Abstract
PurposeThis study aimed to compare the dose and effectiveness of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids with different sizes and explore the effect of uterine fibroid size on dose, which provided dose evaluation for clinicians in accordance with the size of uterine fibroids.Materials and MethodsA total of 1,000 patients with symptomatic uterine fibroids who received a single-session USgHIFU treatment were enrolled in this study. The size of fibroids was divided into seven groups: 3–4 cm, 4–5 cm, 5–6 cm, 6–7 cm, 7–8 cm, 8–9 cm, and 9–11 cm. The dose was expressed on the basis of the energy efficiency factor (EEF) as the energy required for ablation per unit volume of tissue, and the non-perfused volume ratio (NPVR) was used to assess the effect of HIFU ablation.ResultsThe median NPVR of 88.3% (IQR: 80.3%–94.8%) was obtained, and no significant difference was observed among the seven groups. The classification of T2-weighted image signal intensity fibroids in the 4–5 cm group was compared with that in the 6–7 cm and 8–9 cm groups, and the difference was significant (p < 0.05). However, the proportion of T2WI hyperintense signal fibroids had no significant difference among the seven groups (p > 0.05). The median EEF was 3.88 J/mm3, and a significant difference was observed among the seven groups of EEF (p < 0.05). The EEF of groups with a fibroid size less than 6 cm was more than double the EEF of groups with a fibroid size above 6 cm. In addition, the EEF of groups with a fibroid size of 4–5 cm and 3–4 cm was 3–4 times higher than those with a fibroid size above 7 cm (p < 0.05).ConclusionsA single-session HIFU ablation for uterine fibroids of 3–11 cm can obtain an NPVR of more than 80%. The EEF decreased with the increase of the size of uterine fibroids. A fibroid size of 6.5 cm was considered as a clinical meaningful point affecting EEF.
Highlights
Uterine fibroids (UFs) are common benign tumors in women of childbearing age
The non-perfused volume ratio (NPVR) of high-intensity focused ultrasound (HIFU) ablation of UFs refers to the ratio of the volume of the non-perfusion area in the postoperative enhanced MR image to the volume of the fibroids
NPVR is related to symptom relief, which can be used as the imaging gold standard for evaluating the effect of HIFU ablation [14,15,16]
Summary
Uterine fibroids (UFs) are common benign tumors in women of childbearing age. Many patients complain of clinical symptoms such as menorrhagia, irregular bleeding, pelvic pain, or infertility [1,2,3], which seriously affect their quality of life. The high-intensity focused ultrasound (HIFU) treatment is widely used in clinical practice. This noninvasive technique is safe and effective, and it can preserve organs without damaging endocrine function [9, 10]. The assessment of ultrasound dosimetry and ablation effect is important to ensure the safe and effective treatment of HIFU. The non-perfused volume ratio (NPVR) of HIFU ablation of UFs refers to the ratio of the volume of the non-perfusion area in the postoperative enhanced MR image to the volume of the fibroids. NPVR is related to symptom relief, which can be used as the imaging gold standard for evaluating the effect of HIFU ablation [14,15,16]
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