Magnetic-resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive
thermo-ablative technique that uses focused high-energy ultrasound to ablate fibroid
tissue. As in conventional diagnostic ultrasound, the ultrasound waves pass through
the anterior abdominal wall. Significant heating only occurs where the waves converge
at the focus. Magnetic resonance guidance provides continuous imaging of the fibroid
and other vital structures such as bowel, bladder and sacral nerves.
Significant improvement in quality-of-life parameters has been reported in women
undergoing MRgFUS. Given considerable symptoms at enrolment and a large decrease
in mean symptom levels, this appears to be a clinically significant result. The volume
reduction after treatment is small compared with the mean levels seen after both myomectomy
and uterine artery embolization (UAE). MRgFUS appears to be a safe intervention
for uterine fibroids.31 None of the MRgFUS-treated patients had urgent
surgical procedures or bowel injuries, which are reported in many early studies of
new investigational devices for uterine fibroids. Furthermore, women who have
treatment with MRgFUS do not appear to develop symptoms similar to the postembolization
syndrome symptoms associated with UAE.
The mean time of return to work after MRgFUS was approximately 1 day, compared
with 13 days after UAE and approximately 6 weeks after abdominal myomectomy
or hysterectomy. However, the true place of MRgFUS has yet to be
established in comparison with the other available treatment modalities by way of randomized
controlled clinical trials.