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MR-HIFU A NEW PARADIGM IN UTERINE FIBROID THERAPY


Article provided by Philips Healthcare


H


igh Intensity Focused Ultrasound guided by Magnetic Resonance Imaging (also known as MR


guided HIFU, MRgHIFU, or MRgFUS) is a non-invasive therapeutic technique using focused ultrasound waves to heat and coagulate tissue deep inside the body without damaging intervening tissue. Diederik Zeven - General Manager of Philips Healthcare in the Middle East, explains how this makes it a valuable tool for supporting new treatment alternatives for conditions where current methods may have significant side effects and for patients who may not be able to tolerate an invasive procedure. For over half a century it has been


known that focused ultrasound waves applied to the human body offer the possibility of heating deep-lying tissue noninvasively. But a lack of suitable means for guiding and monitoring these waves has prevented the technique from gaining widespread acceptance for medical use. Applying HIFU energy to a patient’s lesion needs careful treatment planning, plus tools for effectively targeting the US beam, monitoring the energy delivery and development of heating zones, as well as tools for post- treatment assessment and quantification. MR imaging, with its excellent soft tissue contrast, 3D imaging capabilities and non-invasive temperature measurement techniques has already established itself as a truly effective means of providing the necessary guidance and monitoring. In addition, it offers the possibility of accurate real-time temperature imaging, which can be used to provide feedback to the HIFU system and control the


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amount of energy to the focal zone, thus ensuring reproducible results for a wide variety of tissue types.


 A NEW TREATMENT OF UTERINE FIBROIDS In recent years, MR-HIFU has gained wide acceptance for the treatment of uterine fibroids, and over the past decade more than 8,000 patients have been treated and benefitted from the non-invasive nature of this procedure. Uterine fibroids are non-malignant growths that can affect women primarily between the ages of 30 years and the onset of menopause. A study in the USA has shown that by the age of 50, the cumulative incidence of fibroids is more than 80% for black women and nearly 70% for white women with a higher incidence in women with a high body mass index. Approximately 25% of women with fibroids have symptoms severe enough to require treatment. These symptoms are typically bleeding, pain and pelvic pressure due to the mass effect, all of which can cause a major impairment to the patient’s quality of life. In contrast to current surgical treatments, after MR-HIFU fibroid therapy the patient typically goes home the same day and is fully recovered after a day or two, with a clear reduction in symptoms. This makes MR-HIFU fibroid therapy a very attractive option from the patient’s point of view. Moreover, there is now a body of


published literature demonstrating the long-term outcome of MR-HIFU fibroid therapy. Once a substantial portion of the fibroid (> 60%) has been


ablated in the procedure, the 2-year recurrence rate is comparable to that of myomectomy. These clinical outcomes are


based on experience with the first generation MR-HIFU systems and early treatment protocols. These systems had some technical limitations making treatment times excessively long, and the treatment protocols were very cautious, allowing only a limited part of the fibroid to be ablated. With the latest generation of MR-HIFU systems and the clinical experience gained to date, both of these limitations have been addressed, making the technique accessible to more patients and significantly reducing treatment times. In addition, from the economic standpoint, these innovations are also making MR- HIFU fibroid therapy a highly attractive solution for healthcare providers. ■


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 REFERENCES References available on request (magazine@informa.com)


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