MRI guided HIFU, or Magnetic Resonance Imaging guided High Intensity Focused

Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do  not  require  any  treatment  for  these  fibroids. Occasionally,  the  fibroids  can  cause  pain,  heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of micturition due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.

Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.

As fibroids are almost always benign, with a neglible percentage (0.07% of operated patients - Parker W, Berek J, Fu YS., Obstetrics and Gynecology 1994; 83:414-8) showing the presence of a sarcoma (malignancy), fibroids only require treatment for the alleviation of symptoms due to the fibroid.

Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.

The   mainstay   of   treatment   of   symptomatic   fibroids   has   been   surgery,   which  could   be   either myomectomy  (removal  of  the  fibroid),  or  hysterectomy  (removal  of the  uterus).  Of  these,  only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery   period   before  the   patient   returns   to   normal   activities.   Both   hysterectomy   as   well   as myomectomy  can  also  be  done  laparoscopically  (key-hole  surgery),  dramatically reducing  the  post- operative   morbidity.   However,   even   these   are   invasive  techniques,   and   the   risks   and   possible complications of surgery and anesthesia remain a constant threat.

The  search  for  non-invasive  techniques  to  provide  the  patient  with  relief  from  this otherwise  non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency   Ablation   which   however   had   limited   efficacy,  and   considerable   adverse   effects   like excruciating post-treatment pain.

MRI guided HIFU, or Magnetic Resonance Imaging guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

The  procedure  is  gaining  wide  acceptance  because  of  the  ease  of  use,  exemplary safety  and  minimal disruption in the patients’ daily routine. This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure.

The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term (Elizabeth A Stewart et al, Obstet Gynecol 2007;
110:279-87).