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From the RSNA Refresher Courses

Image-guided Thermal Therapy of Uterine Fibroids¹

¹ From the Department of Clinical Focused Ultrasound, Brigham & Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115. Presented as a refresher course at the 2007 RSNA Annual Meeting. Received May 4, 2007; revision requested May 16 and received July 25; accepted August 3. The author has received support from and is a consultant for Insightec. Address correspondence to the author (e-mail: ctempany{at}bwh.harvard.edu).

One of the most recent additions to the methods for image-guided therapy is magnetic resonance (MR)-guided focused ultrasound. This method represents a unique closed-loop therapy, with planning, guidance, control, and direct feedback (called MR thermometry), which work together to ensure an effective therapy. The focused ultrasound induces focal tissue destruction by thermocoagulation in a noninvasive manner.

MR also enables real-time thermometry to be performed during each and every sonication. These characteristics make MR-guided focused ultrasound an exciting new approach for treating fibroids. Fibroids are diagnosed based on findings from the patient’s physical examination supplemented by imaging results. MR imaging is preferred to other imaging modalities because it enables the fibroids and the entire pelvis to be fully examined. After individual fibroids are identified and the target area is defined by the radiologist, the target volume is analyzed in a three-dimensional assessment to ensure the patient’s safety. The procedure begins with the delivery of low-power sonication, and the power is gradually increased until the therapeutic dose is reached. After the procedure, postcontrast images are acquired; these should demonstrate tissue necrosis. The results of clinical trials have shown that the treatment is safe, effective, and highly acceptable to patients.

© RSNA, 2007