Updates on MR-Guided Focused Ultrasound for Symptomatic Uterine Fibroids

Abstract

Magnetic-resonance-guided focused ultrasound (MRgFUS), also called high-intensity focused ultrasound (HIFU) is an effective, noninvasive uterine-preserving treatment for symptomatic uterine fibroids. As the use of this therapeutic modality is not yet widespread, it may remain unfamiliar to many interventional radiologists. The purpose of this review is to discuss MRgFUS, including technology, patient selection, technique, outcomes, complications, and recent data on fertility and comparative effectiveness.

Keywords: High-intensity focused ultrasound; fibroids; interventional radiology; menorrhagia.

Fig. 1

Sagittal GRE image demonstrates loops of intestine (white arrows) anterior to the fibroid, in the intended treatment path.

Fig. 2

Following filling of the bladder (black arrow) and rectum (open arrow), the intestine (white arrow) has been displaced superiorly and out of the treatment path.

Fig. 3

Sagittal GRE image demonstrates the distance from the skin to the posterior aspect of the fibroid to be 13.3 cm, which is outside the 12 cm range recommended for optimal therapy.

Fig. 4

Following rectal fill (arrow), the uterus and the fibroid are displaced anteriorly, within the recommended 12 cm range.

Fig. 5

The blue overlay ( a ) corresponds to the nonenhancing portion of the fibroid ( b ).

Fig. 6

Sagittal T1-weighted postcontrast fast-saturated images. ( a ) Multiple enhancing fibroids are present in the uterus. ( b ) Following magnetic-resonance–guided focused ultrasound, none of the fibroids are enhancing resulting in a high nonperfused volume.