MRgFUS: Information & MRgFUS Specialists

MRgFUS is a safe, gentle, low-pain, non-invasive procedure. It does not involve surgery and therefore requires no skin incisions. As a result, it is also suitable for patients who

• refuse surgical intervention under anesthesia or
• for whom surgery might be too risky under certain circumstances.

Most treatments are performed under analgosedation. This means that any potential pain is well controlled with pain medication during the procedure. If pain does occur, the patient can signal this, and the thermal ablation can be paused.

This makes the treatment very safe.

For patients with prostate cancer or a bone tumor, general anesthesia is necessary. It ensures that the doctor can work with precision.

Which conditions can be treated with MRgFUS?

Conditions that can be treated with MRgFUS include, for example:

• Uterine fibroids (uterine myomas)
• Adenomyosis (adenomyosis uteri)
• Benign bone tumors (osteoid osteomas)
• Malignant bone tumors (painful bone metastases)
• Benign soft tissue tumors (desmoid tumors)
• Early-stage prostate cancer
• Osteoarthritis of the intervertebral joints (facet joint osteoarthritis)
• Essential tremor or tremor associated with Parkinson’s disease

What can MRgFUS achieve?

The goal of MRgFUS treatment is the complete destruction of a tumor. If that is not possible, the aim is to alleviate severely debilitating symptoms such as

• back pain,
• heavy menstrual bleeding,
• tremor associated with Parkinson’s disease

. In doing so, healthy, functionally important tissue is spared.

MRgFUS for Uterine Fibroids

Uterine fibroids are benign tumors of the uterus. They are common and cause symptoms such as

• heavy and prolonged menstrual bleeding,
• infertility by preventing the implantation of fertilized eggs,
• back pain, and
• pain during menstruation.

The goal of uterine fibroid treatment is to thermally destroy at least 80% of the fibroid tissue. This causes the fibroids to shrink, and the symptoms caused by the fibroids subside or disappear.

The uterus and fertility are preserved with MRgFUS. The procedure is therefore an alternative to surgery for women of childbearing age. Surgery cannot always guarantee the preservation of fertility. In severe cases, surgical treatment would otherwise require removal of the uterus (hysterectomy). This is not necessary with MRgFUS.

In cases of unwanted childlessness, the goal of MRgFUS is to destroy uterine fibroids. This can make pregnancy possible.

An MRI scan of the pelvis using contrast dye determines whether MRgFUS can effectively remove the uterine fibroids. If there are multiple fibroids or relatively large ones, a single treatment is often insufficient. In such cases, the treatment may need to be repeated at intervals of several weeks.

The Joint Federal Committee (G-BA) is currently evaluating MRgFUS treatment for symptomatic uterine fibroids. This evaluation is based on excellent study results and many years of clinical experience.

The G-BA has commissioned a multicenter clinical trial for this purpose. This so-called MARGI-T study examines the use of MRgFUS for uterine fibroids. It is currently open and enrolling patients with symptomatic uterine fibroids.

MRgFUS for Adenomyosis

Adenomyosis of the uterus is a specific form of endometriosis. In this condition, cells from the uterine lining grow into the muscle layer of the uterine wall.

MRgFUS destroys the adenomyosis tissue. This helps alleviate symptoms—such as heavy menstrual bleeding, pain, and cramps.

MRgFUS for Prostate Cancer

MRgFUS is used for the precise treatment of prostate cancer. It is particularly suitable for early-stage tumors. The tumor must not have metastasized yet, and its growth must be confined to the prostate (Gleason scores 6 and 7).

MRgFUS destroys the cancerous tissue while maintaining a safe distance from healthy tissue. The surrounding tissue is spared, and the prostate is preserved.

As a result, problems such as erectile dysfunction or urinary incontinence are not expected after treatment.

MRgFUS for Osteoidosteomas

An osteoid osteoma is a benign but painful bone tumor.

MRgFUS can destroy the bone nucleus (nidus). If complete destruction of the bone nucleus is achieved, the patient is cured.

MRgFUS for Bone Metastases

Malignant bone metastases can be very painful. The goal of MRgFUS therapy in this case is to destroy the cancerous tissue and the pain-conducting nerves in the bone.

This can significantly reduce bone pain or, ideally, eliminate it entirely.

MRgFUS for desmoid tumors

A desmoid tumor is a localized, aggressively growing, benign soft-tissue tumor. MRgFUS can significantly reduce the tumor’s volume and thus control its growth.

Symptoms are alleviated or completely eliminated.

MRgFUS for Symptomatic Facet Joint Osteoarthritis

Facet joint osteoarthritis can cause severe and persistent back pain. Treatment initially involves conservative methods, such as physical therapy or pain medication.

If these are unsuccessful, MRgFUS can destroy the pain-conducting nerves. This interrupts the transmission of pain to the pain center, and the back pain subsides.

MRgFUS for essential tremor or Parkinson’s tremor

MRgFUS is used to treat essential tremor or tremor in patients with Parkinson’s disease.

The core areas in the brain that trigger the tremor are located deep within the brain tissue. With MRgFUS, these core areas can be heated noninvasively while sparing the healthy surrounding brain tissue. The tremor then subsides.

MRgFUS treatments are out-of-pocket services. This means that public health insurance plans do not cover the costs. Private insurance plans often cover the costs upon request.

Before treatment, the MRgFUS therapist uses an MRI to examine the anatomical conditions in the treatment area. The planning MRI is necessary to assess eligibility and contraindications, e.g., in patients with

• pacemakers,
• cochlear implants, or
• certain metal implants

—to determine whether treatment is possible.

An ultrasound unit integrated into the MRI table generates highly focused ultrasound waves. These are directed into the patient’s body, just as in a conventional ultrasound examination. By focusing the ultrasound waves, heat of up to 80° Celsius is generated within a clearly defined volume (focus). With the help of MRI, the heat is generated only in the target tissue.

Using a uterine fibroid as an example, the focus is positioned within the fibroid. The focus then gradually scans the entire fibroid.

MRI monitors the positioning of the focus and measures temperature changes within the target structure and adjacent organs. This ensures precise destruction of the target area while sparing the surrounding organs.

The treatment requires neither a scalpel nor a needle, meaning there are no external signs of treatment.

The body naturally breaks down and reabsorbs the cells destroyed by MRgFUS. In the case of pain management, the pain-conducting nerves are heated. This prevents the transmission of pain signals to the brain.

Most MRgFUS treatments are performed under analgosedation and are well tolerated by patients. MRgFUS treatments for prostate cancer or bone tumors, however, are performed under general anesthesia. The treatment usually takes several hours.

MRgFUS treatment is generally performed on an outpatient basis. This means that patients are monitored for a short time after treatment and may then leave the treatment center.

On the day of treatment, patients are not permitted to drive a car. The patient should ensure that someone is available to accompany them afterward.

Most patients can resume their normal activities as early as the following day. Depending on the condition and initial situation, symptoms may improve shortly after treatment or over the course of a few days.

After treatment, patients continue to have a point of contact at the treatment center who is available to answer any questions.

In most cases, a follow-up MRI is recommended after 6 months. This allows doctors to document the morphological response of the treated tumor to the treatment. The progression of clinical symptoms is also documented during this process.

This allows doctors to determine whether treatment is complete. In rare cases, follow-up treatment is necessary.

If your condition is suitable for MRgFUS therapy, there is a good chance of symptom relief or even a cure.

In some cases, symptoms may return, or a tumor may recur or develop anew. In such cases, an MRI must be performed to determine whether and how further treatment with MRgFUS can be carried out.

Side effects and complications can occasionally occur with MRgFUS treatments. These include, for example, during or after treatment

• circulatory problems,
• a sensation of heat, and
• pain.

Some patients have allergic reactions to contrast agents and sedatives.

Depending on the area of the body being treated or the specific condition, side effects may be more specific, such as:

• redness and superficial skin burns
• Dizziness,
• Nausea and vomiting
• Anxiety
• Nerve irritation
• Urinary tract infections
• Vaginal discharge, spotting, and breakthrough bleeding

Serious complications could include

• erectile dysfunction,
• urinary incontinence, and
• bowel injuries.

However, these occur extremely rarely. If they do occur, they may require surgical treatment. The other side effects and complications mentioned resolve on their own without causing any lasting damage.