Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) for uterine fibroids: our experience on patients’ eligibility

Abstract

Learning objectives The aim of our work is to discuss the clinical and technical eligibility for MRgFUS of women with symptomatic uterine fibroids emphasizing the lack of knowledge of this technique among both patients and physicians. Background MRgFUS represents a feasible, effective, and completely noninvasive thermal ablation procedure that may be alternatively used as a fertility-preserving technique in selected cases. To date, no absolute inclusion criteria have been defined to establish treatment indications and most cases are referred for MRgFUS treatment after many clinical and imaging examinations. Findings and procedure details From June 2012 to August 2013, 29 outpatients women (mean age 43.14±5.96 years) with uterine fibroids were considered clinically eligible for MRgFUS by a general practitioner or a gynecologist and underwent pretreatment pelvic imaging to determine candidacy for the procedure. 13 patients were technical eligible: 11 were treated and 1 of the treated patients underwent myomectomy anyway. Most frequent reasons for ineligibility were: thickness of subcutaneous fat layer, not avoidable bowel interposition, extensive cutaneous scars, fibroid size/structure/location, severe adenomyosis, uterine size, poor compliance and patients’ decision of alternative treatments. In 11 of the 29 patients the pelvic MR could be avoided since the reason of ineligibility could be detected through an accurate clinical examination and/or by ultrasound imaging. Conclusion In our experience MRgFUS treatment is technically possible in less than a half (44,8%) of outpatients women with symptomatic fibroids. However, we can speculate that this result is partially due to the lack of knowledge about of MRgFUS technique among both patients and physicians.