Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy

Abstract

ObjectiveThe purpose of this prospective multicenter study was to assess the safety and technical feasibility of volumetric Magnetic Resonance-guided High Intensity Focused Ultrasound (MR-HIFU) ablation for treatment of patients with symptomatic uterine fibroids.MethodsThirty-three patients with 36 fibroids were treated with volumetric MR-HIFU ablation. Treatment capability and technical feasibility were assessed by comparison of the Non-Perfused Volumes (NPVs) with MR thermal dose predicted treatment volumes. Safety was determined by evaluation of complications or adverse events and unintended lesions. Secondary endpoints were pain and discomfort scores, recovery time and length of hospital stay.ResultsThe mean NPV calculated as a percentage of the total fibroid volume was 21.7%. Correlation between the predicted treatment volumes and NPVs was found to be very strong, with a correlation coefficient r of 0.87. All patients tolerated the treatment well and were treated on an outpatient basis. No serious adverse events were reported and recovery time to normal activities was 2.3 ± 1.8 days.ConclusionThis prospective multicenter study proved that volumetric MR-HIFU is safe and technically feasible for the treatment of symptomatic uterine fibroids.Key Points• Magnetic-resonance-guided high intensity focused ultrasound allows non-invasive treatment of uterine fibroids.• Volumetric feedback ablation is a novel technology that allows larger treatment volumes• MR-guided ultrasound ablation of uterine fibroids appears safe using volumetric feedback

Renal ablation using magnetic resonance-guided high intensity focused ultrasound: Magnetic resonance imaging and histopathology assessment

“…In order to exploit the use of hyperthermia in the clinic, investigators need a better understanding of heating effects on various cell types and tissues [8] . MRg-HIFU has been used for treating uterine fibroids [9,10] , palliation of bone metastases [11] , ablation in the brain tumor through the skull [12] , breast cancer [13,14] , prostate [15] and hepatocellular carcinoma [16] . The safety and feasibility of using extracorporeal HIFU in treating patients with kidney tumor has been demonstrated [17,18] .…”

MR-guided high-intensity focused ultrasound treatment of uterine fibroids

“…As targeted vessel ablation is feasible with MR-HIFU, this could be an interesting advancement of UF therapy combining the advantages of UAE and MR-HIFU: on demand, three-dimensional real-time reconstruction of the vessel supply on MRI followed by targeted MR-HIFU means a seminal approach in the therapy of UF and other pathologies. 31,32,47 …”

“…Only one case of severe skin burns that needed surgical intervention after MR-HIFU treatment is reported, further underlining the noninvasiveness of this method. 31,48,[50][51][52][53][54] …”

Reduction of peak acoustic pressure and shaping of heated region by use of multifoci sonications in MR‐guided high‐intensity focused ultrasound mediated mild hyperthermia

“…Traditional sonication trajectories that involve rapid HIFU steering through single focus points, as used in MR-HIFU volumetric thermal ablations, 40,63 tend to exhibit elongated heated volume shape in the beam axis direction. This approach with high heating energy efficiency may benefit ablation of large volumes.…”