Preoperative MR T2WI signal characteristics of adenomyosis are closely related with the outcome of high-intensity focused ultrasound ablation: a propensity score-matched cohort study / 南方医科大学学报

OBJECTIVE@#To evaluate the correlation of magnetic resonance (MR) T2-weighted image (T2WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation.@*METHODS@#Based on the presence or absence of patchy hyperintense foci on preoperative MR T2WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups.@*RESULTS@#A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05).@*CONCLUSION@#The signal characteristics of adenomyosis on T2WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.

Signal characteristics of MR T2WI in prediction of HIFU treatment outcome for adenomyosis / 中国介入影像与治疗学

Objective To investigate the effect of signal characteristics of MR T2WI for predicting HIFU treatment outcome for adenomyosis.Methods According to signal characteristics of MR T2WI before HIFU treatment,502 adenomyosis patients were divided into group Ⅰ (lesions with most hypointense and/or little isointense) and group Ⅱ (lesions with most isointense and/or little hypointense).Then patients in each group were further subdivided into subgroup A (without slightly and extremely hyperintense foci in the lesions),subgroup B (with slightly hyperintense foci in the lesions) or subgroup C (with extremely and/or slightly hyperintense foci in the lesions).The correlation of signal characteristics of MR T2WI for adenomyosis on HIFU ablation results and parameters were analyzed.Results There was no statistical difference of non-perfused volume ratio (NPVR) between group Ⅰ and group Ⅱ (t=-0.504,P=0.612).In both group Ⅰ and group Ⅱ,NPVR of subgroup A was higher than that of subgroup B and subgroup C,respectively (group Ⅰ:LSD-t=2.608,3.677,P=0.009,＜0.001;group Ⅱ:LSD-t=3.255,3.778,P=0.001,＜0.001).There was no statistical difference of NPVR between subgroup B and subgroup C (group Ⅰ:LSD-t=-0.852,P=0.395;group Ⅱ:LSD-t=0.278,P=0.781).There was no statistical difference of sonication time,total ablation energy and energyefficiency factor (EEF) between group Ⅰ and group Ⅱ,respectively (sonication time:t=-1.716,P=0.087;total ablation energy:t=-1.676,P=0.094;EEF:Z=0.044,P=0.965).In both group Ⅰ and group Ⅱ,sonicationtime,total ablation energy and EEF of subgroup A were lower than those of subgroup B and subgroup C (all P＜0.05),while no statistical difference was found between subgroup B and subgroup C (all P＞0.05).Conclusion Signal characteristics of adenomyosis on MR T2WI can be used as predictors of HIFU treatment outcome for adenomyosis.