Hochintensiver fokussierter Ultraschall (HIFU)

Background: High-intensity focussed ultrasound [HIFU, synonym: focussed ultrasound surgery (FUS)] is an established therapeutic method for the noninvasive or minimally invasive thermoablation of organ lesions through focussed ultrasound beams. By integrating HIFU transducers into diagnostic MR scanners, HIFU treatment can optimally be guided and monitored in real time. For several reasons uterine fibroids are very well suited for noninvasive HIFU treatment. Objectives: In this article, the technical conditions, applications, indications and clinical outcome of HIFU treatment of symptomatic uterine fibroids are described. Materials and methods: Based on the technical fundamentals of MR-guided HIFU [MR-HIFU, synonym: MR-guided focussed ultrasound surgery (MRgFUS)], indications and contraindications for fibroid treatment are discussed. Second, the various steps of HIFU uterine fibroid ablation are described. Finally, data from recent studies on the symptomatic outcome of HIFU fibroid treatment are provided. Results: MR-HIFU is technically feasible in many patients and offers a high level of patient safety. Given careful indication and proper patient selection, very good symptomatic improvement can be achieved with low risk and few side effects in a completely noninvasive manner and on an out-patient basis. Conclusions: MR-HIFU has been established as a safe and noninvasive treatment option for patients with symptomatic uterine fibroids and should be considered an equitable alternative to conservative, interventional or surgical treatment.