Proof quality and the possibility of bias
Two reviewers separately measured the level of proof in all publications using the Oxford Centre for Evidence-based Medicine (OCEBM) recommendations. A Delphi methodology was used to build an 18-criterion method to determine the consistency of the case series. A score of 14 or higher showed high efficiency. Dissension was used to identify and address discrepancies. When the two authors could not agree, a third author was contacted.
The articles that were considered had applied similar inclusion criteria: patients of more than 18 years of age or at pre-or peri-menopausal state. These studies have excluded patients in whom MRI with gadolinium is contraindicated or pregnant women. Chen et al. 15, Tung S L et al. 16, Jeong J, H et al. 17 and Tan N et al.20excluded uterine fibroids larger than 10 to 12 cm. Funaki Type 3 fibroid was also excluded in Chen et al. 15, Tung S L et al. 16, Jeong J H et al. 17 and Park M J et al.22. Besides, Jeong J H et al. 17 also included the effectiveness of MR-HIFU in patients with concomitant adenomyosis. The characteristics of these studies are tabulated in Table 2.
Meta-analysis was performed using NCSS software. The data were analyzed at a 95% confidence level with a level of precision at 0.05. The NPV%, tSSS change%, and QoL were computed. Meta-Regression was done to evaluate the association between the different parameters.