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