The role of magnetic resonance-guided focused ultrasound in fertility sparing treatment of uterine fibroids—current perspectives

Abstract

Uterine fibroids (UFs) are the most common benign tumours of the female reproductive system and the most frequent reason for hysterectomy worldwide. UFs are reported in 20%-70% of women of reproductive age depending on a study group. Although most women with UFs are asymptomatic, over 30% of them will present with different symptoms. Abnormal uterine bleeding, pain, pressure and infertility are the most common. Lesions that cause these kinds of symptoms may require medical intervention.Trends in UF treatment change along with patient awareness and the introduction of new methods and techniques. Selecting an appropriate treatment option should be individualised and adjusted to the patient's expectations as much as possible. This choice will mostly depend on the patient's age, UF location, the size and number of lesions, severity of symptoms and, most importantly, the patient's expectations concerning the preservation of fertility. Observations made for the past few years showed an increasing number of pre-and perimenopausal women who wish to preserve their uterus or decline surgery. In line with current trends and demands in medicine, great importance is attached to the development and upgrade of new minimally invasive or noninvasive procedures in UF therapy.Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is not associated with severe destruction of the uterine cavity and walls. For this reason, this method may be considered as a kind of hope in fertility-sparing UF therapy and the data about its use in this indication raises future hope. In this review, we summarise the available data on the use of MR-HIFU as a fertility-sparing method in the treatment of UFs. We also indicate how it could evolve in the future.According to the available data, MR-HIFU is a relatively safe noninvasive method which seems not to deteriorate fertility compared to the pre-treatment status. MR-HIFU may constitute an alternative solution and be chosen in patients who meet the qualification criteria and deny other methods, which also facilitates the use of other treatment options in case the procedure is ineffective. Further randomised studies are necessary to confirm the above information.

Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids — five-year experience

“…Nevertheless, factors which would have ruled out the procedure several years before (e.g. reproductive plans) might currently, or in the nearest future, be the indications for the therapy, depending on the manifestations and other clinical issues [47].…”

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids—Efficiency Assessment with the Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and the Potential Role of the Administration of Uterotonic Drugs

“…For this reason, depending on the radiologists who interpret the examination, the changes are classified into different groups [ 43 ]. Therefore, the clinicians who use focused ultrasound therapy procedures constantly look for other, especially quantitative, radiological features of UFs, which would allow for a better prediction of the therapeutic effect of the procedure [ 7 ]. Attempts are made to assess changes in multiple parameters (multiparametric MRI) on the basis of the numerical value of the signal intensity in dependent T2 images, dynamic contrast tests and diffusion parameters.…”

“…Presumably, the administration of uterotonics would facilitate an effective procedure. Further research and development of appropriate criteria seem to be advisable, which, thanks to the perfusion assessment, will make it possible to predict the therapeutic effect of the procedure with high accuracy [ 7 , 12 ].…”

“…The most commonly chosen surgical treatment involves myomectomy or hysterectomy. However, in women who wish to preserve fertility and/or their uterus, surgery might not be the preferred solution [ 5 , 6 , 7 ]. Other existing treatment options should be directed towards an improvement in symptomatology and the quality of life [ 8 , 9 ].…”

“…Other existing treatment options should be directed towards an improvement in symptomatology and the quality of life [ 8 , 9 ]. As regards the conservative interventional treatment options currently available for women with symptomatic UFs, uterine artery embolization (UAE) [ 10 ] and focused energy delivery methods are promising but long-term data are still scarce [ 7 , 8 ].…”