MRI Guided High Intensity Focused Ultrasound (HIFU) in the Management of Uterine Fibroids

Abstract

Fibroids are the most common benign uterine tumors in women of reproductive age. Associated symptoms include dysmenorrhea, spotting, hypermenorrhea, anemia, lower abdominal pain, pressure on adjacent organs and disorders of micturition and defecation. The common treatment modalities for symptomatic women are hysterectomy or myomectomy. However, these surgical procedures are associated with morbidity in many cases, and involve at least several days of hospitalization as well as several weeks of convalescence. The high incidence of symptomatic uterine fibroids and the high cost of surgical interventions and their sequelae create a significant financial burden that has stimulated the search for alternative approaches. Treatment of fibroids using high-intensity focused procedure is applied transcutaneously. In this procedure, the fibroid is gradually heated under continuous MRI monitoring in small, focused stages, until temperatures > 55 °C are reached to achieve complete denaturation of the localized tumor. The high energy concentration in a very small, ellipsoid focus to create discrete areas of tissue necrosis preserves both adjacent tissue and the structures between the energy source and the target tissue.