MR-HIFU therapy for adenomyosis

In adenomyosis, the cells of the uterine lining invade the muscles of the uterus and grow there, causing it to double or triple in size in some cases. As these cells continue to behave as they would in their natural location and grow in line with the menstrual cycle, adenomyosis can be accompanied by severe symptoms, some of which are cycle-dependent. The typical symptoms that patients suffer from include excessively heavy and heavy periods, pelvic pain and a feeling of pressure in the bladder and rectum. Pain during sexual intercourse is also part of the symptom spectrum. In addition to medical and surgical procedures, HIFU therapy is available at the University Hospital of Cologne as a non-invasive treatment option.

If you are interested in undergoing MR-HIFU therapy to treat your adenomyosis or have been referred to us by your treating physician, you can find out more about this treatment method below.

If you would like more information or have a specific treatment request, please contact us at mr-hifu.therapie@uk-koeln.de.

Why is MR-HIFU therapy suitable for adenomyosis?

HIFU (high-intensity focused ultrasound) is a non-invasive treatment method and offers an effective alternative to surgery and/or drug therapy. Similar to focusing the sun's rays on a spot with a magnifying glass, the HIFU procedure focuses ultrasound waves non-invasively through the abdominal wall onto the adenomyosis tissue, heating it to around 60°C for a short time in a controlled manner without damaging the skin or surrounding tissue. The adenomyosis tissue dies after the treatment and is broken down by the body on its own, resulting in a significant reduction in symptoms in the weeks following the treatment. HIFU treatment is performed in a magnetic resonance imaging scanner (MR-HIFU), which allows the doctor to control the focused ultrasound with millimeter precision using MRI images of the adenomyosis and the surrounding tissue and to monitor the therapy.

What are the advantages of MR-HIFU therapy?

One of the biggest advantages of MR-HIFU treatment is that the procedure is completely non-invasive and has few side effects. There is no surgery involved, so some patients prefer HIFU therapy to surgery for cosmetic reasons. The patient is conscious during the entire treatment and does not need to be anesthetized. In contrast to total surgery, with this treatment method the patient still has the opportunity to fulfill her desire to have children. The treatment can be performed on an outpatient basis, but overnight admission is recommended for better control. Patients can usually return to their daily routine within a few days. Several studies have shown that MR-HIFU therapy effectively alleviates symptoms and improves patients' quality of life.

Who is eligible for MR-HIFU therapy for adenomyosis?

In principle, MR-HIFU therapy is suitable for women who decide against surgery for their adenomyosis and prefer a non-invasive treatment without anesthesia. In order to determine whether the patient is suitable for MR-HIFU therapy, it is absolutely necessary to carry out an MRI examination beforehand to determine the exact location of the adenomyosis and thus the accessibility for MR-HIFU.

For whom is MR-HIFU treatment of adenomyosis not suitable?

Patients should discuss in advance with the responsible radiologist to what extent MR-HIFU treatment is possible and sensible in the case of metal parts in the body (surgical staples or screws, pacemakers, dentures, etc.), extreme claustrophobia, existing pregnancy or allergies to contrast agents. In general, the location and size of the adenomyosis should also be discussed in a personal consultation with the radiologist to see whether MR-HIFU treatment is sensible. In general, MRI imaging is performed in advance to ensure that MR-HIFU treatment is possible. MRI imaging may also be requested as a follow-up.

How can the patient prepare for the adenomycosis treatment?

For hygienic reasons, MR-HIFU treatment is normally avoided during menstruation; this should be taken into account when making an appointment.

The day before the treatment, the hair in the pelvic area should be removed (the easiest way is to shave). No skin cream or oil should be used in this area until the procedure. The patient should have an empty stomach on the day of treatment. The last meal should be eaten at least 12 hours before the treatment. A small glass of water is permitted on the morning of the treatment day.

What exactly happens during the treatment?

The HIFU ultrasound transducer is built into the patient table of a magnetic resonance tomograph (MRT). For treatment, the patient is positioned lying on her stomach over the ultrasound transducer. The treatment table is then inserted into the MRI scanner and remains there during the treatment. The first step is to take MRI images of the uterus and the adenomyosis in order to plan the treatment. Using these images, the radiologist can then direct focused ultrasound waves at the adenomyosis and heat the tissue change in a targeted manner, whereby the tissue temperature is continuously measured and controlled with the help of the magnetic resonance tomograph (real-time image control). The patient and radiologist are only separated by a window and can communicate with each other at any time via a microphone. The treatment is largely painless. Occasionally, discomfort similar to menstrual pain may occur. Pain medication is available for such cases. In most cases, a urinary bladder catheter is inserted before the start of treatment to prevent movement of the uterus due to the bladder filling up during treatment.

What happens after the treatment?

After the treatment, the patient will remain in the university hospital overnight for observation. The treatment has few, if any, side effects. These are considerably fewer than the possible complications experienced by patients after surgery. On average, patients are on sick leave for one day after HIFU treatment and can then resume their normal physical activities.

• Read more about our equipment here
• Interventional radiology and MR-HIFU as a focus at the institute
• Research in experimental imaging and interventional radiology