Through the Sonalleve MRI guided High Intensity Focused Ultrasound

What are fibroids?

Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do not require any treatment for these fibroids. Occasionally, the fibroids can cause pain, heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of urination due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.

Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.

Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

The search for non-invasive techniques to provide the patient with relief from this otherwise non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.

How can Fibroids be treated in a non invasive manner? [without surgery]

MRI guided HIFU or Magnetic Resonance Imaging- guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

As fibroids are almost always benign, with a neglible percentage (0.07% of operated patients - Parker W, Berek J, Fu YS., Obstetrics and Gynecology 1994; 83:414-8) showing the presence of a sarcoma (malignancy),fibroids only require treatment for the alleviation of symptoms due to the fibroid.

The procedure is gaining wide acceptance because of the ease of use, exemplary safety and minimal disruption in the patients' daily routine. This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure. The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term (Elizabeth A Stewart et al, Obstet Gynecol 2007;110:279-87).

 

How MRI does guided HIFU work?

The MRI acquires high resolution 3-D images of the fibroid and surrounding structures. These images are used for accurate planning and mapping of the treatment. During treatment, the HIFU transducer focuses the ultrasound beam into the fibroid as per the planned areas (cells) and heats the tissue up to 65 degree Celsius, coagulating it. This is called sonication.

Sonalleve MRI guided HIFU ensures patient safety by having a number of safety mechanisms built into the system. All of these ensure that apart from the tissue being targeted, no other organ or tissue is affected by the treatment.

During treatment, the MRI plays an important role by monitoring temperatures within the treatment areas as well as in the surrounding tissues. The recorded temperatures are then superimposed in the form of colour coded maps on the 3-D images that are being used for the treatment monitoring.

The real-time feedback loop ensures that adequate heating takes place, treating every bit of tissue that has been targeted and volumetric ablation (a Philips proprietary technology) helps treat larger volumes efficiently and quickly.

Thermal mapping contributes to safety by ensuring that the treatment remains within the recommended temperature levels, and that the surrounding tissues are not affected at all.

In addition, Motion detection with automatic adjustment/suspension of sonication also ensures that the procedure is safe.

An emergency stop button that is controlled by the patient allows the patient to pause the treatment whenever she needs to, and the treatment can be resumed once she is comfortable.

What does the Patient experience?

The patient is awake throughout the procedure and does not require any anaesthesia as there is minimal discomfort during the procedure. It is an out-patient procedure, where the patient walks in, undergoes preparation, treatment, is observed for a couple of hours, and is able to walk out comfortably. She can return to normal activities the next day. As the procedure is done under MRI guidance, there is absolutely no radiation involved.

The procedure time takes approximately 3 hours on an average, depending on the size and the number of fibroids. This includes the preparation time before the procedure.The patient experiences relief from her symptoms by the next menstrual cycle, and the treated fibroid gradually shrinks in size over the next few months.

The success of the treatment is evaluated immediately after the treatment by performing a contrast enhanced MRI to delineate the ablated and the non-perfused volume.

An example of the before and after scans of a patient treated at Apollo Hyderabad, India, is seen, where approximately 90% ablation has been achieved. The patient had a pain free procedure and walked out immediately after the procedure. She has reported excellent relief from her symptoms.

As such, MRI guided HIFU satisfies the need for a non-invasive procedure that is a safe, gentle, and convenient way to provide long-lasting relief from the symptoms caused by uterine fibroids.

This facility is now available at Apollo Hospitals Hyderabad, Chennai, Delhi and Bangalore.

Contact Details at each facility :

Indraprashtha Apollo Hospitals, New Delhi
Dr. Harsh Rastogi
Phone: +91 9350222885, 011 60601066
011 26925858 / 26925801, Ext: 1091 / 1090
E mail : assistance@apollohospitalsdelhi.com

Apollo Hospitals, Hyderabad
Dr. Shalini Reddy
Phone: +91 83411050564, 040 60601066
E mail : touchinglives@apollohospitals.com

Apollo Hospitals, Chennai
Dr. Bagyam Raghavan
Phone: +91 9941056677, 044 24334455
E mail : ash@apollohospitals.com

Apollo Hospitals, Bangalore
Dr. Shrivalli N, Dr. Amitha V K. S
Phone:+91 9886681568, 080 2630 4050 / 51, 080 6600 1066
E mail : radiology_bglr@apollohospitals.com

FAQ's for Patients

What is MRI guided HIFU?

It is Magnetic resonance image guided High Intensity Focused Ultrasound. The MRI helps in imaging and monitoring the treatment, and the HIFU treats the fibroid by focusing sound waves at a high intensity into the tissues to heat and coagulate them. The high degree of precision involved ensures that apart from the tissue being treated, no other organs or tissues are damaged.

What is special about MRI guided HIFU?

It is non-invasive. That means no incisions or scars, and no associated pain either. It allows you to get back to your regular routine within 24 hours. So, there is no disruption in your daily activities, and you do not need to be dependent on others during this short recovery period.

Is it really non-invasive? Not even a small cut?

Yes, it is completely non-invasive. No incisions or cuts, no scars. The sound waves leave the skin and other tissues intact, and coagulate tissues only at the point of focus.

What about the radiation?

Unlike X-rays or CT scans, neither MRI nor HIFU use any type of radiation. Hence there is no risk of exposure to radiation.

Will I have to undergo anesthesia? I am scared about being knocked unconscious.

MRI guided HIFU is a relatively pain-free procedure, which means that you do not require any anesthesia, and will be fully conscious during the treatment. No being knocked unconscious, no uncomfortable injections into your spine. At the most, you will be given a pain-killer to take care of any mild discomfort that may occur. You can even ask your near and dear one to sit with you during the procedure if you wish.

Will I be hospitalised?

As it is a walk-in and walk-out procedure, there is no hassle of admission and hospitalization. You need to report to the hospital an hour before the treatment for preparation. You can walk out of the centre after the treatment, but we recommend that you stay in the recovery room for an hour or two after the procedure before you leave for home.

Can all types of fibroids be treated by MRI guided HIFU?

Almost all types of fibroids can be treated by MRI guided HIFU. However, persons with pacemakers or metallic implants in their bodies cannot be treated if these are not compatible with the MRI. To get personalized information, please contact your nearest MRI guided HIFU centre.

How do I schedule a treatment?

Once you contact a MRI guided HIFU centre, you will be provided with detailed information about the procedure, and you will be evaluated for suitability for the procedure. Your evaluation will include a MRI scan which will take around 15 minutes, and the doctor will then discuss the results with you and guide you regarding the next steps.

How soon will I get relief from my symptoms?

This depends on a number of factors including the size and location of the fibroid, as well as the severity of the symptoms. Symptomatic relief can be observed from as soon as a few days after the treatment. Almost all patients report significant symptomatic relief within the first two menstrual cycles following the treatment.

What about recurrence?

Studies have shown that long-term symptomatic relief is comparable to that obtained from a surgery like myomectomy.

How does the fibroid disappear?

The fibroid tissue is heated and coagulated by HIFU. Over a period of time, the body removes the dead cells, causing the fibroid to gradually shrink in size over the next few months. However, symptomatic relief occurs much before this shrinkage can be observed, and is independent of the rate of shrinkage.

Will MRI guided HIFU affect my uterus/ovaries or harm my chances of getting pregnant in future?

MRI guided HIFU for uterine fibroid does not affect your uterus/ovaries or any other organs at all. Your chances of getting pregnant will not be harmed after this procedure.

The doctors say I am high risk for surgery and anesthesia. Can I have a MRI guided HIFU done?

MRI guided HIFU can be safely performed in most cases that are unfit for traditional surgery and anesthesia. Your case would need to be evaluated individually.

I am pregnant, and my fibroids have increased in size, and I am worried. Can I have a MRI guided HIFU done?

We do not recommend this procedure during pregnancy.