Magnetic Resonance (MR) Guided High Intensity Focused Ultrasound (HIFU) is a revolutionary, completely non-invasive treatment for women with one or more classical smaller and medium sized fibroids.
This 'knife-less and needle-less procedure' is performed on an outpatient basis, allowing patients to be conscious with light sedation and feel no pain during or after the procedure with full recovery in hours to days. Although relatively new, this treatment option will give a subset of women a treatment choice that gives them fast recovery with limited side effects. Currently this is the only FDA interventional procedure approved for pre-menopausal women with symptomatic uterine fibroids who wish to retain the option of future pregnancy.
MR guided High Intensity Focused Ultrasound (HIFU) is a completely non-invasive, outpatient procedure performed by an Interventional Radiology (IR) physician in an MR scanner. An Interventional Radiologist is a medical doctor who has specialized experience in diagnostic and vascular imaging, which is used to guide therapeutic procedures. An electronic ultrasound source within the MR table produces and focuses multiple sound waves to a very narrow 2-4 cm portion of the targeted fibroid, killing it as it heats up above 60o C (> 100 o F), without affecting any of the other tissues around the fibroid. This is similar to focusing the sun’s rays with magnifying glass spark a fire on a dry leaf. The focused ultrasound energy is directed at a small volume of the fibroid, raising its temperature high enough to cause thermal ablation (killing of the cells) without impacting other tissues. Pulses of energy are repeated until the entire volume is treated. Safety is assured because the IR physician can not only see exactly which part of the fibroid is treated, but also measure the temperature within this treated area, providing near-continuous visual and thermal treatment monitoring for maximal safety.
MR is an advanced imaging technology and provides 3D imaging of internal organs without radiation unlike CT or PET. The MR guided HIFU treatment uses MR images to identify where the fibroid is and what portion has been treated, without the need for any incisions. It also provides real time feedback about temperature changes of the treated fibroid to make sure that the fibrotic tissue has been destroyed.
If you require treatment for your fibroid related symptoms, but want to avoid surgery and preserve your uterus, please schedule a consultation with an IR physician. We will discuss your fibroid symptoms, general health and, medical history. You will also have routine blood work, an internal gynecological examination, and a diagnostic MR-imaging of your fibroids. Based on this information and your personal goals, we can discuss the best treatment option for you.
The IR physiciancan determine ifone or most your fibroids are suitable for treatment. HIFU may be appropriate for submucosal, subserosal, and intramural classicaluterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated per procedure. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or nerves), or in a location inaccessible by the focused ultrasound, may be poor candidates for HIFU.
During the procedure, the patient would lie on her stomach on a table that fits into a standard MRI scanner. First, the IR physician would identify the fibroid(s) on the MR images taken of the patient’s pelvic region. Then, after detailed planning, high energy focused ultrasound waves heat a small spot in the uterine fibroid to a temperature of up to 85°C. During the pulse or sonication, which lasts about 15 seconds, the IR physician monitors the progress and reviews temperature-sensitive images. Since each sonication treats a very small volume, this process could be repeated 50 to 100 times, until the entire target fibroidis treated. The procedure lasts about three hours depending upon the size and number of fibroids treated. Following the treatment, the body gradually removes the treated tissue over a period of months, providing symptom relief.
Before treatment, the patient is given a sedative and pain medication to help her relax. The patient starts by lying on a table and are made comfortable before starting treatment. The treatment takes place with on the table inside the MR scanner. The clinical team, made of the IR physician, nurses, and technologists, will be communicating with the patient using a microphone and a speaker. The IR physician will inform the patient when images are being acquired (scanning) and when the system is sonicating (treatment).
During treatment, it is normal to feel a warming sensation in the pelvic region. The patient is given a safety-stop-button that allows her to immediately stop the sonication if the treatment becomes painful. The patient is conscious the entire time and provide feedback during the procedure to the IR physician.
Following the treatment, the patient would be asked to rest for a few hours in the clinic, while the light sedation wears off. Once cleared by the nursing staff, the patient is released to go home with discharge instructions from the IR physician. If needed, the IR physician may recommend over-the-counter pain relief medication. Occasionally, women may experience some cramping, similar to menstrual period cramping or shoulder/back pain, from lying in the treatment position. Most women are able to return to work and normal activity one to two days after the procedure.
Although this treatment may be successful in destroying the fibroids causing painful symptoms, more fibroids might grow over time, which might become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed.
