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DOI: 10.1055/s-0030-1251481
Magnetic Resonance-Guided Focused Ultrasound Surgery
Publication History
Publication Date:
22 April 2010 (online)
ABSTRACT
Magnetic resonance guided focused ultrasound surgery (MRgFUS) is a noninvasive thermoablative therapy that was approved by the Food and Drug Administration in 2004 for the treatment of uterine fibroids (leiomyomas). Data on safety and long-term efficacy are accumulating to establish the unique usefulness of this therapy in targeting and treating leiomyomas through the integration of MR imaging. This article describes the established thermoablative therapies in the treatment of uterine fibroids, emphasizing their role in the genesis of MRgFUS. Treatment specifications are highlighted, and an overview of the procedure is given. Data from both clinical trials and commercial treatments are detailed for multiple efficacy outcomes, including symptom improvement, leiomyoma shrinkage, and use of alternative procedures. The concept of nonperfused volume as a surrogate marker for treatment success is discussed. Importantly, favorable pregnancy outcomes following MRgFUS have been reported. Applications of MRgFUS have recently expanded into the realm of adenomyosis treatment. MRgFUS has been deemed a safe and effective method of fibroid treatment and offers the advantages of no incisions or blood loss, speedy recovery, and a cost-effective means of treatment.
KEYWORDS
MRgFUS - leiomyomas - nonperfused volume (NPV) - adenomyosis - pregnancy
REFERENCES
- 1 Walker C L, Stewart E A. Uterine fibroids: the elephant in the room. Science. 2005; 308(5728) 1589-1592
- 2 Day Baird D, Dunson D B, Hill M C, Cousins D, Schectman J M. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003; 188(1) 100-107
- 3 Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol. 2006; 195(4) 955-964
- 4 Hartmann K E, Birnbaum H, Ben-Hamadi R et al.. Annual costs associated with diagnosis of uterine leiomyomata. Obstet Gynecol. 2006; 108(4) 930-937
- 5 Stewart E A. Uterine Fibroids: The Complete Guide. Baltimore, MD; Johns Hopkins University Press 2007
- 6 Goldfarb H A. Laparoscopic coagulation of myoma (myolysis). Obstet Gynecol Clin North Am. 1995; 22(4) 807-819
- 7 Zupi E, Piredda A, Marconi D et al.. Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas. Am J Obstet Gynecol. 2004; 190(3) 639-643
- 8 Law P, Gedroyc W M, Regan L. Magnetic-resonance-guided percutaneous laser ablation of uterine [letter]. Lancet. 1999; 354(9195) 2049-2050
- 9 Hindley J, Gedroyc W M, Regan L et al.. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol. 2004; 183(6) 1713-1719
- 10 Cowan B D, Sewell P E, Howard J C, Arriola R M, Robinette L G. Interventional magnetic resonance imaging cryotherapy of uterine fibroid tumors: preliminary observation. Am J Obstet Gynecol. 2002; 186(6) 1183-1187
- 11 Jolesz F A, Hynynen K. Magnetic resonance image-guided focused ultrasound surgery. Cancer J. 2002; 8(suppl 1) S100-S112
- 12 Jolesz F A, Hynynen K H. MRI-Guided Focused Ultrasound Surgery. New York, NY; Informa Healthcare 2008
- 13 Vaezy S, Fujimoto V Y, Walker C, Martin R W, Chi E Y, Crum L A. Treatment of uterine fibroid tumors in a nude mouse model using high-intensity focused ultrasound. Am J Obstet Gynecol. 2000; 183(1) 6-11
- 14 Hanstede M MF, Stewart E A, Tempany C MC.
Uterine fibroids and MRI-guided focused ultrasound surgery . In: Jolesz FA, Hynynen KH MRI-Guided Focused Ultrasound Surgery. New York, NY; Informa Healthcare 2008: 111-128 - 15 American College of Obstetricians and Gynecologists . ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008; 112(2 Pt 1) 387-400
- 16 Hesley G K, Gorny K R, Henrichsen T L, Woodrum D A, Brown D L. A clinical review of focused ultrasound ablation with magnetic resonance guidance: an option for treating uterine fibroids. Ultrasound Q. 2008; 24(2) 131-139
- 17 Zaher S, Gedroyc W M, Regan L. Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids. Eur J Obstet Gynecol Reprod Biol. 2009; 143(2) 98-102
- 18 Stewart E A, Gedroyc W M, Tempany C M et al.. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003; 189(1) 48-54
- 19 Stewart E A, Gostout B, Rabinovici J, Kim H S, Regan L, Tempany C M. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007; 110(2 Pt 1) 279-287
- 20 Spies J B, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves S M. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002; 99(2) 290-300
- 21 Stewart E A, Rabinovici J, Tempany C M et al.. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril. 2006; 85(1) 22-29
- 22 Fennessy F M, Tempany C M, McDannold N J et al.. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery—results of different treatment protocols. Radiology. 2007; 243(3) 885-893
- 23 Hesley G K, Felmlee J P, Gebhart J B et al.. Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging-guided focused ultrasound. Mayo Clin Proc. 2006; 81(7) 936-942
- 24 Morita Y, Ito N, Hikida H, Takeuchi S, Nakamura K, Ohashi H. Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids-early experience. Eur J Obstet Gynecol Reprod Biol. 2008; 139(2) 199-203
- 25 Funaki K, Sawada K, Maeda F, Nagai S. Subjective effect of magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res. 2007; 33(6) 834-839
- 26 Rabinovici J, Inbar Y, Revel A et al.. Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance-guided focused ultrasound surgery. Ultrasound Obstet Gynecol. 2007; 30(5) 771-777
- 27 Stewart E A. Magnetic resonance imaging-guided focused ultrasound: no panacea, but nevertheless a safe step forward. Fertil Steril. 2006; 85(1) 49
- 28 Stewart E A. Letters to the editor. Obstet Gynecol. 2007; 110(6) 1428-1429
- 29 Taran F A, Hesley G K, Gorny K R, Stewart E A. What factors currently limit magnetic resonance-guided focused ultrasound of leiomyomas? A survey conducted at the first international symposium devoted to clinical magnetic resonance-guided focused ultrasound. Fertil Steril. 2009; , April 20 (Epub ahead of print)
- 30 Smart O C, Hindley J T, Regan L, Gedroyc W G. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol. 2006; 108(1) 49-54
- 31 Leon-Villapalos J, Kaniorou-Larai M, Dziewulski P. Full thickness abdominal burn following magnetic resonance guided focused ultrasound therapy. Burns. 2005; 31(8) 1054-1055
- 32 Manufacturer and User Facility Device Experience .2009 Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFM Accessed February 5, 2010
- 33 Zowall H, Cairns J A, Brewer C, Lamping D L, Gedroyc W M, Regan L. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG. 2008; 115(5) 653-662
- 34 O'Sullivan A K, Thompson D, Chu P, Lee D W, Stewart E A, Weinstein M C. Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids. Int J Technol Assess Health Care. 2009; 25(1) 14-25
- 35 Rabinovici J, David M, Fukunishi H, Morita Y, Gostout B S, Stewart E A. for the MRgFUS Study Group . Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril. 2010; 93(1) 199-209
- 36 Rabinovici J, Stewart E A. New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006; 20(4) 617-636
- 37 Yoon S W, Kim K A, Cha S H et al.. Successful use of magnetic resonance-guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis. Fertil Steril. 2008; 90(5) e13-e15
- 38 Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol. 2008; 15(5) 571-579
Elizabeth A StewartM.D.
Professor of Obstetrics and Gynecology, Division of Reproductive Endocrinology
Department of Obstetrics and Gynecology, Mayo Clinic and Medical School, 200 First
St, SW, Rochester, MN 55905
Email: stewart.elizabeth@mayo.edu