Bian Xuelian, Sun Qi, Ren Qiongzhen, Chen Guangqiang
Department of Radiology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu Province, China.
Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 16 Bai-Ta-Xi Road, Suzhou, 215001, Jiangsu Province, China.
Abdom Radiol (NY). 2025 Jun 16. doi: 10.1007/s00261-025-05055-y.
This study was designed to investigate the preoperative prediction of the mid-term efficacy of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids by apparent diffusion coefficient (ADC) histogram analysis.
Eighty-six patients with a total of 101 uterine fibroids were retrospectively collected consecutively. The region of interest (ROI) was outlined layer by layer on diffusion-weighted imaging (DWI) images with b = 1000 s/mm to obtain ADC histogram parameters, including the mean, maximum, minimum, 10th, 25th, 50th, 75th and 90th percentiles as well as skewness, kurtosis, and entropy. The volume reduction rate (VRR) of fibroids at 6 months postoperatively was calculated as an indicator of the mid-term effect, and according to the VRR, the cohort was divided into a markedly effective group (VRR ≥ 50%) and a nonmarkedly effective group (VRR < 50%). Differences in ADC histogram parameters between the markedly effective and nonmarkedly effective groups were analyzed by applying univariate and multivariate binary logistic regression to screen out statistically significant indicators, and the predictive efficacy of the relevant ADC histogram parameters was assessed by receiver operating characteristic (ROC) curves.
The markedly effective group included 42 fibroids, and the noneffective group included 59 fibroids. The results of the univariate analysis showed that ADCmean, ADCmax, ADC10th, ADC25th, skewness, kurtosis, and entropy were significantly different between the two groups. The results of the multivariate analysis showed that ADC10th and skewness were statistically significant indicators, the area under the ROC curve (AUC) was 0.678 and 0.739, respectively, and the combined AUC of the two was 0.790. Major study limitations include: this is a single-center retrospective study, the investigator manually segmented the lesions, and no further analysis of postoperative pathology regarding the findings of the study.
ADC histogram analysis helps to preoperatively predict the mid-term efficacy of HIFU in the treatment of uterine fibroids. ADC10th and skewness are independent predictors of the mid-term efficacy of HIFU, and the combined efficacy of the two is superior to that of a single indicator.
本研究旨在通过表观扩散系数（ADC）直方图分析探讨高强度聚焦超声（HIFU）治疗子宫肌瘤中期疗效的术前预测。
回顾性连续收集86例共101个子宫肌瘤患者。在b = 1000 s/mm²的扩散加权成像（DWI）图像上逐层勾勒感兴趣区（ROI），以获得ADC直方图参数，包括均值、最大值、最小值、第10百分位数、第25百分位数、第50百分位数、第75百分位数和第90百分位数，以及偏度、峰度和熵。计算术后6个月肌瘤的体积缩小率（VRR）作为中期疗效指标，并根据VRR将队列分为显著有效组（VRR≥50%）和非显著有效组（VRR<50%）。应用单因素和多因素二元逻辑回归分析显著有效组和非显著有效组之间ADC直方图参数的差异，筛选出具有统计学意义的指标，并通过受试者工作特征（ROC）曲线评估相关ADC直方图参数的预测效能。
显著有效组包括42个肌瘤，无效组包括59个肌瘤。单因素分析结果显示，两组之间的ADC均值、ADC最大值、ADC第10百分位数、ADC第25百分位数、偏度、峰度和熵存在显著差异。多因素分析结果显示，ADC第10百分位数和偏度是具有统计学意义的指标，ROC曲线下面积（AUC）分别为0.678和0.739，两者联合AUC为0.790。主要研究局限性包括：这是一项单中心回顾性研究，研究者手动分割病变，且未对研究结果进行术后病理的进一步分析。
ADC直方图分析有助于术前预测HIFU治疗子宫肌瘤的中期疗效。ADC第10百分位数和偏度是HIFU中期疗效的独立预测因子，两者联合效能优于单一指标。
