P27.04: Ablation of uterine adenomyosis by magnetic resonance guided focused ultrasound surgery (MRgFUS)

We investigated the feasibility of ablating uterine adenomyosis by MR-guided focused ultrasound surgery (MRgFUS) and any adverse events that may arise during, immediately after and 1-week after MRgFUS. The subjects were 40 women with symptomatic adenomyosis, who had completed their family planning. The clinical trial was approved by the Ethics Committee of our hospital. The patients were treated by MRgFUS, a system comprising ExAblate 2000 (InSightec Israel), that generates high intensity focused ultrasound beams, and MRI, that provides real-time visualization of patient anatomy and temperature changes in and around the treated area. The treatment was applied to an area a few millimeters inside the adenomyosis as done in myoma treatment. After treatment, the non-perfused area and ablation result were evaluated through contrast enhanced T1-weighted MR images. Seventeen patients with extensive adenomyosis underwent a second treatment for the remnant lesion. Adverse events were examined during the treatment and one week after MRgFUS. Temperature rise of 60 °C to 90 °C was recorded in the sonicated region of the adenomyosis, and almost all the patients reported mild to moderate pain during the procedure. One patient unable to tolerate pain did not complete the treatment. The architecture at the periphery of the non-perfused area on sagittal view of MR images after the treatment was almost round (type R) in 28 patients, serrated in 7 (type S) and honeycombed (type H) in 4. Type R was considered well ablated, leaving no perfused lesion in the targeted tissue. Watery and thin bloody discharge was often reported by patients at their 1-week follow-up visit. Most of the patients were able to return to work within 3 days of the treatment. The adenomyosis tissue was ablated by MRgFUS, without severe complications. This method for treatment of uterine adenomyosis is promising at this first stage of tissue ablation.