Introduction
Women, mostly in their reproductive age, suffer from uterine leiomyomas,
also called uterine fibroids or uterine myomas. These are benign tumors
of uterine muscle and are clinically detectable with prolonged heavy
bleeding during the menstrual period, sacral pain, secondary
dysmenorrhea, constipation, increased frequency of UTIs, and
pregnancy-associated problems1. About 25% of women
are clinically symptomatic2. Fibroids may affect
fertility, thereby negatively influencing a woman who desires pregnancy.
These uterine fibroids also impact the usual activities, leads to
diminished quality of life and increasing healthcare
costs3. Although surgeries like hysterectomy are the
gold standard for most women4, this approach is not
the prime choice for women who want to conceive. Enucleation via
laparoscopy is a uterine-conserving treatment. Medical treatment options
are also available and applied, but their aftermath is sizeable as it
results in the recurrence of leiomyomas. Non-invasive procedures are
making ground in recent years because of fewer complications, patient
compliance, short hospital stay, and cost-effectiveness. They include
uterine artery embolization (UAE) and Magnetic Resonance-High Intensity
Focused Ultrasound (MR-HIFU)5-6.
In place of uterine conserving treatment and fertility, however, UAE
leads to a potential reduction of the ovarian reserve. Even though it is
an attractive efficacious treatment choice, its implication is confined
only to pre-or post-menopausal women.
MR-HIFU is a non-invasive ablative novel therapy. The process of MR-HIFU
involves coagulative necrosis of the fibroid by thermal effect and no
disruption to the adjacent structures. There are no bleeding or drug
side effects after this treatment modality7. Usually,
tissue necrosis occurs when subjected to 43°C or more for at least an
hour; however, the necrosis can occur within a second if subjected to
56°C or more 8,9. Two real times guided HIFU
treatments are available; ultrasound-guided and MRI-guided. The
ultrasonography-guided HIFU has a low resolution and limited precision
for targeting and visualizing the adjacent structure’s details.
Simultaneously, MRI-guided HIFU has a high resolution allowing detection
of even a tiny thermal increase outside the target points before any
tissue damage10-11. Various studies have also shown
that MR-HIFU effectively eradicates multiple uterine fibroids and leads
to a reduction in the non-perfused volume (NPV) of fibroids with no side
effects12.
Even after the effective therapy of MRI guided HIFU, all patients are
not eligible for this treatment modality. Funaki type 3 fibroids are
challenging to treat because of high T2 signal intensity and high BMI of
women are the significant reasons for excluding this treatment option
for uterine fibroid 13.
Rationale: Several studies on the efficacy of MRHIFU therapy for
uterine fibroids have been released to date. Overall, they found that
MRHIFU successfully reduces symptoms, but there was a high rate of
re-intervention14–17. However, trials that used
restrictive treatment methods that are no longer in use in clinical
practice influenced the findings of these analyses.
Objectives: The aim was to re-evaluate the efficacy of MR-HIFU in
reducing fibroid-related symptoms using treatment protocols that focused
solely on total ablation. We also looked at care failures and technical
performance as assessed by the post-treatment NPV percent. We also
looked at the disease-specific quality of life, re-intervention rates,
stability, fertility, costs, and fibroid shrinkage.