Fibroids treated with MR-HIFU

Virtually all types of fibroid can be treated, provided they can be reached by the HIFU beam without the beam's path being blocked by the intestine. Subserosal, intramural and submucosal fibroids can be subjected to routine treatment. Subserosal fibroids can be treated up to a margin of 1.5 cm from the serosal surface. In women who do not wish to have children, submucosal fibroids can be treated up to the endometrial surface. Pedunculated fibroids with thin stalks must not be treated.

As MR imaging is used to plan the treatment, MR characteristics are used to determine which fibroids respond best to HIFU treatment. Fibroids with low signal intensity in pretherapeutic T2-weighted images (dark fibroids) shrink more than fibroids with high signal intensity (light fibroids).

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Due to the heterogeneous nature of the fibroid tissue and patient-specific, physiological differences in the near field, it is anticipated that, when using methods to determine the fibroid type prior to MR-HIFU therapy, other factors, such as DCE-MR, will also need to be considered. A combination of anatomical findings and the MR image characteristics must therefore be used to determine whether MR-HIFU is the best treatment for a particular patient.

There may be some practical considerations that prevent a patient from having MR-HIFU therapy. Certain patient characteristics can cause difficulties when treating fibroids located deep within the body with MR-HIFU. The geometric focus of the transducer is 14 cm from the transducer surface. The distance between the skin and the center of the fibroid must be approximately 10 cm in order to ensure treatment is as easy as possible. If a patient has a very thick layer of subcutaneous fatty tissue or the fibroid is located too far back, more careful preparation may be needed to ensure that the treatment reaches the entire fibroid.

Care must also be taken with any large scars from previous pelvic operations if the scars are located in the path of the ultrasonic beam. Ultrasonic energy must not be directed through fresh and/or extensive scars as it may cause localized heating of the tissue. These structures can be avoided by positioning the patient in such a way as to change the path of the beam. The beam-shaping feature of the MR-HIFU software can be used for this purpose or a protective cover can be placed over the scar tissue. Finally, all contraindications that apply to MRI scans (e.g. pacemakers etc.) are also applicable to MR-HIFU therapy.

There is currently no restriction on the percentage of a fibroid that can be treated with MR-HIFU, however a treatment volume of at least 50–60% of the total fibroid volume is currently recommended. Physicians currently aim to relieve the patient's most acute symptoms. This may mean that one fibroid is treated, but others are not, and/or that the total treatment volume is reduced.

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