Data Extraction:
Data were derived separately from all qualifying studies by the same two scientists. A description of findings table was developed, which included (a) research characteristics such as authors, year of publication, study style, MRHIFU method, sample size, and follow-up time; (b) Treatment parameters: NPV percent, patient eligibility percentage, number of technological errors, use of bowel-interference reduction methods, and sonication duration are all metrics to consider. (c) primary outcome: reduction of fibroid-related symptoms, preferably as measured by the validated disease-specific Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QoL); (d) secondary outcomes: Health-Related Quality of Life (HRQL), as measured by the UFS-QoL questionnaire, fibroid shrinkage as measured by follow-up MR imaging, and the occurrence of any (serious) adverse events.
The outcomes analyzed were NPV%, defined by the formula: (non-perfused volume/fibroid volume)*10025-27. Fibroid shrinkage is defined as the reduction in the size of the uterine fibroids after MR-HIFU. A higher transformed Symptom Severity Score (ISS) indicates more significant symptom severity28. Health-related quality of life concerning uterine fibroid comprises questions asked on a five-point Likert scale, and the score is transformed in numeric from 0 to 10029. The patient who had to undergo a second intervention after MRI-HIFU treatment for uterine fibroid related problems was considered in reintervention percentage.
Skin burns, menstrual bleeding or unexplained discharge, cystitis, urinary obstruction, constitutional complications, nerve injury, or discomfort for more than seven days were all considered minor adverse events. Patients that needed a second injection due to fibroid-related symptoms were included in the re-intervention percentage (second MR-HIFU, hysterectomy, myomectomy, or UAE).
Disagreements are settled by dialogue or consultation with a third author. Several reports of a single clinical trial were available, the most recent publication was used as the guide, and additional information was gleaned from secondary journals. We tried to reach the relevant authors by submitting an e-mail with a submission for supplementary data if results were unavailable. A second e-mail was sent if there was no response after seven days.