MRI (magnetic resonance imaging)-guided focused ultrasound therapy (MRgFUS) (synonym: MR-HIFU = magnetic resonance high intensity focused ultrasound) is a more recent treatment option for uterine fibroids (benign uterine tumors) that is becoming increasingly important because it provides therapy with the following options: it is outpatient, has few side effects, does not require surgery, does not require anesthesia, and is gentle.
Indications (areas of application)
- Uterine fibroids
Contraindications
Relative contraindications
- Pedunculated fibroids (risk of detachment of the fibroid into the free abdominal cavity).
- Large fibroids (> 10 cm)
- High number of fibroids (> 5-7)
- Os sacrum (sacral bone) near findings (irritation of sacral nerves).
Absolute contraindications
- Acute inflammation in the small pelvis
- Gravidity (pregnancy)
- Suspected malignancy (malignancy)
Contraindications to MRI
- Patients with a cochlear implant, insulin pump, pacemaker, metal inserts.
- Intolerance of the contrast agent
Before treatment
Prior to treatment, an MRI scan of the pelvis must be performed to determine if MR-HIFU is possible and appropriate based on the location, number and size of the fibroids.
On the day of treatment, an intravenous line will be placed for the necessary pain medication and sedation. If necessary, a bladder catheter is required to control the filling of the urinary bladder. The therapy is performed in the prone position. The ultrasound machine is located just below the pelvis or uterus myomatosus.
The procedure
In the MRI in real-time image control, ultrasound waves are bundled, as in a burning glass, and focused specifically on the fibroids in question. Temperatures between 60 and 90 °C are generated there, leading to the death of the fibroid cells. The surrounding tissue is spared. Duration of the treatment is about 3-5 hours. Over months, the denatured tissue is broken down by the immune system and replaced by connective tissue.
After the treatment
After the therapy, an MRI with contrast agent is performed to document the success of the therapy. For 1-2 hours, the patient remains in the clinic to recover from the procedure. Due to the pain and sedative medication administered, reaction time is limited for at least 12 hours, so that the patient is not allowed to drive or perform any other activities that require a quick reaction. As a rule, the patient is taken off sick for one day. After that, all activities can be performed again.
Possible complications
- Rare are: Pain (minor and brief) during treatment, minor burns of the skin, minor inflammation of the subcutaneous fat and muscles of the abdominal wall, paresthesias (insensations) of the legs due to nerve irritation.
- Extremely rare are: Leg vein thrombosis (occlusion of a blood vessel by a blood clot in the deep veins of the leg), thermal (heat-related) damage to the small intestine For several months, bleeding disorders (hypermenorrhea (bleeding is too heavy), irregular bleeding) and shedding of tissue may occur.
