We performed a systematic review about studies reporting data of myomectomy performed by magnetic resonance-guided focused ultrasound (MRgFUS) technique in order to define its safety, feasibility, indications, complications, and impact on uterine fibroid symptom and health-related quality of life (UFS-QOL) and fertility. Outcomes were considered according to fibroids shrinkage, nonperfused volume (NPV), NPV ratio, and uterine fibroid symptoms assessed with UFS-QOL questionnaire (baseline 3, 4, 6, and 12 months). We analyzed 38 eligible studies reporting outcomes about 2500 patients (mean age 43.67 years). The MRgFUS results a safe, efficient, and cost-effective minimal invasive technique for treatment of uterine fibroids. Increasing experience, device improvements, and availability for a larger number of patients are enhancing the outcomes, while the obstetrical ones should be more extensively explored. The MRgFUS could be considered as a minimal invasive alternative to traditional surgical or radiological procedures for the treatment of symptomatic uterine myomas improving both QOL and subsequent fertility.
WalkerCLStewartEA. Uterine fibroids: the elephant in the room. Science. 2005;308(5728):1589–1592.
2.
MachtingerRInbarYCohen-EylonSAdmonDAlagem-MizrachiARabinoviciJ. MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success. Hum Reprod. 2012;27(12):3425–3431.
3.
TaranFATempanyCMReganLInbarYRevelAStewartEA; MRgFUS Group. Magnetic resonance-guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas. Ultrasound Obstet Gynecol. 2009;34(5):572–578.
4.
JenneJWPreusserTGüntherM. High-intensity focused ultrasound: principles, therapy guidance, simulations and applications. Z Med Phys. 2012;22(4):311–322.
5.
RingoldS. FDA approves ultrasound fibroid therapy. JAMA. 2004;292(23):2826.
6.
DobrotwirAPunE. Clinical 24 month experience of the first MRgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol. 2012;56(4):409–416.
7.
HesleyGKGornyKRWoodrumDA. MR-guided focused ultrasound for the treatment of uterine fibroids. Cardiovasc Intervent Radiol. 2013;36(1):5–13.
8.
VoogtMJTrillaudHKimYS. Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol. 2012;22(2):411–417.
9.
ZhangLChenWZLiuYJ. Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus. Eur J Radiol. 2010;73(2):396–403.
10.
TempanyCMStewartEAMcDannoldNQuadeBJJoleszFAHynynenK. MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology. 2003;226(3):897–905.
11.
StewartEAGostoutBRabinoviciJKimHSReganLTempanyCM. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007;110(2 pt 1):279–287.
NyapathyVPolinaL. MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine. J Radiol Case Rep. 2012;6(2):1–8.
14.
MoritaYItoNHikidaHTakeuchiSNakamuraKOhashiH. Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids—early experience. Eur J Obstet Gynecol Reprod Biol. 2008;139(2):199–203.
15.
de MeloFCDiacoyannisLMollATovar-MollF. Reduction by 98% in uterine myoma volume associated with significant symptom relief after peripheral treatment with magnetic resonance imaging-guided focused ultrasound surgery. J Minim Invasive Gynecol. 2009;16(4):501–503.
16.
FunakiKFukunishiHFunakiTKawakamiC. Mid-term outcome of magnetic resonance-guided focused ultrasound surgery for uterine myomas: from six to twelve months after volume reduction. J Minim Invasive Gynecol. 2007;14(5):616–621.
17.
RabinoviciJDavidMFukunishiHMoritaYGostoutBSStewartEA; MRgFUS Study Group. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril. 2010;93(1):199–209.
18.
HindleyJGedroycWMReganL. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol. 2004;183(6):1713–1719.
19.
FunakiKFukunishiHSawadaK. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol. 2009;34(5):584–589.
20.
OkadaAMoritaYFukunishiHTakeichiKMurakamiT. Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: impact of the learning curve on patient outcome. Ultrasound Obstet Gynecol. 2009;34(5):579–583.
21.
PilatouMCStewartEAMaierSE. MRI-based thermal dosimetry and diffusion-weighted imaging of MRI-guided focused ultrasound thermal ablation of uterine fibroids. J Magn Reson Imaging. 2009;29(2):404–411.
22.
KimKAYoonSWYoonBSParkCTKimSHLeeJT. Spontaneous vaginal expulsion of uterine myoma after magnetic resonance-guided focused ultrasound surgery. J Minim Invasive Gynecol. 2011;18(1):131–134.
23.
ZaherSLyonsDReganL. Uncomplicated term vaginal delivery following magnetic resonance-guided focused ultrasound surgery for uterine fibroids. Biomed Imaging Interv J. 2010;6(2):e28.
24.
ZaherSLyonsDReganL. Successful in vitro fertilization pregnancy following magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res. 2011;37(4):370–373.
25.
HardingGCoyneKSThompsonCLSpiesJB. The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes. 2008;6:99.
26.
SpiesJBCoyneKGuaou GuaouNBoyleDSkyrnarz-MurphyKGonzalvesSM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002;99(2):290–300.
27.
StewartEARabinoviciJTempanyCM. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril. 2006;85(1):22–29.
28.
LeBlangSDHoctorKSteinbergFL.Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol. 2010;194(1):274–280.
29.
FennessyFMTempanyCMMcDannoldNJ. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery—results of different treatment Protocolls. Radiology. 2007;243(3):885–893.
KimYSKimJHRhimH. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology. 2012;263(2):600–609.
32.
MikamiKMurakamiTOkadaAOsugaKTomodaKNakamuraH. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience. Radiat Med. 2008;26(4):198–205.
33.
SmartOCHindleyJTReganLGedroycWG.Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol. 2006;108(1):49–54.
34.
TrummCGStahlRClevertDA. Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest Radiol. 2013;48(6):359–365.
35.
VenkatesanAMPartanenAPulanicTK. Magnetic resonance imaging-guided volumetric ablation of symptomatic leiomyomata: correlation of imaging with histology. J Vasc Interv Radiol. 2012;23(6):786–794.e4.
36.
YoonSWSeongSJJungSGLeeSYJunHSLeeJT. Mitigation of abdominal scars during MR-guided focused ultrasound treatment of uterine leiomyomas with the use of an energy-blocking scar patch. J Vasc Interv Radiol. 2011;22(12):1747–1750.
37.
ParkHYoonSWKimKAJung KimDJungSG. Magnetic resonance imaging-guided focused ultrasound treatment of pedunculated subserosal uterine fibroids: a preliminary report. J Vasc Interv Radiol. 2012;23(12):1589–1593.
38.
DesaiSBPatilAANikamRDesaiASBachhavV. Magnetic resonance-guided focused ultrasound treatment for uterine fibroids: first study in indian women. J Clin Imaging Sci. 2012;2:74.
39.
YoonSWLeeCKimKAKimSH. Contrast-enhanced dynamic MR imaging of uterine fibroids as a potential predictor of patient eligibility for MR guided focused ultrasound (MRgFUS) treatment for symptomatic uterine fibroids. Obstet Gynecol Int. 2010;2010:834275.
40.
GornyKRWoodrumDABrownDL. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 2011;22(6):857–864.
41.
HanstedeMMTempanyCMStewartEA.Focused ultrasound surgery of intramural leiomyomas may facilitate fertility: a case report. Fertil Steril. 2007;88(2):497.e5–497.e7.
42.
BouwsmaEVGornyKRHesleyGKJensenJRPetersonLGStewartEA. Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility. Fertil Steril. 2011;96(1):e9–e12.
43.
Gavrilova-JordanLPRoseCHTraynorKDBrostBCGostoutBS. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma. J Perinatol. 2007;27(1):59–61.
44.
VoogtMJvan StralenMIkinkME. Targeted vessel ablation for more efficient magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids. Cardiovasc Intervent Radiol. 2012;35(5):1205–1210.
45.
SmartOCHindleyJTReganLGedroycWM. Magnetic resonance guided focused ultrasound surgery of uterine fibroids—the tissue effects of GnRH agonist pre-treatment. Eur J Radiol. 2006;59(2):163–167.
46.
O’SullivanAKThompsonDChuPLeeDWStewartEAWeinsteinMC. Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids. Int J Technol Assess Health Care. 2009;25(1):14–25.
47.
ZowallHCairnsJABrewerCLampingDLGedroycWMReganL. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG. 2008;115(5):653–662.
48.
NieboerTEJohnsonNLethabyA. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;(3):CD003677.
49.
GriffithsAD'AngeloAAmsoN.Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2006;(3):CD003857.
50.
MossJGCooperKGKhaundA. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011;118(8):936–944.
51.
GizzoSAnconaEPatrelliTS. Fertility preservation in young women with cervical cancer: an oncologic dilemma or a new conception of fertility sparing surgery?Cancer Invest. 2013;31(3):189.
