Yu Jingwen, Jiang Li, Su Xueyao, Yang Meijie, Yang Chao, Chen Jinyun
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
College of Public Health, Chongqing Medical University, Chongqing, China.
J Obstet Gynaecol Res. 2023 Apr;49(4):1189-1197. doi: 10.1111/jog.15567. Epub 2023 Feb 2.
To compare the therapeutic efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) in the treatment of adenomyosis with different signal intensity (SI) on T2-weighted images (T2WI).
A total of 299 adenomyosis patients who underwent HIFU and completed a one-year follow-up were retrospectively reviewed. Based on the SI values of adenomyosis relative to myometrium and endometrium on T2WI MRI, the patients were classified into three groups: the hypointense adenomyosis (Hypo-AM) group, the isointense adenomyosis (Iso-AM) group, and the hyperintense adenomyosis (Hyper-AM) group. The non-perfused volume ratio (NPVr) and relief of dysmenorrhea were used to assess the therapeutic efficacy. Optimal cutpoints (CPs) of NPVr were determined using the postoperative dysmenorrhea score as an anchor. Logistic regression analysis was used to test the relationship between the NPVr and SI.
The clinical effectiveness rate was significantly lower in the Hyper-AM group than in the Hypo-AM and Iso-AM groups (P < 0.05 for both). The NPVr in the Hypo-AM and Iso-AM groups were significantly higher than that in the Hyper-AM group (P < 0.05 for both). The optimal CP was 54.0% for NPVr. Logistic regression analysis showed that the SI on T2WI was an effect factor for NPVr (P < 0.05), and the probability of NPVr ≥54.0% decreased continuously as the SI of adenomyosis increased.
The NPVr of 54.0% has a clinically significant impact on dysmenorrhea scores in patients. The efficiency of the Hypo-AM and Iso-AM was better than that of the Hyper-AM.
比较超声引导下高强度聚焦超声（USgHIFU）治疗T2加权成像（T2WI）上具有不同信号强度（SI）的子宫腺肌病的疗效。
回顾性分析299例行HIFU治疗并完成1年随访的子宫腺肌病患者。根据子宫腺肌病在T2WI MRI上相对于子宫肌层和子宫内膜的SI值，将患者分为三组：低信号子宫腺肌病（Hypo-AM）组、等信号子宫腺肌病（Iso-AM）组和高信号子宫腺肌病（Hyper-AM）组。采用非灌注体积比（NPVr）和痛经缓解情况评估治疗效果。以术后痛经评分作为锚定指标确定NPVr的最佳切点（CP）。采用逻辑回归分析检验NPVr与SI之间的关系。
Hyper-AM组的临床有效率显著低于Hypo-AM组和Iso-AM组（两者均P < 0.05）。Hypo-AM组和Iso-AM组的NPVr显著高于Hyper-AM组（两者均P < 0.05）。NPVr的最佳CP为54.0%。逻辑回归分析显示，T2WI上的SI是NPVr的影响因素（P < 0.05），随着子宫腺肌病SI的增加，NPVr≥54.0%的概率持续降低。
54.0%的NPVr对患者痛经评分有临床显著影响。Hypo-AM组和Iso-AM组的疗效优于Hyper-AM组。
