Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids

Abstract

Uterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period. Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women. The aim of this study is to review the role of Magnetic resonance-guided high-intensity focused ultrasound in the treatment of uterine fibroids in symptomatic patients. We performed a review of the MEDLINE and Cochrane databases up to April 2016. The analysis and data collection were performed using the following keywords: Leiomyoma, High-Intensity Focused Ultrasound Ablation, Ultrasonography, Magnetic Resonance Imaging, Menorrhagia. Two reviewers independently performed a quality assessment; when there was a disagreement, a third reviewer was consulted. Nineteen studies of Magnetic resonance-guided high-intensity focused ultrasound-treated fibroid patients were selected. The data indicated that tumor size was reduced and that symptoms were improved after treatment. There were few adverse effects, and they were not severe. Some studies have reported that in some cases, additional sessions of Magnetic resonance-guided high-intensity focused ultrasound or other interventions, such as myomectomy, uterine artery embolization or even hysterectomy, were necessary. This review suggests that Magnetic resonance-guided high-intensity focused ultrasound is a safe and effective technique. However, additional evidence from future studies will be required before the technique can be recommended as an alternative treatment for fibroids.

The safety and efficacy of add-on use of oxytocin in uterine leiomyoma patients undergoing high-intensity focused ultrasound and ultrasound-guided intratumoral ethanol injection: a randomized controlled trial

“…In recent years, as a type of minimally invasive treatment, ultrasound-guided percutaneous anhydrous ethanol injection has been used to treat uterine leiomyomas (19,20). Its mechanism of action involves the anhydrous ethanol embolization of leiomyoma blood vessels, and it directly causes tissue protein coagulation in the tumor, thus resulting in leiomyoma coagulative necrosis.…”

“…Oxytocin binds the receptors in the uterine smooth muscle and causes smooth muscle contraction and compression in the myometrium blood vessels, thereby reducing blood perfusion (17)(18)(19). Through the uterus contrast-enhanced sonogram, patients with uterine leiomyomas in the oxytocin group that received the intravenous drip were found to have decreased blood flow and reduced blood supply.…”

Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology

“…Sometimes a different treatment paradigm may prove more suitable. For example, magnetic resonance imaging (MRI)-focussed ultrasound may prove more effective for certain groups of patients with fibroids, 90 and this is currently being trialled. 91 Similarly, the EVAR strategy of internal graft fixation by radial force and non-abolition of the aneurysm sac may be superseded.…”

Proton resonance frequency‐based thermometry for aqueous and adipose tissues

“…Magnetic resonance imaging (MRI) provides a noninvasive and nonionizing approach to monitor thermal therapies for focused ultrasound (FUS) by measuring temperature changes at the targets. 1 FUS has been clinically applied to thermal ablations of uterine fibroids, 2,3 essential tremors, 4 and breast tumors. 5,6 During treatments, MR imaging parameters sensitive to temperature variations are utilized to monitor temperature changes in tissues, 7,8,9 such as T1, T2, proton density, and proton resonance frequency (PRF) shift.…”