Exploring the Diagnostic Performance of Magnetic Resonance Imaging in Ultrasound-Guided High-Intensity Focused Ultrasound Ablation for Abdominal Wall Endometriosis.

Rongsheng Chen,Shangying Hu,Yuhang Liu,Zhibo Xiao

doi:10.3389/fphys.2022.819259

Abstract

ObjectiveThis study aimed to explore the clinical value of magnetic resonance imaging (MRI) combined with ultrasound-guided high-intensity focused ultrasound (USg-HIFU) for the diagnosis and treatment of abdominal wall endometriosis (AWE).MethodsMagnetic resonance imaging was performed before and after USg-HIFU. Information on clinical characteristics of patients, MRI characteristics of lesions, and treatment outcomes were collected. Thirty AWE lesions in 29 patients were examined before HIFU treatment, while 27 patients were examined after treatment. The results of MRI and color doppler ultrasound before surgery, as well as the volume and the apparent diffusion coefficient (ADC) values of the lesions before and after USg-HIFU treatment were compared. We also observed the clinical symptoms remission, recurrence, and ablation rates of the lesions in follow-up after HIFU treatment.ResultsThe locations of the 30 AWE lesions were identified by MRI before USg-HIFU treatment. Their sizes appeared larger on MRI than ultrasound (P < 0.05). A total of 27 lesions were evaluated by MRI after USg-HIFU treatment, of which 92.6% (25/27) lesions were of high or slightly high signal intensity on T1-weighted images, and 77.8% (21/27) lesions were of mixed signal intensity on T2-weighted images. The mean ADC values of AWE lesions were 1.47 (1.20–1.59) × 10–3mm2/s and 1.86 (1.61–2.12) × 10–3mm2/s for pre-and post-HIFU treatment (P < 0.05). Patients with higher ablation rates (>50%) had a higher complete/partial remission rate than those with lower ablation rates (<50%), and had a lower recurrence rate (P < 0.05).ConclusionMRI is a useful tool for identifying the location, size, and concurrent changes of AWE before and after USg-HIFU treatment, which is beneficial for follow-up monitoring and defining treatment efficacy.

Highlights

Endometriosis (EM) occurs when active endometrial tissue proliferates outside the endometrial area (Horton et al, 2008; Neha and Arulselvi, 2010; Zondervan et al, 2020)
Most EM lesions are found in the pelvic cavity (Allen et al, 2021), but abdominal wall EM (AWE) may develop in association with a previous surgical scar after a cesarean section, abdominal hysterectomy, ectopic pregnancy, and other gynecological surgeries (Horton et al, 2008; Efremidou et al, 2012; Matalliotakis et al, 2020)
Medications used in the treatment of AWE are not effective and pose serious adverse effects (Gunes et al, 2005; Rindos and Mansuria, 2017)

Summary

Introduction

Endometriosis (EM) occurs when active endometrial tissue proliferates outside the endometrial area (Horton et al, 2008; Neha and Arulselvi, 2010; Zondervan et al, 2020). It is a common gynecological disease among women of reproductive age (Zondervan et al, 2020). Most EM lesions are found in the pelvic cavity (Allen et al, 2021), but abdominal wall EM (AWE) may develop in association with a previous surgical scar after a cesarean section, abdominal hysterectomy, ectopic pregnancy, and other gynecological surgeries (Horton et al, 2008; Efremidou et al, 2012; Matalliotakis et al, 2020). As a non-invasive treatment, HIFU does not cause scarring, and offers a new and effective therapeutic option for patients with AWE (Luo et al, 2017; Zhao et al, 2018)

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Discussion

Conclusion