This paper presents a practical implementation of an integrated MRI-compatible CMOS amplifier capable of directly driving a piezoelectric ultrasound transducer suitable for high-intensity focused ultrasound (HIFU) therapy. The amplifier operates in Class DE mode without the need for an output matching network. The integrated amplifier has been implemented with the AMS AG H35 CMOS process. A class DE amplifier design methodology for driving unmatched piezoelectric loads is presented along with simulation and experimental results. The proposed design achieves approximately 90% efficiency with over 800 mW of output power at 1010 kHz. The total die area including pads is 2 mm(2). Compatibility with MRI was validated with B1 imaging of a phantom and the amplifier circuit.