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MRI Guidance of Focused Ultrasound Therapy of Uterine Fibroids: Early Results

¹ Departments of Magnetic Resonance Imaging and Academic Obstetrics and Gynaecology, Interventional MR Unit, St Mary's Hospital London and Imperial College School of Medicine, Praed St., London W2 1NY, England.
² Departments of Obstetrics and Gynaecology and Reproductive Biology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115.
³ Department of Radiology and Obstetrics and Gynaecology, Sheba Medical Centre, Tel-Hashomer 91120, Israel.
⁴ Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287.
⁵ Department of Radiology and Obstetrics and Gynaecology, Mayo Clinic, Rochester, MN 55905.
⁶ Department of Radiology, Charité Medical Centre and Humboldt University, Virchow Clinic Campus, Berlin D-13353, Germany.
⁷ Department of Radiology, Hadassah Medical Centre, Jerusalem 52621, Israel.

OBJECTIVE. The purpose of this study was to explore our hypothesis that MRI-guided focused ultrasound therapy for the treatment of uterine fibroids will lead to a significant reduction in symptoms and improvement in quality of life. We describe focused ultrasound therapy applications and the method for monitoring the thermal energy deposited in the fibroids, including the MRI parameters required, in a prospective review of 108 treatments.

MATERIALS AND METHODS. Patients presenting with symptomatic uterine fibroids who attained a minimal symptom severity score and who would otherwise have been offered a hysterectomy were recruited. Thermal lesions were created within target fibroids using an MRI-guided focused ultrasound therapy system. The developing lesion was monitored using real-time MR thermometry, which was used to assess treatment outcome in real time to change treatment parameters and achieve the desired outcome.

Fibroid volume, fibroid symptoms, and quality-of-life scores were measured before treatment and 6 months after treatment. Adverse events were actively monitored and recorded.

RESULTS. In this study, 79.3% of women who had been treated reported a significant improvement in their uterine fibroid symptoms on follow-up health-related quality-of-life questionnaires, which supports our hypothesis. The mean reduction in fibroid volume at 6 months was 13.5%, but nonenhancing volume (mean, 51 cm³) remained within the treated fibroid at 6 months.

CONCLUSION. This early description of MRI-guided focused ultrasound therapy treatment of fibroids includes follow-up data and shows that, although the volume reduction is moderate, it correlates with treatment volume and the symptomatic response to this treatment is encouraging.

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