Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study

Figures & data

Table 1. Baseline characteristics of the patients with adenomyosis.

Characteristics	HIFU group	Pretreatment group	p value
No. of patients (HIFU/pre-treatment)	38	23
Age, years	41.24 ± 7.07	41 ± 3.53	0.87
Body mass index, kg/cm^2	23.91 ± 1.10	23.01 ± 2.76	0.07
Volume of uterus, cm^3	268.86 ± 112.70	297.94 ± 137.57	0.71
Volume of lesion, cm^3	78.94 ± 43.5	88.42 ± 71.13	0.52
VAS scores of dysmenorrhoea	7.95 ± 2.12	7.52 ± 0.71	0.96
Prior abdominal surgical scar (no/yes)	21/17	11/12

The body mass index is weight in kilograms divided by the square of height in metres.

Figure A1–4. (A1) MRI T2WI before the HIFU procedure. (A2) MRI contrast enhancement before the HIFU procedure. (A3) MRI T2WI after the HIFU procedure. (A4) MRI enhancement of the non-perfusion area after the HIFU procedure.

Figure B1–2. (B1) CEUS image before the HIFU procedure. (B2) CEUS image immediately after the HIFU procedure.

Figure 3. Consort HIFU/HIFU-GnRH Flow Diagram.

Table 2. Comparison of the volumes of the uterus and lesions in the pre-treatment group before and after treatment with GnRH.

	Volume of uterus	Volume of lesions	p value
Pretreatment, cm^3	452.48 ± 280.31	297.94 ± 137.5	0.0000
Post-treatment, cm^3	189.09 ± 97.93	88.42 ± 71.13	0.0000

Table 3. Comparison of HIFU outcomes between the HIFU group and pre-treatment group.

Variable	HIFU group N = 38	Pre-treatment group N = 23	p value
NPV, cm^3	54.34 ± 21.19	76.56 ± 56.51	0.0323
NPVR%	80.98 ± 46.67	90.58 ± 7.95	0.000
Treatment time, min	86.66 ± 29.70	80.22 ± 18.38	0.05
Sonication time, s	1002.45 ± 787.01	983.65 ± 159.10	0.31
Average sonication power, W	399.08 ± 0.71	398.26 ± 0	0.00
Treatment intensity, s/h	724.88 ± 268.00	747.65 ± 43.13	0.00
Total energy, KJ	412.22 ± 315.23	392.73 ± 63.64	0.24
Treatment volume, cm^3	3.59 ± 1.01	3.39 ± 1.80	0.15
Intra-procedural VAS scores	4.78 ± 2.12	4.00 ± 0.71	0.17
Post-procedural VAS scores	3.79 ± 2.12	3.87 ± 0.00	0.86

NPVR: non-perfused volume ratio; NPV: non-perfused volume; VAS: visual analogue score.

Table 4. Comparison of intra-procedural and post-procedural adverse effects between the HIFU group and pre-treatment group.

		HIFU group		Pre-treatment group
Variable	N, %	SIR grade A	SIR grade B	SIR grade A	SIR grade B
Intra-procedure	65.57% (40/61)	100% (38/38)	84.21% (32/38)	82.6% (19/23)	65.22% (15/23)
Post-procedure	19.67% (12/61)	63.16% (24/38)	26.32% (10/38)	56.52% (13/23)	26.09% (6/23)

Table 5. Comparison of the VAS and the relief rate between the HIFU-only group and HIFU + GnRH group from 3 months to 12 months after treatment.

	HIFU-only group		HIFU + GnRH group
	VAS	Relief rate(%)	VAS	Relief rate(%)	p* value	p** value	p*** value
Before treatment	7.92 ± 0.71		8.29 ± 0.71		0.000	0.52
After treatment
3 m	3.33 ± 0.71	57.84 ± 7.07	3.2 ± 2.83	63.69 ± 38.3	0.000	0.7901	0.4997
6 m	3.94 ± 0	50.53 ± 4.71	3 ± 0.71	75.81 ± 34.5	0.000	0.000	0.8132
12 m	4.44 ± 0.71	56.15 ± 19.45	5 ± 2.83	56.00 ± 2.95	0.000	0.2751	0.4963

p*: VAS self-comparison in the two groups.

p**: VAS comparison between the two groups.

p***: relief rate comparison between the two groups.

Table 6. Comparison of the clinical effectiveness between the HIFU-only group and HIFU + GnRH group from 3 months to 12 months after treatment.

	HIFU-only group		HIFU + GnRH group
	Effectiveness	Non-effectiveness	Effectiveness	Non-effectiveness	p value
3 m	91.89% (34/37)	5.41% (2/37)	73.91% (17/23)	13.04% (3/23)	0.4997
6 m	85.29% (29/34)	1.76% (4/34)	90% (18/20)	10% (2/20)	0.8132
12 m	79.41% (27/34)	17.65% (6/34)	80% (16/20)	20% (4/20)	0.4963