Abstract
MR-guided high intensity focused ultrasound (MRg HIFU) is a novel method of tissue ablation that incorporates high energy focused ultrasound for tissue heating and necrosis within an MR scanner that provides simultaneous stereotactic tissue targeting and thermometry. To date, MRg HIFU has been used primarily to treat uterine fibroids, but many additional applications in the pelvis are in development. This article reviews the basic technology of MRg HIFU, and the use of MRg HIFU to treat uterine fibroids, adenomyosis, and prostate cancer.
Similar content being viewed by others
References
Dobrotwir A, Pun E (2012) Clinical 24 month experience of the first MRgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol 56:409–416
Lindstrom PA (1954) Prefrontal ultrasonic irradiation: a substitute for lobotomy. AMA Arch Neurol Psychiatry 72:399–425
Ren XL, Zhou XD, Yan RL, et al. (2009) Sonographically guided extracorporeal ablation of uterine fibroids with high-intensity focused ultrasound: midterm results. J Ultrasound Med 28:100–103
Tsakiris P, Thüroff S, de la Rosette J, Chaussy C (2008) Transrectal high-intensity focused ultrasound devices: a critical appraisal of the available evidence. J Endourol 22:221–229
Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22:571–588
Marshall LM, Spiegelman D, Barbieri RL, et al. (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90:967–973
Jacoby VL, Autry A, Jacobson G, et al. (2009) Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol 114:1041–1048
http://www.alternativesurgeryblog.com/sexual-dysfunction-with-hysterectomy/. Accessed 28 Jan 2013
Mokate T, Wright C, Mander T (2006) Hysterectomy and sexual function. Menopause Int 12:153–157
Altman D, Granath F, Cnattingius S, Falconer C (2007) Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 370:1494–1499
Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272
Harding G, Coyne KS, Thompson CL, Spies JB (2008) The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes 6:99
Stewart EA, Gostout B, Rabinovici J, et al. (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110:279–287
Wyatt KM, Dimmock PW, Walker TJ, O’Brien PM (2001) Determination of total menstrual blood loss. Fertil Steril 76:125–131
http://www.accessdata.fda.gov/cdrh_docs/pdf4/P040003b.pdf. Accessed 28 Jan 2013
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=20708. Accessed 28 Jan 2013
Pistofidis G, Makrakis E, Balinakos P, et al. (2012) Report of 7 uterine rupture cases after laparoscopic myomectomy: update of the literature. J Minim Invasive Gynecol 19:762–767
Pitter MC, Gargiulo AR, Bonaventura LM, Lehman JS, Srouji SS (2013) Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod 28:99–108
Rabinovici J, David M, Fukunishi H, et al. (2010) Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 93:199–209
http://www.clinicaltrials.gov/ct2/show/NCT00730886. Accessed 28 Jan 2013
Lénárd ZM, McDannold NJ, Fennessy FM, et al. (2008) Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–imaging predictors of success. Radiology 249:187–194
deSouza NM, Williams AD (2002) Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome. Radiology 222:367–374
Stewart EA, Rabinovici J, Tempany CM, et al. (2006) Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85:22–29
Judson O (2010) Enhancing the placebo. Op-Ed column. New York Times, May 4, 2010. http://www.nytimes.com/2010/05/04/opinion/04judson.html. Accessed 5 March 2011
Sanket D, Bero L, Redberg R, et al. (2009) Strength of study evidence examined by the FDA in premarket approval of cardiovascular devices. JAMA 302:2679–2685
http://clinicaltrials.gov/ct2/show/NCT00656305?term=mrgfus&rank=7. Accessed 5 March 2011
Bodenheimer T (2000) Uneasy alliance–clinical investigators and the pharmaceutical industry. N Engl J Med 342:1539–1544
Angell M (2008) Industry-sponsored clinical research: a broken system. JAMA 300:1069–1071
Steinbrook R (2009) Controlling conflict of interest—proposals from the institute of medicine. N Engl J Med 360:2160–2163
Jacoby V, Jacoby A, Kohi M, et al. (2012) MR guided focused ultrasound for uterine fibroids: a pilot randomized placebo controlled trial. In: Current and future applications of focused ultrasound 2012, 3rd International Symposium, Program Book. p 44
Yoo EH, Lee PI, Huh CY, et al. (2007) Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol 14:690–697
Hanafi M (2005) Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 105:877–881
Funaki K, Fukunishi H, Sawada K (2009) Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 34:584–589
Spies J, Bruno J, Czeyda-Pommersheim F, et al. (2005) Long-term outcome of uterine artery embolization of leiomyomas. Obstet Gynecol 106:933–939
Katsumori T, Kasahara T, Akazawa K (2006) Long-term outcomes of uterine artery embolization using gelatin sponge particles alone for symptomatic fibroids. AJR Am J Roentgenol 186:848–854
Ruuskanen A, Sipola P, Hippeläinen M, Wüstefeld M, Manninen H (2009) Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol 19:2977–2985
Kim KA, Yoon SW, Yoon BS, et al. (2011) Spontaneous vaginal expulsion of uterine myoma after magnetic resonance-guided focused ultrasound surgery. J Minim Invasive Gynecol 18:131–134
Radeleff B, Eiers M, Bellemann N, et al. (2010) Expulsion of dominant submucosal fibroids after uterine artery embolization. Eur J Radiol 75:e57–e63
http://lawmedconsultant.com/385/recent-large-malpractice-verdicts/. Accessed 28 Jan 2013
Cockerham AZ (2012) Adenomyosis: a challenge in clinical gynecology. J Midwifery Womens Health 57:212–220
Vercellini P, Vigano P, Somigliana E, et al. (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynecol 20:465–477
Fan TY, Zhang L, Chen W, et al. (2012) Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis. Eur J Radiol 81:3624–3630
Fukunishi H, Funaki K, Yamaguchi K, Sawada K (2011) Two-year outcome of MRgFUS treatment of adenomyosis. Poster at 21st World Congress of the International Society of Ultrasound in Obstetrics and Gynecology, 2011
Kim MD, Kim S, Kim NK, et al. (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol 188:176–181
Stamey TA, McNeal JE (1992) Adenocarcinoma of the prostate. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED (eds) Campbell’s urology, vol. 2, 6th edn. Philadelphia: WB Saunders, pp 1159–1221
Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271:368–374
Carter HB, Sauvageot J, Walsh PC, Epstein JI (1997) Prospective evaluation of men with stage T1C adenocarcinoma of the prostate. J Urol 157:2206–2209
Eggener SE, Mueller A, Berglund RK, et al. (2013) A multi-institutional evaluation of active surveillance for low risk prostate cancer. J Urol 189(1 Suppl):S19–S25
Ahmed HU, Moore C, Emberton M (2009) Minimally-invasive technologies in uro-oncology: the role of cryotherapy, HIFU and photodynamic therapy in whole gland and focal therapy of localised prostate cancer. Surg Oncol 18:219–232
Marberger M, Carroll PR, Zelefsky MJ, et al. (2008) New treatments for localized prostate cancer. Urology 72(6 Suppl):S36–S43
Polascik TJ, Mouraviev V (2008) Focal therapy for prostate cancer. Curr Opin Urol 18:269–274
Shelley M, Wilt TJ, Coles B, Mason MD (2007) Cryotherapy for localised prostate cancer. Cochrane Database Syst Rev 18:CD005010
Barqawi AB, Crawford ED (2007) The current use and future trends of focal surgical therapy in the management of localized prostate cancer. Cancer J 13:313–317
Muto S, Yoshii T, Saito K, et al. (2008) Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol 38:192–199
Ahmed HU, Emberton M (2008) Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way? World J Urol 26:457–467
Miller DC, Sanda MG, Dunn RL, et al. (2005) Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy. J Clin Oncol 23:2772–2780
Barocas DA, Cowan JE, Smith JAJr, Carroll PR, CaPSURE Investigators (2008) What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance? An analysis of the CaPSURE database. J Urol 180:1330–1334
Schröder FH, Hugosson J, Roobol MJ, et al. (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320–1328
Andriole GL, Crawford ED, Grubb RL III, et al. (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360:1310–1319
Sanghvi NT, Foster RS, Bihrle R, et al. (1999) Noninvasive surgery of prostate tissue by high intensity focused ultrasound: an updated report. Eur J Ultrasound 9:19–29
Lee HM, Hong JH, Choi HY (2006) High-intensity focused ultrasound therapy for clinically localized prostate cancer. Prostate Cancer Prostatic Dis 9:439–443
Blana A, Walter B, Rogenhofer S, Wieland WF (2004) High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology 63:297–300
Vallancien G, Prapotnich D, Cathelineau X, Baumert H, Rozet F (2004) Transrectal focused ultrasound combined with transurethral resection of the prostate for the treatment of localized prostate cancer: feasibility study. J Urol 171(6 Pt 1):2265–2267
Ficarra V, Antoniolli SZ, Novara G, et al. (2006) Short-term outcome after high-intensity focused ultrasound in the treatment of patients with high-risk prostate cancer. BJU Int 98:1193–1198
Han KR, Cohen JK, Miller RJ, et al. (2003) Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol 170(4 Pt 1):1126–1130
Mouraviev V, Mayes JM, Polascik TJ (2009) Pathologic basis of focal therapy for early-stage prostate cancer. Nat Rev Urol 6:205–215
Jayram G, Eggener SE (2009) Patient selection for focal therapy of localized prostate cancer. Curr Opin Urol 19:268–273
Scheidler J, Hricak H, Vigneron DB, et al. (1999) Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging–clinicopathologic study. Radiology 213:473–480
Yu KK, Scheidler J, Hricak H, et al. (1999) Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 213:481–488
Coakley FV, Kurhanewicz J, Lu Y, et al. (2002) Prostate cancer tumor volume: measurement with endorectal MR and MR spectroscopic imaging. Radiology 223:91–97
Chang S, Westphalen A, Jha P, et al. (2011) Endorectal MRI and MR spectroscopic imaging of prostate cancer: developing selection criteria for MR-guided focused ultrasound surgery-preliminary experience. American Roentgen Ray Society Annual Program. p 33
Anwar MM, Westphalen AC, Jung A, et al. (2012) Role of endorectal MRI and MRSI in defining the dominant intraprostatic lesion in prostate cancer: quantitative analysis of imaging contour compared to whole-mount histopathology. Int J Radiat Oncol Biol Phys 84:S403
Yerram N, Hoang A, Partanen A, et al. (2012) MR-guided trans-urethral prostate HIFU in a preclinical model. Mid Atlantic Section of the American Urological Association 2012 Annual Meeting Abstract. http://meeting.maaua.org/abstracts/2012/MP24.cgi. Accessed 11 April 2013
Kinsey AM, Diederich CJ, Rieke V, et al. (2008) Transurethral ultrasound applicators with dynamic multi-sector control for prostate thermal therapy: in vivo evaluation under MR guidance. Med Phys 35:2081–2093
Zini C, Hipp E, Thomas S, et al. (2012) Ultrasound- and MR-guided focused ultrasound surgery for prostate cancer. World J Radiol 4:247–252
Falk MH, Issels RD (2001) Hyperthermia in oncology. Int J Hyperthermia 17:1–18
Mukhopadhaya A, Mendecki J, Dong X, et al. (2007) Localized hyperthermia combined with intratumoral dendritic cells induces systemic antitumor immunity. Cancer Res 67:7798–7806
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coakley, F.V., Foster, B.R., Farsad, K. et al. Pelvic applications of MR-guided high intensity focused ultrasound. Abdom Imaging 38, 1120–1129 (2013). https://doi.org/10.1007/s00261-013-9999-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-013-9999-2