MR-HIFU therapy of uterine fibroids

Uterine fibroids are the most common benign tumors of the uterus and cause symptoms in around 25% of women affected. They are usually single large or several smaller fibroids that cause symptoms such as heavy periods, bleeding disorders and severe pain during sexual intercourse or during menstruation. A strong urge to urinate can also be part of the symptoms, as the fibroids can press on the bladder in some cases. In some cases, fibroids can also be the reason for an unfulfilled desire to have children or a premature birth or miscarriage. From a certain size of fibroid and if the quality of life is impaired due to the symptoms, HIFU therapy is available as a non-invasive treatment method at the University Hospital of Cologne, in addition to surgical and other invasive treatment methods.

If you are interested in undergoing MR-HIFU therapy to treat your uterine fibroids or have been referred to us by your doctor, 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 uterine fibroids?

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 fibroid tissue, heating it to around 60°C for a short time in a controlled manner without damaging the skin or surrounding tissue. The fibroid tissue dies after the treatment and is broken down by the body on its own, resulting in a significant reduction in the size of the fibroid 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 imaging of the fibroid 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 uterine fibroids?

In principle, MR-HIFU therapy is suitable for women who decide against surgery for their uterine fibroids and prefer a non-invasive treatment without anesthesia. In order to determine whether the patient is suitable for MR-HIFU therapy, it is essential to perform an MRI scan in advance to determine the exact location of the uterus and uterine fibroids and thus the accessibility for MR-HIFU. On the other hand, it is essential to visualize the signal characteristics of the uterine fibroid itself (Funaki classification) using MRI before treatment, as fibroids with a certain signal intensity (Funaki III) do not heat up sufficiently and MR-HIFU is therefore not able to provide sufficient symptom reduction.

For whom is MR-HIFU treatment of uterine fibroids not suitable?

Patients should always discuss with the responsible radiologist in advance to what extent MR-HIFU treatment is possible and appropriate, especially if they have metal parts in their body (surgical staples or screws, pacemakers, dentures, etc.), extreme claustrophobia, are pregnant or are allergic to contrast agents. In general, the number and size of the fibroids should also be discussed in a personal consultation with the radiologist to see whether MR-HIFU treatment makes sense. MRI imaging is generally performed in advance to ensure that MR-HIFU treatment is possible. MRI imaging may also be requested as a follow-up.

How can I prepare for uterine fibroid treatment?

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

The hair in the pelvic area should be removed the day before the treatment (the easiest way to do this 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 fibroid in order to plan the treatment. Using these images, the radiologist can then direct focused ultrasound waves at the fibroid and heat the tumor in a targeted manner, while the tissue temperature is constantly measured and monitored with the help of the MRI scanner (real-time image control). The patient and radiologist are only separated by a window and can communicate with each other at any time via 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