HIFU Treatment Research Articles

Integrating intratumoral and peritumoral radiomics with clinical risk factors for prognostic prediction in pancreatic ductal adenocarcinoma patients undergoing combined chemotherapy and HIFU ablation

Objective A radiomics nomogram will be created utilizing MRI data from intratumoral and peritumoral areas to forecast survival outcomes in patients who have had treatment for pancreatic ductal adenocarcinoma (PDAC). Methods A total of 87 individuals diagnosed with PDAC were included in the study, with 60 patients in the training cohort and 27 patients in the validation cohort. A grand total of 2395 radiomics characteristics were extracted from the tumor region and the peritumoral region. The least absolute shrinkage and selection operator (LASSO) method was used to select features and create a radiomics score, also known as the Rad-score. A multivariate regression analysis was then conducted to build the radiomics nomogram. The evaluation of the nomogram included discrimination, calibration, and clinical utility assessments. Results Based on the conclusions derived from the multivariate Cox model, Rad-Score, jaundice, and tumor size were identified as independent risk factors for overall survival (OS). The inclusion of the Rad-score in the radiomics nomogram led to improved accuracy in predicting survival compared to the clinical model. Patients were categorized into high-risk and low-risk groups based on their Rad-Score. Kaplan-Meier analysis revealed a statistically significant difference between the two groups (p < 0.05). Furthermore, the radiomics nomogram demonstrated excellent ability to differentiate, calibrate, and provide clinical utility in both the training and validation groups. Conclusions The MRI-based intratumoral and peritumoral radiomics nomogram, integrating the Rad-score and clinical data, provided better prognostic prediction for PDAC patients after HIFU treatment, which may hold great potential for guiding personalized care for these patients.

Revolutionizing Fertility: A Review Of High-Intensity Focused Ultrasound On Uterine Fibroids

Background: The aim of the study is to review the safety and the success in fibroid patients by using high intensity focused ultrasound and compare with those of other surgeries for treatment of fibroid. Materials and Methods: We searched in Google Scholar, PubMed, Scopus and Web of Science by using the keywords MRHIFU and High Intensity Focused Ultrasound, uterine fibroid, fertility sparing and pregnancy. The literature reviews for the recent 7 years were searched. The database search was limited to English although much of publications and studies were those of China. Results: HIFU has significant advantage over other methods and improving the health related quality of life. It has a significant effect in shortening pregnancy interval thereby preserving ovarian function. HIFU treatment displayed a relatively higher pregnancy rate, shorter pregnancy interval by preserving ovarian function. This, it is an excellent option for treating symptomatic fibroid patients willing to conceive. Conclusion: HIFU is a safe and effective non-invasive treatment for patients with symptomatic fibroids,offering a good quality of life with minimal complications.

Eye injuries caused by high intensity macro and micro focused ultrasound treatment: a case report

BackgroundHigh Intensity Macro and Micro Focused Ultrasound ( HIFU) is a safe and effective method for the treatment of skin laxity. However, the application of high-intensity focused ultrasound energy on eyelids has been associated with potential ocular complications including traumatic cataract, iridocyclitis, and conjunctival hemorrhage, among others.Case presentationA 40-year-old female developed blurred vision in her left eye after receiving HIFU treatment on binocular eyelids, and her left far vision was 20/66. The examination revealed left eye iris depigmentation and conjunctival hemorrhage. Both eyes exhibited multiple white streaking or tadpole-shaped opacities in the lenses.ConclusionExcessive ultrasonic energy generated by HIFU can cause protein denaturation, leading to conditions such as traumatic cataract, visual impairment, injuries to the iris and conjunctiva when applied to the eyes. We recommend that individuals undergoing cosmetic treatment in the periorbital region should be highly aware of the possible ocular side effects.

Study of Biological Effects Induced in Solid Tumors by Shortened-Duration Thermal Ablation Using High-Intensity Focused Ultrasound.

The HIFU ablation technique is limited by the long duration of the procedure, which results from the large difference between the size of the HIFU beam's focus and the tumor size. Ablation of large tumors requires treating them with a sequence of single HIFU beams, with a specific time interval in-between. The aim of this study was to evaluate the biological effects induced in a malignant solid tumor of the rat mammary gland, implanted in adult Wistar rats, during HIFU treatment according to a new ablation plan which allowed researchers to significantly shorten the duration of the procedure. We used a custom, automated, ultrasound imaging-guided HIFU ablation device. Tumors with a 1 mm thickness margin of healthy tissue were subjected to HIFU. Three days later, the animals were sacrificed, and the HIFU-treated tissues were harvested. The biological effects were studied, employing morphological, histological, immunohistochemical, and ultrastructural techniques. Massive cell death, hemorrhages, tissue loss, influx of immune cells, and induction of pro-inflammatory cytokines were observed in the HIFU-treated tumors. No damage to healthy tissues was observed in the area surrounding the safety margin. These results confirmed the efficacy of the proposed shortened duration of the HIFU ablation procedure and its potential for the treatment of solid tumors.

Combination of latent diffusion and U-shaped networks for HIFU treatment target region extraction

Combination of latent diffusion and U-shaped networks for HIFU treatment target region extraction

Efficacy and Safety of Ultrasound-Guided High-Intensity Focused Ultrasound Ablation in Women With Multiple Uterine Fibroids: An Exploratory Study.

The aim of the work described here was to explore the clinical efficacy and safety of ultrasound-guided high-intensity focused ultrasound (USg-HIFU) treatment in women with multiple fibroids and identify the characteristic parameters predicting USg-HIFU efficacy in multiple fibroids. From February 2021 to August 2022, 138 patients with multiple fibroids (group A comprising 125 patients with two to four fibroids and 13 patients with five or more fibroids) and 149 patients with solitary fibroids (group B) were included. HIFU treatment information, efficacy comparisons and adverse events were recorded. A nomogram model of the characteristic parameters used to predict the efficacy of USg-HIFU in multiple fibroids was established. After USg-HIFU treatment, the statistical comparison of pre-operative versus post-operative symptom scores and fibroid volume in the two groups indicated obvious symptom relief and substantial shrinkage of fibroid volume (all p values <0.001). Nevertheless, group A required more energy and longer treatment and sonication times to achieve a 70% non-perfused volume (NPV) ratio, and had a lower energy efficiency factor than group B (all p values <0.05). No severe complications were observed in either group. The nomogram model included fibroid volume, fibroid location and signal intensity on T2-weighted imaging (T2WI). The area under the receiver operating characteristic curve and the accuracy of the model were 0.698 and 0.686, respectively. USg-HIFU appears to be an effective and safe treatment option for multiple fibroids. Knowledge of the fibroid volume, location and signal intensity on T2WI may help determine the efficacy of USg-HIFU in multiple fibroids.

Cavitation-enhanced high-intensity focused ultrasound treatment for cancer therapy

Cavitation has been known to have a potential to enhance HIFU treatment in a few ways. It can multiply the particle displacement by orders of magnitude and thereby enhance the mechanical effect (1) of ultrasound hugely and the in vivo thermal effect (2) significantly. It can even induce chemical effect (3) when its bubble collapses. We are developing a cavitation-enhanced HIFU therapy system by which the effects (2) and (3) are aimed to obtain. The higher priority was set on the effect (2), because combination with a certain drug may be needed for the effect (3), which can make the process for the approval more difficult. In vivo cavitation threshold can hugely vary on the conditions. It can be reduced by stabilized microbubbles and nanobubbles, nanodroplets, and certain chemicals. However, these are not assumed in combination with our system for the same reason above. Instead, an ultrasonic pulse at an extremely high-intensity in the order of 10 MPa with a duration in the order of 10 ms is used to generate cavitation, which is immediately followed by a typical HIFU burst to obtain the effect (2). The results from swine tests of our HIFU system will be shown in the presentation.

The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder.

To evaluate the feasibility and effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder. We retrospectively analyzed 40 PAS patients between April 2017 and October 2021. All the patients received one session of HIFU treatment. Regular follow-up was done after HIFU treatment until normal menstruation returned and placental tissue disappeared. The patient's reproductive-related outcomes were obtained through telephone interviews. The median follow-up time for the 40 patients was 30.50 (15.75-44.00) months and the mean placental tissue elimination time was 45.29 ± 33.32days. The mean duration of bloody lochia was 13.43 ± 10.01days, with no incidences of severe bleeding. Notably, Linear regression analysis showed that the residual placenta volume before HIFU was a factor affecting the duration of bloody lochia after HIFU (R2 = 0.284, B = 0.062, P = 0.000). The normal menstrual return time was 58.71 ± 31.14days. One (2.50%) patient developed an infection. Two (5.00%) patients were subjected to ultrasound-guided suction curettage for persistent vaginal discharge for more than one month without infection. Notably, 7 of the 18 patients who expressed reproductive plans became pregnant during the 4 to 53months of follow-up without placental abnormalities. The remaining 11 patients were on contraceptives. Single HIFU is an effective treatment option for managing PAS. However, future studies on further treatment strategies to reduce complications and promote patient recovery after HIFU ablation are desirable.

FIBROID DISEASE PROGNOSIS AND METHODS OF TREATMENT IN KSA: A SYSTEMATIC REVIEW

Objective: A growing number of research on fibroid disease among women and methods of treatment. The goal of this systematic review was to spot light on fibroid disease prognosis and to determine the methods of treatment used in Kingdom of Saudi Arabia (KSA). Methods: Authors began with recognizing the important examination proof that spots light on fibroid disease prognosis and to determine the methods of treatment used in KSA. We led electronic writing look in the accompanying data sets: Ovid Medline (2010-present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2010-present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language were incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: A total of 19 studies were identified in the search, all of them were assessed for eligibility, and 6 articles were included in this review.HIFU is now utilized therapeutically in the treatment of leiomyomas in gynecologic oncology. Since the 1990s, when clinical studies of HIFU treatment for leiomyomas first started, HIFUNIT 9000 and prototype single focus ultrasound devices have been used to treat the vast majority of leiomyoma patients. Excellent-intensity focused ultrasound (HIFU) is a non-invasive, gold-standard therapy for all sizes of leiomyomas, with high effectiveness, minimal surgical morbidity, and no systemic adverse effects. Conclusion: Fibroids of the uterus that were causing symptoms responded well to HIFU therapy. The literature on embolization of the uterine artery is sparse (UAE). HIFU is a great choiceto treat fibroids in your uterus.

High-intensity focused ultrasound ablation combined with systemic methotrexate treatment of intramural ectopic pregnancy: A case report

Intramural ectopic pregnancy (IMP) is a rare ectopic pregnancy with an unclear etiology, and standard treatment guidelines currently remain unclear. The main treatment option is local excision of IMP via laparoscopy or laparotomy. A 32-year-old woman with adenomyosis presented with amenorrhea for 7 weeks and a serum β-human chorionic gonadotropin (HCG) level of 6882 IU/L. The patient had a history of laparotomy for adenomyosis 5 years previously. Three-dimensional ultrasonography showed a live gestational sac (GS) of 9 × 15 × 18 mm located in the left posterior wall of the uterus and a sinus tract connecting the sac and the endometrial cavity. MRI revealed the GS located in the adenomyosis and a 1.0-cm sinus tract connecting the GS and the endometrial cavity. IMP with adenomyosis. High-intensity focused ultrasound (HIFU) treatment combined with systemic methotrexate (MTX) was performed to treat IMP, which would avoid operation and massive bleeding. Serum β-HCG levels decreased to normal 4 weeks after HIFU treatment and the GS was not found on MRI after 4 months. The sinus tract was significantly shortened after the HIFU treatment. HIFU ablation combined with systemic MTX is effective for the treatment of IMP and is favorable for maintaining fertility.

Stability testing of gadoteridol and gadobenate dimeglumine formulations under exposure to high-intensity focused ultrasound.

Contrast-enhanced MRI could be useful to guide high-intensity focused ultrasound treatment (HIFU), but the effects of HIFU on gadolinium-based agents is not known. Here, we tested in vitro the stability of gadoteridol and gadobenate dimeglumine, two widely used MR contrast agents, after exposure to HIFU at power levels typically applied in the clinical practice. 0.5 M (gadoteridol and gadobenate dimeglumine) and diluted formulations (1:10 gadoteridol in saline) were exposed to different HIFU sequences. Unexposed and exposed solutions were characterized by high-performance liquid chromatography in terms of concentration of gadolinium complex, free gadolinium and free ligand. Gadoteridol formulation after treatment showed concentrations of the complex not significantly different from control. Free Gd and/or free ligand concentrations in the order of 0.002/0.004% w/w, were observed occasionally without significant correlation with intensity and duration of exposure to HIFU. Gadobenate dimeglumine formulation after treatment showed complex assay content values, by-products (0.24-0.26%) and free BOPTA levels (0.07%) comparable to control sample within the experimental error. In the range of conditions explored, HIFU exposure did not induce significant dissociations of gadoteridol and gadobenate dimeglumine, nor a detectable increase in the concentration of free species. Our study strengthens the hypothesis that gadolinium-based contrast agents are stable during HIFU treatment for body applications (e.g. thermal ablation of uterine fibroids).

Comparison of high-intensity focused ultrasound ablation and uterine artery embolization in the management of cervical pregnancy.

BackgroundCervical pregnancy (CP) is an uncommon type of ectopic pregnancy with a rising risk to life. Currently, there is no universal protocol for the safe and effective management of CP. This study aimed to investigate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) vs. uterine artery embolization (UAE) in the management of CP to develop a standard for the treatment of CP.MethodsFrom January 2015 to October 2021, 36 patients with CP were diagnosed, treated, and followed up at the Department of Gynecology of Third Xiangya Hospital of Central South University. A total of 11 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, and 25 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Medical records and pregnancy outcomes were retrospectively analyzed.ResultsCompared to the UAE group, the HIFU group had a shorter interval time (1.5 ± 0.21 days vs. 2.6 ± 0.26 days), shorter duration of hospitalization (5.5 ± 0.31 days vs. 6.6 ± 0.21 days), shorter recovery time of menstruation (30.6 ± 7.09 days vs. 36.9 ± 5.54 days), fewer adverse reactions (0/11 vs. 9/25), and fewer postoperative complications (1/11 vs. 8/25). There were no significant differences in age, gravidity, parity, abortion, gestational age, cardiac pulsation, admission symptoms, hemoglobin level, largest diameter of the sac/mass, serum human chorionic gonadotropin (hCG) level at admission, hospitalization expenses, hospitalization days, blood loss during curettage, degree of hCG decline, residue after curettage, fertility requirement, and pregnancy outcomes.ConclusionBoth HIFU and UAE are safe and effective in the treatment of patients with CP. Compared to UAE, HIFU treatment for CP is a safer and more effective therapeutic schedule owing to the advantages of being more minimally invasive, shorter interval time, shorter hospitalization days and recovery time of menstruation, fewer adverse reactions, and fewer postoperative complications.

Effect of Paracervical Block Before Ultrasound Guided High Intensity Focused Ultrasound Treatment in Uterine Fibroids and Adenomyosise

Background: The purpose of this article was to evaluate the effect of paracervical block before ultrasound-guided high-intensity-focused ultrasound treatment of adenomyosis and uterine fibroids. Methods: This retrospective analysis examined 2173 women who received HIFU treatment for uterine fibroids and adenomyosis, among them 311 patients with paracervical block and 1862 patients without paracervical block, from February 4, 2010 to March 8, 2019. We assessed treatment time, ablation time, treatment energy and volume reduction. Paracervical block (10 cc of 2% lidocaine diluted with epinephrine 1:1 million) was performed before treatment. Results: When paracervical block was performed, the total treatment time was estimated to be 0.886 times (expected (–0.121)) which was statistically significantly shorter (p &lt; 0.0001), ablation time was statistically significantly shorter by 0.853 times (expected (–0.159)) (p &lt; 0.0001), and the total energy was statistically significantly smaller by 0.891 times (expected (–0.115)) (p = 0.0003). There was no significant difference in volume change between the group with and without paracervical block. However, total treatment time, ablation time, and treatment energy were all statistically significantly lower in the group treated with paracervical block. Conclusions: Paracervical block before USgHIFU treatment was a cost-effective method because it helped reduce the total treatment time, ablation time, and total energy.

A Novel Concept of a Phased-Array HIFU Transducer Optimized for MR-Guided Hepatic Ablation: Embodiment and First In-Vivo Studies.

PurposeHigh-intensity focused ultrasound (HIFU) is challenging in the liver due to the respiratory motion and risks of near-/far-field burns, particularly on the ribs. We implemented a novel design of a HIFU phased-array transducer, dedicated to transcostal hepatic thermo-ablation. Due to its large acoustic window and strong focusing, the transducer should perform safely for this application.Material and MethodsThe new HIFU transducer is composed of 256 elements distributed on 5 concentric segments of a specific radius (either 100, 111, or 125 mm). It has been optimally shaped to fit the abdominal wall. The shape and size of the acoustic elements were optimized for the largest emitting surface and the lowest symmetry. Calibration tests have been conducted on tissue-mimicking gels under 3-T magnetic resonance (MR) guidance. In-vivo MR-guided HIFU treatment was conducted in two pigs, aiming to create thermal ablation deep in the liver without significant side effects. Imaging follow-up was performed at D0 and D7. Sacrifice and post-mortem macroscopic examination occurred at D7, with the ablated tissue being fixed for pathology.ResultsThe device showed −3-dB focusing capacities in a volume of 27 × 46 × 50 mm3 as compared with the numerical simulation volume of 18 × 48 × 60 mm3. The shape of the focal area was in millimeter-range agreement with the numerical simulations. No interference was detected between the HIFU sonication and the MR acquisition. In vivo, the temperature elevation in perivascular liver parenchyma reached 28°C above physiological temperature, within one breath-hold. The lesion was visible on Gd contrast-enhanced MRI sequences and post-mortem examination. The non-perfused volume was found in pig #1 and pig #2 of 8/11, 6/8, and 7/7 mm along the LR, AP, and HF directions, respectively. No rib burns or other near-field side effects were visually observed on post-mortem gross examination. High-resolution contrast-enhanced 3D MRI indicated a minor lesion on the sternum.ConclusionThe performance of this new HIFU transducer has been demonstrated in vitro and in vivo. The transducer meets the requirement to perform thermal lesions in deep tissues, without the need for rib-sparing means.

Cryotherapy As Treatment of Curative Intent for Localized Adenocarcinoma of The Prostate Gland with A Focus on Low-risk and Medium – (Intermediate-) Risk Localized Adenocarcinoma of The Prostate Gland: A Review and Update

Cryotherapy As Treatment of Curative Intent for Localized Adenocarcinoma of The Prostate Gland with A Focus on Low-risk and Medium – (Intermediate-) Risk Localized Adenocarcinoma of The Prostate Gland: A Review and Update

Optimization of HIFU monotherapy for prostate cancer

Introduction. One of the most researched alternative treatments for localized prostate cancer (PCa) is ultrasound ablation (HIFU ¾ High-intensity Focused Ultrasound). Although the world history of the application of this method of PCa treatment is more than 15 years old, the scope of the application of the method has not finally been determined.Purpose of the study. To study the results of the application of ultrasound ablation in the treatment of patients with localized and locally advanced PCa.Materials and methods. The study included 147 patients with PCa who underwent HIFU treatment using the AblathermÒ device («EDAP TMS», Vaulx-en-Velin, Lyon, France). Group 1 included patients with localized and locally advanced PCa treated at the stage of gaining experience and evaluating the results of treatment (n = 82). Group 2 consisted of patients with localized PCa of low and moderate oncological risk (n = 65). The number of sessions in group 1 varied from 1 (65) to 2 (17). The need to perform a second session was associated with the ineffectiveness of the first. HIFU was also performed after the failure of external beam radiation (2), and photodynamic (1) therapy. In group 2, 61 patients received one treatment session, 4 patients received 2 sessions each. The mean follow-up time for the patients in group 1 was 17.4 ± 5.2 (3 – 29) months, for group 2 was 18.2 ± 7.3 (3 – 29) months.Results. In group 1 of patients with a low degree of oncological risk, a decrease in blood prostate-specific antigen (PSA) below the threshold value and the absence of its significant increase during the observation period was noted in 87.5% of cases (28 patients), with an average degree of oncological risk in 65.6% of cases (21 patients), with a high degree in 27.7% of cases (5 patients). In 34.1% (28 patients), the treatment was ineffective, 21 of them underwent repeated ultrasound ablation of the prostate, and 7 patients received subsequent external beam radiation therapy. These results led us to abandon the use of HIFU in patients with baseline blood PSA levels greater than 20 ng/ml and locally advanced disease. In group 2, biochemical recurrence was noted in 9 patients. A control biopsy in 6 patients confirmed local recurrence, which became the basis for a second HIFU session (4). Five patients received adjuvant hormonal therapy. The total effectiveness of the treatment in group 2 was 86.2%.Conclusion. The results support the notion that HIFU is a treatment option for localized PCa only. The evaluation of the initial results led us to abandon treatment with this method in patients with locally advanced and high-risk localized PCa.

Phase-Changeable Nanoparticle-Mediated Energy Conversion Promotes Highly Efficient High-Intensity Focused Ultrasound Ablation.

This review describes how phase-changeable nanoparticles enable highly-efficient high-intensity focused ultrasound ablation (HIFU). HIFU is effective in the clinical treatment of solid malignant tumors; however, it has intrinsic disadvantages for treating some deep lesions, such as damage to surrounding normal tissues. When phase-changeable nanoparticles are used in HIFU treatment, they could serve as good synergistic agents because they are transported in the blood and permeated and accumulated effectively in tissues. HIFU's thermal effects can trigger nanoparticles to undergo a special phase transition, thus enhancing HIFU ablation efficiency. Nanoparticles can also carry anticancer agents and release them in the targeted area to achieve chemo-synergistic therapy response. Although the formation of nanoparticles is complicated and HIFU applications are still in an early stage, the potential for their use in synergy with HIFU treatment shows promising results.

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

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.

Recognition study of denatured biological tissues based on multi-scale rescaled range permutation entropy.

The recognition of denatured biological tissue is an indispensable part in the process of high intensity focused ultrasound treatment. As a nonlinear method, multi-scale permutation entropy (MPE) is widely used in the recognition of denatured biological tissue. However, the traditional MPE method neglects the amplitude information when calculating the time series complexity. The disadvantage will affect the recognition effect of denatured tissues. In order to solve the above problems, the method of multi-scale rescaled range permutation entropy (MRRPE) is proposed in this paper. The simulation results show that the MRRPE not only includes the amplitude information of the signal when calculating the signal complexity, but also extracts the extreme volatility characteristics of the signal effectively. The proposed method is applied to the HIFU echo signals during HIFU treatment, and the support vector machine (SVM) is used for recognition. The results show that compared with MPE and the multi-scale weighted permutation entropy (MWPE), the recognition rate of denatured biological tissue based on the MRRPE is higher, up to 96.57%, which can better recognize the non-denatured biological tissues and the denatured biological tissues.

Pretreatment bowel manipulation during ultrasound-guided high-intensity focused ultrasound therapy for posterior wall uterine masses

ObjectiveHigh-intensity focused ultrasound (HIFU) therapy is a noninvasive alternative to conventional abdominal surgery in obstetrics and gynecology. The aim of this study is to evaluate the reduction of pain intensity with bowel manipulation before ultrasound-guided HIFU treatment in women with posterior wall uterine fibroids and/or adenomyosis. Materials and methodsThis is a multicenter retrospective observational study. Data from all patients who underwent HIFU therapy at three HIFU clinics (Sichuan Maternal and Child Health Hospital, Xiangya Hospital of Central South University, and Kuo General Hospital) between January 2019 and December 2019 were analyzed. We compared pain intensity with and without bowel manipulation during the HIFU treatment and evaluated tolerability without intravenous sedation. The presence of discomfort or pain during the HIFU procedure was evaluated using the visual analog scale (VAS). ResultsA total of 86 women were included in this study. All women underwent HIFU therapy with the PRO-2008 system in the supine position for posterior wall uterine fibroids and/or adenomyosis. Thirty-seven women received pretreatment anal catheterization with a condom and 49 women were not subjected to bowel manipulation. All patients received pretreatment condom-catheter device were well tolerated during the procedure of bowel manipulation. During the HIFU procedure, the women who had received bowel manipulation experienced lower pain intensity, especially less sacrococcygeal pain (VAS score 1.56 ± 1.46 vs 2.89 ± 1.61), target region pain (1.54 ± 1.30 vs 2.53 ± 1.29), and radiating pain (0.13 ± 0.34 vs 0.41 ± 0.54), compared with the women without bowel manipulation. ConclusionBowel manipulation with anal catheterization before HIFU therapy for posterior wall uterine masses can be safely performed and is effective as a low risk intervention to aid in reducing potential HIFU complications related to nerve involvement.