A Clinical Review of Focused Ultrasound Ablation With Magnetic Resonance Guidance

Abstract

Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affecting the quality of life of women. Whereas patients have several options available for treatment, focused ultrasound ablation is one of the least invasive treatment options outside medical therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging, guidance for therapy, and thermal feedback provided by magnetic resonance imaging. In 2004, the MRgFUS system ExAblate 2000 (InSightec, Haifa, Israel) was approved by the United States Food and Drug Administration for clinical treatments of uterine fibroids. Since its approval, our institution has performed more than 140 treatments. This paper provides an overview of our site's clinical experience with MRgFUS, including a brief description of the treatment system, pertinent features to review on screening magnetic resonance imaging, how the procedure is performed, and risks and benefits of the treatment. Some potential clinical applications of the technology are also briefly reviewed.

Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids

“…During MRgFUS treatment, a high-intensity focused ultrasound beam induces the selective, rapid heating of multiple sequential foci leading to thermocoagulation only within the targeted tumor tissue while neighboring structures along the beam path are preserved. 8 The combination of the heat-generating focused ultrasound technology with a magnetic resonance (MR) system allows for the anatomically precise definition of a target volume, real-time thermal monitoring of the ablation process, and postprocedural evaluation of the treatment result.…”

Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center

“…It is a noninvasive thermoablative technique that uses an external US energy source to induce a thermal ablation of tissue deep under the intact skin based on its ability to concentrate US waves precisely (12). High-intensity focused US has been used for the treatment of uterine fibroids, showing a symptom reduction in women with symptomatic uterine leiomyomas and an excellent safety profile (13)(14)(15), with obvious necrosis histopathologically (16). Similarly, HIFU has been used recently to treat patients with symptomatic adenomyosis.…”

A strategy for blood biomarker amplification and localization using ultrasound

“…Image-guided focused ultrasound has been used for the past decade to ablate tumors in humans; thus, many of the potential pitfalls of using ultrasound to deposit energy locally in patients have already been overcome. In fact, the United States Food and Drug Administration granted approval of MR-guided focused ultrasound to treat uterine fibroids in 2004 (31). Since that time, thousands of patients have been treated using this technology for tumors, including those of the uterus, breast, and brain and metastatic disease of the bone (27,32,33).…”