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Targeting symptomatic fibroids with MR-HIFU therapy

Case Study
van den Bosch, Maurice, M.D., Ph.D. University Medical Center Utrecht • Netherlands
Ikink, Marlijne, M.D. University Medical Center Utrecht • Netherlands

Patient history

51 year-old married female. BMI 24.5 kg/m2. G6P4. No relevant medical history.

Complaints of menorrhagia. Treatment with progestin intra-uterine device (mirena) and contraceptive injection (depo-provera). Baseline Symptom Severity Score (tSSS) of 90.6 points and Health Related Quality of Life (HRQoL) of 4.3 points. 

Hysteroscopic diagnosis of partly submucosal (2/3) and intramural (1/3) uterine fibroid. 

Request for help: Hormonal therapies provide inadequate symptom relief - additional treatment required.

MR examination

MRI was done on Sonalleve MR-HIFU V2 R3.1

Planning images before treatment

T2-weighted planning image T1-weighted, contrast enhanced image
T2-weighted planning image
T1-weighted, contrast enhanced image

T2-weighted image shows an anteverted uterus and multiple uterine fibroids. The dominant fibroid is partly submucosal and intramural located with a diameter of 3.5 cm in three orthogonal planes, with a corresponding fibroid volume of 23 ml.

It is defined as Type I fibroid, hypo-intense on T2W Imaging¹ .

Mirena in situ. 

Contrast enhanced, T1-weighted image acquired during examination. Enhancement following the administration of intravenous contrast agent (Gadovist®).

¹ Funaki et. al.
Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. 
American Journal of Obstetrics and Gynecology, 2007, Vol 196,(2), 184.e1-184.e6)

MR-HIFU Treatment

Sonalleve MR-HIFU V2 system with R3.1L1 version software was used.


A total of 16 treatment cells of 8 mm, including 4 test shots, were used with a power level range of 130-150 Watts (1.2 MHz frequency). 

Procedure times:
Total MR room time: 2:50 hours
Sonication time: 1:15 hours

*note: MR room time defined as the moment the patient entered the MR room and the moment exited. Sonication time is defined as the time from the start of the first to the last sonication.

Case considerations

A potential challenge of this case was the relatively small uterine fibroid, the small treatment window and high risk of intermediate bowel loops with propagation of ultrasound waves and possible heat in near-field.
With abdominal massage and sharp angulation of the ultrasound beam, treatment was possible.

Post-treatment MR images

T1W, contrast-enhanced post-treatment sagittal image T1W, contrast-enhanced post-treatment coronal image
T1W, contrast-enhanced post-treatment sagittal image
T1W, contrast-enhanced post-treatment coronal image


Immediately after treatment, a contrast enhanced-T1-weighted MR scan was acquired to visualize the treatment result. Non-perfused volume (NPV) was calculated on Viewforum, R5.1V1L2SP3 (Philips Medical Systems, Best) using the sum-by-slice method. 

5ml / 23ml = 0.22 (22%)
NPV / total fibroid volume = NPV ratio

Note that the objective in this treatment was to address the dominant symptomatic fibroid to achieve symptomatic relief.

Outcomes and follow-up

3-months follow-up MR scan:
The dominant fibroid has dimensions of 2.5 cm in three orthogonal planes, corresponding volume of 8 ml. This corresponds to a fibroid volume reduction of 65%. 

6-months follow-up MR scan:
The dominant fibroid has dimension of 2 cm, corresponding volume of 4 ml, corresponding to a fibroid volume reduction of more than 80%.

Patient reported a normalized menstrual cycle with a significant symptom improvement of 71.8 points. Discontinuation of hormonal medication was possible.

T2-weighted image - 6 month follow-up
T2-weighted image - 6 month follow-up

Note: Results from case studies are not predictive of results in other cases. Case results may vary.

*NetForum case studies provide information about procedures performed by Philips users, yet Philips takes no responsibility for non-device content (medicine used, positioning preparation, etc)

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Sep 26, 2012

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Case Study
Sonalleve MR-HIFU
Body, fibroid, HIFU, Interventional, MR-HIFU, Uterine fibroid, Uterus, Women's health

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