Role of magnetic resonance-high intensity focused ultrasound (MR-HIFU) in uterine fibroids management: an updated systematic review and meta-analysis

Introduction
Magnetic resonance-high intensity focused ultrasound (MR-HIFU) has revolutionized the treatment of Uterine fibroids. Usually, they are associated with prolonged heavy bleeding during the menstrual period, sacral pain, and increased frequency of UTIs, secondary dysmenorrhea, constipation, and pregnancy-associated problems. It also impacts usual activities, which lead to diminished quality of life and rising healthcare costs. Generally, surgery is the only choice for uterine fibroids; however, MR-HIFU is an entirely non-invasive novel therapy, preferred in pregnancy desiring females.
Aim: To re-evaluate the efficacy of magnetic resonance-high intensity focused ultrasound (MRHIFU) therapy for uterine fibroids.

Material and methods
Randomized clinical trials (RCTs), prospective or retrospective non-randomized, and cross-over studies that considered clinically symptomatic uterine fibroid treatment were included. Meta-analysis was performed using NCSS software, and data were analyzed at a 95% confidence level with a significance level of 0.05. In addition, the non-perfused volume percentage (NPV%), transformed Symptom Severity Score percentage change (tSSS change%), and health-related quality of life (HR-QoL) were computed.

Results
The overall effect of NPV% was 67.60%, where the 95% confidence interval ranged from 55.58% to 79.62%. The overall impact of tSSS% change was approximately 50% (0.54) with 95% CI of 0.41–0.66 of 3 months, 6 months, and 12 months in the included studies. There was a significant improvement in the health-related quality of life (HR-QoL).

Conclusions
The efficacy of MR-HIFU therapy was improved as treatment protocols aimed for total ablation.