Factors influencing the ablative efficiency of high intensity focused ultrasound (HIFU) treatment for adenomyosis: A retrospective study

Abstract

Objectives The aim of this study was to investigate factors affecting ablative efficiency of high intensity focused ultrasound (HIFU) for adenomyosis. Materials and methods In all, 245 patients with adenomyosis who underwent ultrasound guided HIFU (USgHIFU) were retrospectively reviewed. All patients underwent dynamic contrast-enhanced magnetic resonance imaging (MRI) before and after HIFU treatment. The non-perfused volume (NPV) ratio, energy efficiency factor (EEF) and greyscale change were set as dependent variables, while the factors possibly affecting ablation efficiency were set as independent variables. These variables were used to build multiple regression models. Results A total of 245 patients with adenomyosis successfully completed HIFU treatment. Enhancement type on T1 weighted image (WI), abdominal wall thickness, volume of adenomyotic lesion, the number of hyperintense points, location of the uterus, and location of adenomyosis all had a linear relationship with the NPV ratio. Distance from skin to the adenomyotic lesion's ventral side, enhancement type on T1WI, volume of adenomyotic lesion, abdominal wall thickness, and signal intensity on T2WI all had a linear relationship with EEF. Location of the uterus and abdominal wall thickness also both had a linear relationship with greyscale change. Conclusion The enhancement type on T1WI, signal intensity on T2WI, volume of adenomyosis, location of the uterus and adenomyosis, number of hyperintense points, abdominal wall thickness, and distance from the skin to the adenomyotic lesion's ventral side can all be used as predictors of HIFU for adenomyosis.

Feasibility and safety assessment of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated mild hyperthermia in pelvic targets evaluated using an in vivo porcine model

“…The hyper-intensive lesion shown in the contrast-enhanced MR were consistent with results from a prior publication [45], and matched the severe hemorrhage and fluid-filled cavities observed in the macroscopic and histological results. With that said, some studies found post-ablation targets to be seen as non-perfused areas in the MR images, as opposed to the hyper-intense regions seen here [46][47][48]. However, the power of 200 W and the sonication duration of 20 s that we employed were much lower than the power of 305-402 W [46][47][48] and sonication duration of 90-3864 s [46][47][48] used in these studies, implying that the immediate effect on the tissue could be different.…”

“…With that said, some studies found post-ablation targets to be seen as non-perfused areas in the MR images, as opposed to the hyper-intense regions seen here [46][47][48]. However, the power of 200 W and the sonication duration of 20 s that we employed were much lower than the power of 305-402 W [46][47][48] and sonication duration of 90-3864 s [46][47][48] used in these studies, implying that the immediate effect on the tissue could be different. Furthermore, the ablative target of normal uterus here is generally more vascularized than uterus fibroid targets of these studies [47].…”

High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility

“…It is therefore important to optimize the selection criteria, which can indicate patients with adenomyosis suitable for treatment with HIFU. Gong et al investigated the factors that affect the ablative efficiency of HIFU treatment for adenomyosis (24). They retrospectively reviewed 245 patients with adenomyosis who underwent USgHIFU and found that the enhancement type of the adenomyotic lesion, the thickness of the abdominal wall, the volume of the adenomyotic lesions, the number of hyperintense foci on T2WI, the location of the uterus, and the location of adenomyotic lesions all had a significant relation to the NPV ratio.…”

Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study

“…The efficacy and safety of HIFU sonication on adenomyosis has been shown in several studies [18][19][20][21]. Multiple noteworthy issues remain as to how to rapidly improve HIFU ablation for adenomyosis, especially with enlarged uteri [22]. GnRH-a is an analogue of the gonadotrophin-releasing hormone agonist, which inhibits ectopic endometrial growth.…”