磁振導引高能聚焦超音波在婦產科的應用

高能量聚焦超音波HIFU (high intensity focused ultrasound)用於婦女醫療已有數10年歷史，其使用聚焦超音波的技術，使治療部位溫度上升至65-85℃，造成病灶凝固型壞死。可用於子宮肌瘤以及子宮肌腺症，以改善病人症狀，是一種無傷口的治療方式。目前影像導引方式包含有超音波導引以及磁振導引。超音波導引是較早發展，並且廣為應用的方式，治療準備時間較短。磁振造影導引，又稱為神波刀，具有多切面影像清晰解剖構造，並且能夠利用磁場相位的變化，即時監控溫度影像，能夠有效的確定治療範圍及效果，並免正常組織之傷害。在子宮肌瘤以及子宮肌腺症的治療中，藥物及手術為主要之治療方式。在藥物治療效果不理想，但仍不希望開刀的病人，可以考慮做HIFU治療。其中，如欲保留子宮並且未來想懷孕的婦女，因HIFU治療子宮無刀口，懷孕時子宮破裂之風險較低，生產時亦不需要進行剖腹產，為病人選擇治療方式之考量。然而，並非所有子宮肌瘤以及子宮肌腺症病人都適合接受MRgFUS治療，肌瘤位置、數量、大小以及其他病人因素，都可能影響治療的有效性及安全性，所以在確定治療方案之前，需要進行醫師評估以及磁振造影檢查，才能夠為病人提供最適合的治療方式。

High Intensity Focused Ultrasound (HIFU) has been utilized in women's healthcare for several decades. It employs focused ultrasound technology to elevate temperatures at the treatment site to 65-85 degrees Celsius, inducing coagulative necrosis of lesions. It can be used for uterine fibroids and adenomyosis to alleviate patient symptoms, offering a non-invasive treatment approach. Currently, image-guided methods include ultrasound guidance and magnetic resonance imaging (MRI) guidance. Ultrasound guidance, being an earlier developed and widely applied approach, requires shorter preparation times. MRI guidance provides clear multiplanar images of anatomical structures and enables real-time monitoring of temperature changes using magnetic phase variations, effectively determining treatment scope and efficacy while avoiding harm to normal tissues. In the management of uterine fibroids and adenomyosis, pharmacotherapy and surgery remain primary treatment modalities. For patients with suboptimal response to medication yet reluctant to undergo surgery, HIFU therapy may be considered. Particularly for women desiring uterine preservation and future fertility, HIFU's incisionless treatment of the uterus entails lower risks of uterine rupture during pregnancy and obviates the need for cesarean section during childbirth, factors to consider when selecting a treatment approach. However, not all patients with uterine fibroids or adenomyosis are suitable candidates for HIFU therapy. Factors such as fibroid location, number, size, and other patient-specific variables may influence treatment efficacy and safety. Therefore, prior to determining a treatment plan, physician assessment and MRI evaluation are necessary to provide the most suitable treatment for patients.