MRI-Guided Focused Ultrasound Surgery for Uterine Fibroids

This is the first non-invasive therapy for uterine fibroids. The patient lies on her back and ultrasound waves are focused with the guidance of Magnetic Resonance Imaging into the center of a particular fibroid. The treatment is limited only to those fibroids where the focused ultrasound energy does not traverse the bowel or bladder on its way to reaching the fibroid. (Otherwise, the bladder or bowel may sustain damage.) The focused ultrasound energy is continued long enough to produce thermalization of the center of the sonicated fibroid. This volume will become necrotic and eventually shrink.

Presently, the procedure is allowed to continue for two or three hours and is limited to fibroids smaller than 7 cm. The treatment leads to a modest reduction in the fibroid volume of about 13%. However, improvement in the quality of life, such as bleeding, pain, and pressure is more significant. Frequently, the procedure has to be discontinued because of the patient’s inability to lie still on her back for such a long time. She often has to tolerate three or more 3-hour sessions inside a noisy, cramped MRI machine without moving. The procedure may cause skin burns at the treatment site and possibly some damage to adjacent tissues such as nerves. The procedure is still in its early stages of evaluation and long-term results and complications are unknown.

A recent study reported that the risk of additional procedures following MR-guided ultrasound-focused surgery is high, raising the possibility that this approach may not produce durable symptom relief. There is a need for a much longer follow-up before more firm conclusions regarding the value of this procedure can be reached.