MR-HIFU

What is MR-HIFU?

MR-HIFU is a treatment that combines an MRI scan with an ultrasound. MR-HIFU is short for Magnetic Resonance guided High Intensity Focused Ultrasound. It is a new treatment for women who suffer from uterine fibroids. The treatment started in 2009 at the University Medical Center Utrecht and at Isala women have been treated since 2016. Several thousand women worldwide have now undergone the MR-HIFU treatment.

The radiologist performs the MR-HIFU treatment. During the treatment you lie on your stomach in an MRI scanner. The MRI table contains an ultrasound machine (Focused Ultrasound transducer), which emits high-energy sound waves (ultrasound). By focusing these sound waves into the uterine fibroid, its temperature rises. This causes the tissue to break down without damaging the surrounding tissue around the fibroid. This allows us to treat the fibroid very precisely from the outside, without cutting into your body. The treatment changes and shrinks the fibroid and reduces your symptoms. Immediately after the treatment, we look at how the treatment went with an MRI scan. In the weeks to months after treatment, you can expect improvement of your symptoms.

Benefits and risks

Benefits and risks?

Every treatment has benefits, but also risks. So does the MR-HIFU treatment.

Benefits of MR-HIFU

The main advantage of MR-HIFU is that the fibroid can be treated from the outside, without cutting into your body.
You do not have to undergo anesthesia, as is the case with uterine or fibroid surgery.
You will be approachable during the treatment. You can express how you feel.
The procedure takes an average of three hours and recovery is less painful than other procedures such as uterine surgery or embolization.
You may return home on the day of treatment.
You recover faster from MR-HIFU treatment than from other fibroid treatments.

Risks of MR-HIFU

Possible side effects of MR-HIFU treatment include:

You may have muscle pain for a few days after the treatment because you have to lie still on your stomach for a long time in the MRI scan.
Your abdomen may be sensitive or you feel cramps.
Sometimes menstruation occurs after treatment.
Although we use the MRI scan to precisely locate the fibroid, there is a chance (0.1%) that we heat tissue elsewhere in your abdomen. Think of the bladder, intestines or spinal nerves. You may then incur damage to these areas for which you will need additional treatment, but usually the symptoms go away on their own.
The skin of your abdomen can also heat up too much, causing a burn. A recovery treatment with burn ointment may then be necessary. In exceptional cases, surgery may be necessary.

Because the uterus is not removed, there is always a chance that a fibroid will grow back or develop elsewhere in your uterus. It is therefore possible that you will have to undergo another treatment because of (new) complaints. This could be another MR-HIFU treatment, but also a uterus operation.

Picture of MR-HIFU fibroid treatment (Profoundmedical.com/sonalleve)

Who is suitable?

If you participate in the MYCHOICE study, you can be enrolled for the MR-HIFU treatment. In order to participate you must be eligible for the MR-HIFU treatment. Unfortunately, not all women with fibroids are eligible for this treatment. In addition, there are a number of criteria you must meet to participate in the MYCHOICE study.

To be eligible you must:

Be older than 18 years of age;
Have symptoms of your fibroids for which you also want to undergo treatment other than MR-HIFU;
Not be pregnant and have no desire to become pregnant in the next year;
Not be post-menopausal (not have gone through the menopause);
Have a BMI below 35kg/m²;
Not be allergic to contrast medium;
Not suffer from claustrophobia;
Not have any metal in your body that cannot or should not be removed;
Be able to sign the consent form.

You may not be able to undergo MR-HIFU treatment if you:

Have a fibroid that is too far away from your abdominal skin;
Have a lot of (small) fibroids;
Have scarring on your abdomen;
Have a fibroid smaller than 2cm in diameter;
Have a fibroid larger than 10cm in diameter, unless you want to use hormones beforehand (maximum 3 months);
Do not want to have an IUD removed beforehand;
Have a fibroid with certain characteristics on the MRI scan.

The research team will use the MRI scan to determine your final eligibility.