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Nichtinvasive Thermoablation symptomatischer Uterusmyome mit MR-gesteuertem hochenergetischem Ultraschall

Non-invasive thermoablation of symptomatic uterine fibroids with magnetic resonance-guided high-energy ultrasound

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Zusammenfassung

Das Uterusmyom ist der häufigste benigne Tumor prämenopausaler Frauen. Aufgrund der manchmal ausgeprägten Symptomatik ist eine effektive Therapie für eine Verbesserung der Lebensqualität der Betroffenen entscheidend. Der „high-intensity focused ultrasound“ (HIFU) stellt als organerhaltende und nichtinvasive Therapiemethode eine viel versprechende Behandlungsalternative dar, die dem hohen Sicherheitsbedürfnis und dem steigenden Wunsch der Patientinnen nach möglichst geringer Invasivität gerecht wird.

Der MRT-gesteuerte hochenergetische Ultraschall erlaubt aufgrund der Echtzeittemperaturüberwachung eine präzise und sichere Thermoablation der Myome, die bei bis zu 90% der Patientinnen zu einer signifikanten Symptombesserung führt. Das Nebenwirkungsprofil erweist sich als ausgesprochen günstig. Bisherige klinische Studien konnten Sicherheit, Effektivität und therapeutischen Nutzen sowie eine deutlich kürzere Rekonvaleszenz im Vergleich zur Uterusarterienembolisation (UAE) und den operativen Verfahren belegen. Weitere prospektive Studien müssen den Langzeiterfolg, die Gleichwertigkeit gegenüber etablierten Therapieverfahren und die Einsatzmöglichkeit bei prospektivem Kinderwunsch evaluieren. Durch stetigen Erfahrungszuwachs und technische Weiterentwicklung wird der HIFU langfristig eine schonende Behandlungsmöglichkeit symptomatischer Uterusmyome darstellen und birgt ein großes Potenzial auch für weitere Indikationen.

Abstract

Uterine fibroids are the most common benign tumors in postmenopausal women which can cause severe symptoms and considerably reduce the quality of life. Patients are requesting minimally invasive, organ-saving therapies increasingly more often and magnetic resonance-guided focused ultrasound is a promising new technology which even surpasses these requirements as it is a totally non-invasive approach. The possibility of real-time temperature mapping allows a safe and precise thermal ablation of uterine fibroids. The rate of adverse events is low and safety and efficiency have been proven in several clinical studies. Further studies will have to be carried out to demonstrate long-term success and comparability to the established therapies and clarify if focused ultrasound is a safe treatment for women with the desire for future pregnancy. The MR-guided focused ultrasound technique is an effective and gentle treatment for uterine fibroids and holds a great potential for further indications.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    T. Eckey, A. Neumann, J. Barkhausen & P. Hunold

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    M.K. Bohlmann

  3. Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    T. Eckey

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  1. T. Eckey
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  2. A. Neumann
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  4. J. Barkhausen
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  5. P. Hunold
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Correspondence to T. Eckey.

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Eckey, T., Neumann, A., Bohlmann, M. et al. Nichtinvasive Thermoablation symptomatischer Uterusmyome mit MR-gesteuertem hochenergetischem Ultraschall. Radiologe 51, 610–619 (2011). https://doi.org/10.1007/s00117-010-2117-3

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  • DOI: https://doi.org/10.1007/s00117-010-2117-3

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