The Role of Magnetic Resonance Guided Focused Ultrasound for Uterine Fibroids

  • Anne Roberts
Part of the Medical Radiology book series (MEDRAD)


Uterine fibroids are the most common pelvic tumor in women. Fibroids can cause significant bleeding during menses, as well as causing pelvic pressure and pain, urinary frequency, urinary incontinence, constipation, obstetrical complications, and infertility. It has been estimated that 30 % of women with fibroids have significant symptoms. (Flynn et al. 2006) The treatment for fibroids includes: medical therapy (oral contraceptives, GRNH agonists), myomectomy (hysteroscopic, laparoscopic, and open), hysterectomy (laparoscopic/robotic and open), and uterine artery embolization (UAE). Magnetic Resonance Guided Focused Ultrasound (MRgFUS) is being increasingly used for the treatment of uterine fibroids. Combining MR imaging to define the target and to control and monitor the ablation, and an ultrasound transducer that controls and delivers the focused ultrasound beam, MRgFUS allows a non-invasive approach to the treatment of uterine fibroids.


Essential Tremor GnRH Agonist Uterine Artery Embolization Uterine Fibroid Focus Ultrasound 
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  1. Arleo EK, Khilnani NM, Ng A, Min RJ (2007) Features influencing patient selection for fibroid treatment with magnetic resonance-guided focused ultrasound. J Vasc Interv Radiol 18(5):681–685PubMedCrossRefGoogle Scholar
  2. Bouwsma EV, Hesley GK, Woodrum DA, Weaver AL, Leppert PC, Peterson LG, Stewart EA (2011) Comparing focused ultrasound and uterine artery embolization for uterine fibroids-rationale and design of the fibroid interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertil Steril 96(3):704–710. doi: 10.1016/j.fertnstert.2011.06.062 PubMedCentralPubMedCrossRefGoogle Scholar
  3. Catane R, Beck A, Inbar Y, Rabin T, Shabshin N, Hengst S, Pfeffer RM, Hanannel A, Dogadkin O, Liberman B, Kopelman D (2007) MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases–preliminary clinical experience. Ann Oncol 18(1):163–167PubMedCrossRefGoogle Scholar
  4. Fan TY, Zhang L, Chen W, Liu Y, He M, Huang X, Orsi F, Wang Z (2012) Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis. Eur J Radiol 81(11):3624–3630. doi: 10.1016/j.ejrad.2011.05.036 PubMedCrossRefGoogle Scholar
  5. Flynn M, Jamison M, Datta S, Myers E (2006) Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol 195(4):955–964PubMedCrossRefGoogle Scholar
  6. Funaki K, Fukunishi H, Funaki T, Kawakami C (2007) Mid-term outcome of magnetic resonance-guided focused ultrasound surgery for uterine myomas: from six to twelve months after volume reduction. J Minim Invasive Gynecol 14(5):616–621PubMedCrossRefGoogle Scholar
  7. Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, Myers ER (2008) Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the fibroid registry. Obstet Gynecol 111(1):22–33PubMedCrossRefGoogle Scholar
  8. Health FCfDaR (2004) Exablate 2000 system—p040003. pp: Part 3 professional labelingGoogle Scholar
  9. Hesley GK, Felmlee JP, Gebhart JB, Dunagan KT, Gorny KR, Kesler JB, Brandt KR, Glantz JN, Gostout BS (2006) Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging-guided focused ultrasound. Mayo Clin Proc 81(7):936–942PubMedCrossRefGoogle Scholar
  10. Hynynen K (2008) Fundamental principles of therapeutic ultrasound. In: Jolesz F, Hynyen K (eds) MRI-guided focused ultrasound surgery. Informa Healthcare, New York, pp 5–23Google Scholar
  11. Kim HS, Baik JH, Pham LD, Jacobs MA (2011) MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol 18(8):970–976. doi: 10.1016/j.acra.2011.03.008 PubMedCentralPubMedCrossRefGoogle Scholar
  12. Kim YS, Keserci B, Partanen A, Rhim H, Lim HK, Park MJ, Kohler MO (2012a) Volumetric MR-HIFU ablation of uterine fibroids: role of treatment cell size in the improvement of energy efficiency. Eur J Radiol 81(11):3652–3659. doi: 10.1016/j.ejrad.2011.09.005 PubMedCrossRefGoogle Scholar
  13. Kim YS, Kim JH, Rhim H, Lim HK, Keserci B, Bae DS, Kim BG, Lee JW, Kim TJ, Choi CH (2012b) Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology 263(2):600–609. doi: 10.1148/radiol.12111707 PubMedCrossRefGoogle Scholar
  14. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O (2008) Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 31(1):73-85.Google Scholar
  15. McDannold N, Tempany CM, Fennessy FM, So MJ, Rybicki FJ, Stewart EA, Jolesz FA, Hynynen K (2006) Uterine leiomyomas: MR imaging-based thermometry and thermal dosimetry during focused ultrasound thermal ablation. Radiology 240(1):263–272PubMedCentralPubMedCrossRefGoogle Scholar
  16. Mikami K, Murakami T, Okada A, Osuga K, Tomoda K, Nakamura H (2008) Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience. Radiat Med 26(4):198–205PubMedCrossRefGoogle Scholar
  17. Olive DL (2008) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 111(3):775, author reply 775–776Google Scholar
  18. Parker WH (2007) Uterine myomas: management. Fertil Steril 88(2):255–271PubMedCrossRefGoogle Scholar
  19. Pelage JP, Guaou NG, Jha RC, Ascher SM, Spies JB (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230(3):803–809PubMedCrossRefGoogle Scholar
  20. Polina L, Nyapathy V, Mishra A, Yellamanthili H, Vallabhaneni MP (2012) Noninvasive treatment of focal adenomyosis with MR-guided focused ultrasound in two patients. Indian J Radiol Imaging 22(2):93–97. doi: 10.4103/0971-3026.101078 PubMedCentralPubMedCrossRefGoogle Scholar
  21. Venkatesan AM, Partanen A, Pulanic, TK, Dreher MR, Fischer J, Zurawin, RK, Muthupillai, R, Sokka, S, Nieminen, HJ, Sinaii, N, Merino, M, Wood, BJ, Stratton, P (2012) Magnetic resonance imaging-guided volumetric ablation of symptomatic leiomyomata: correlation of imaging with histology. J Vasc Interv Radiol 23(6):786–794, e784. DOI  10.1016/j.jvir.2012.02.015
  22. Rabinovici J, Inbar Y, Eylon SC, Schiff E, Hananel A, Freundlich D (2006) Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report. Hum Reprod 21(5):1255–1259PubMedCrossRefGoogle Scholar
  23. Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA (2010) Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 93(1):199–209. doi: 10.1016/j.fertnstert.2008.10.001 PubMedCrossRefGoogle Scholar
  24. Smart OC, Hindley JT, Regan L, Gedroyc WG (2006) Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol 108(1):49–54PubMedCrossRefGoogle Scholar
  25. Spies JB (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol, 110(6):1427–1428, author reply 1428–1429Google Scholar
  26. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300PubMedCrossRefGoogle Scholar
  27. Stafford RJ, Hazle JD (2008) Fundamental principles of magnetic resonance temperature imaging. In: Jolesz F, Hynyen K (eds) MRI-guided focused ultrasound surgery. Informa, New York, pp 25–42Google Scholar
  28. Stewart EA, Rabinovici J, Tempany CM, Inbar Y, Regan L, Gostout B, Hesley G, Kim HS, Hengst S, Gedroyc WM (2006) Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85(1):22–29PubMedCrossRefGoogle Scholar
  29. Tempany CM (2007) From the RSNA refresher courses: Image-guided thermal therapy of uterine fibroids. Radiographics 27(6):1819–1826PubMedCrossRefGoogle Scholar
  30. Trumm CG, Stahl R, Clevert DA, Herzog P, Mindjuk I, Kornprobst S, Schwarz C, Hoffmann RT, Reiser MF, Matzko M (2013) Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest Radiol. doi: 10.1097/RLI.0b013e3182806904 PubMedGoogle Scholar
  31. Voogt MJ, Trillaud H, Kim YS, Mali WP, Barkhausen J, Bartels LW, Deckers R, Frulio N, Rhim H, Lim HK, Eckey T, Nieminen HJ, Mougenot C, Keserci B, Soini J, Vaara T, Kohler MO, Sokka S, van den Bosch MA (2012a) Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol 22(2):411–417. doi: 10.1007/s00330-011-2262-8 PubMedCentralPubMedCrossRefGoogle Scholar
  32. Voogt MJ, van Stralen M, Ikink ME, Deckers R, Vincken KL, Bartels LW, Mali WP, van den Bosch MA (2012b) Targeted vessel ablation for more efficient magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids. Cardiovasc Intervent Radiol 35(5):1205–1210. doi: 10.1007/s00270-011-0313-9 PubMedCentralPubMedCrossRefGoogle Scholar
  33. Yoon SW, Seong SJ, Jung SG, Lee SY, Jun HS, Lee JT (2011) Mitigation of abdominal scars during MR-guided focused ultrasound treatment of uterine leiomyomas with the use of an energy-blocking scar patch. J Vasc Interv Radiol 22(12):1747–1750. doi: 10.1016/j.jvir.2011.07.005 PubMedCrossRefGoogle Scholar
  34. Zaher S, Gedroyc WM, Regan L (2009) Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids. Eur J Obstet Gynecol Reprod Biol 143(2):98–102. doi: 10.1016/j.ejogrb.2008.12.011 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Radiology, UCSD/Thornton HospitalUniversity of CaliforniaSan DiegoUSA
  2. 2.Veterans Administration Medical CenterSan DiegoUSA

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