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Ablation by MR guided high intensity focused ultrasound has become one of the main non-invasive methods for the treatment of symptomatic uterine fibroids, since 2004, when it was approved by the FDA. Much of this growing preference, due to its effectiveness in relieving symptoms, low complication rates, lack of ionizing radiation and prompt recovery after the procedure. Despite all these advantages, the procedure time has become a major constraint in greater diffusion of this technique, especially in the treatment of large fibroids. Another major challenge coming up in the treatment of lesional margins, more susceptible to risks of injuries to surrounding structures, increasing the chances of under-treatment. Given the direct relationship between the non-perfused volume of post-therapy target lesion - which corresponds to the area not contrasted on MRI T1-weighted - and the relief of symptoms, the search for higher ablation zone as possible should always be the ultimate goal. At this time of search for solutions through multicentric experience, a particular vascular effect has been described in the treatment of fibroids for MR-guided HIFU. There has been a reported case of shrinking fibroid treated with MR-guided HIFU estimated at 98% in which only the periphery of the lesion had been treated.[1] In this case, the reduced perfusion in the all fibroid was attributed to the tissue ischemia and necrosis caused by the ablation of major peripheral vessels. In 2011, a new method of treatment of uterine fibroids based on vascular mapping by MR angiography and arterial ablation spot was proposed, getting good results in the two patients described.[2] Given this phenomenon observed in sporadic cases in the literature, our proposal is to describe findings that corroborate the vascular ablation effect in a retrospective observational study of 6 cases of treatment of uterine fibroids with MR-guided HIFU.

Possible vascular ablation effect in the MR-guided HIFU treatment of uterine fibroids: description of an unexpected or desired effect?