High intensity focused ultrasound treatment for adenomyosis: comparison of efficacy based on MRI features

Figures & data

Figure 1. Classification of adenomyosis based on MRI. (A) Type I: the lesion invaded the endometrium layer, and the serosal layer (arrow) was intact; (B) Type II: the lesion invaded the outer uterine layer, the endometrium and the junctional zone (arrow) were intact; (C) Type III: lesions (arrows) confined to the myometrium with intact uterine structure; (D) Type IV: lesion (arrow) invaded the whole uterus.

Table 1. SIR classification system for complications by the outcome.

Grade
A	No therapy, no consequence.
B	Nominal therapy, no consequence; includes overnight admission for observation only.
C	Require therapy, minor hospitalization (48 h).
D	Require major therapy, unplanned increase in the level of care, prolonged hospitalization (48 h).
E	Permanent adverse sequelae.
F	Death.

Table 2. Baseline characteristics of patients with adenomyosis in four groups.

	TypeI (n = 82)	TypeII (n = 75)	TypeIII (n = 34)	Type IV (n = 36)	F value	p value
Age (year)	43 (39, 47)	43 (40, 45)	42.5 (39, 46)	43.5 (40, 47)	1.616	.656
BMI (kg/m²)	22.7 (20.7, 24.2)	22.8 (20.8, 24.2)	23.0 (20.6, 24.9)	22.2 (20.7, 25.8)	0.771	.964
Disease course (year)	3 (1, 5)	3 (1.5, 6)	2 (1, 3.5)	3 (1, 13.5)	6.977	.073
Abortion (times)	2 (1, 2.75)	2 (1, 2)	2 (1, 2.75)	2 (1, 2.5)	4.709	.153
Parity (times)	1 (0.5, 1.5)	1 (1, 1.75)	1 (1, 2)	1 (0.5, 2)	6.235	.067
Menstrual volume score	2 (1, 3)	2 (1, 3)	2 (1, 2.25)	2 (1, 3)	3.858	.277
Dysmenorrhea score	5 (3, 6)	5 (3, 6)	3.5 (2, 5)	6 (4.25, 6)	7.609	.055

Table 3. Lesion characteristics and symptoms of the patients with adenomyosis in four groups [n(%)].

	TypeI (n = 82)	Type II (n = 75)	TypeIII (n = 34)	Type IV (n = 36)	χ²	p value
Single lesion	35(42.7)	31(41.3)	17(50)	14(38.9)	1.011	.799
Multifocal lesion	47(57.3)	44(58.7)	17(50)	22(61.1)
Menorrhagia	45(54.9)	44(58.7)	18(52.9)	26(72.2)	3.670	.299
Dysmenorrhea	73(89.0)	69(92)	31(91.2)	34(94.4)	0.911	.841
Menorrhagia with Dysmenorrhea	34(41.5)	30(40)	12(35.3)	23(63.9)	7.527	.057

Table 4. The conditions required of individuals who completed the HIFU ablation in four groups (x ± s).

Classification	Lesion size(cm³)	NPVR (%)	Average power (W)	Treatment duration (min)	Ablation Time (s)	Treatment intensity (s/h)	Total ablation dose (kJ)
Type I	48.1 ± 33.8	62.1 ± 24.1^a	385.7 ± 28.9	77.4 ± 55.4	607.5 ± 381.6	489.0 ± 132.5	228.8 ± 152.3
Type II	48.1 ± 35.1	60.9 ± 22.0^a	387.4 ± 19.4	71.0 ± 37.8	650.4 ± 603.2	567.4 ± 609.9	230.5 ± 143.7
Type III	42.7 ± 15.6	74.7 ± 20.3	376.5 ± 42.4	84.9 ± 112	512.2 ± 246.3	463.1 ± 119.3	240.2 ± 126.0
Type IV	58.1 ± 35.2	52.4 ± 19.0^a	391.4 ± 22.7	73.8 ± 35.3	667.5 ± 425.2	534.5 ± 146.5	260.2 ± 169.0
F value	6.353	12.741	4.029	0.435	1.643	4.970	3.451
p value	0.065	0.018	0.256	0.933	0.650	0.174	0.327

The sample sizes of each group were the same as in Table 3.

^aCompared with type III patients the NPV and NPVR of the other three types patients had a significant difference, p < .05.

Table 5. Lesion size and menstruation volume before and after HIFU ablation in four groups (x ± s).

	Menstrual volume score	Dysmenorrhea score	Lesion size (cm³)	Lesion reduction rate (%)
Type I
Pre-operation	3.1 ± 0.8	4.9 ± 1.8	48.1 ± 33.8
3 Months after operation	1.6 ± 0.8	1.8 ± 1.6	25.9 ± 16.7^a	41.1 ± 25.4
6 Months after operation	1.3 ± 0.6	1 ± 1.5	21.2 ± 14.0^a	50.7 ± 23.2^c
Type II
Pre-operation	2.6 ± 0.7	4.8 ± 2.0	48.1 ± 35.1
3 Months after operation	1.3 ± 0.6	2.3 ± 1.7	26.0 ± 20.2^a	41.5 ± 29.2
6 Months after operation	1.1 ± 0.5	1 ± 1.4	20.3 ± 17.9^a	52.2 ± 24.9^c
Type III
Pre-operation	2.6 ± 0.8	4.1 ± 2.9	42.7 ± 15.6
3 Months after operation	1.3 ± 0.5	1.9 ± 1.6	29.7 ± 4.2^a	52.5 ± 17.7
6 Months after operation	1	0.7 ± 1.2	15.9 ± 3.3 ^a,b	70.8 ± 14.8
Type IV
Pre-operation	2.7 ± 0.8	5.6 ± 1.7	58.1 ± 35.2
3 Months after operation	1.8 ± 0.9	3.2 ± 1.6	34.4 ± 25.6^a	40.2 ± 17.9
6 Months after operation	1.7 ± 0.9	1.6 ± 1.7	29.4 ± 20.5^a	45.5 ± 28.9^c

The sample size of each group was the same as Table 3.

^aCompared with before operation, p < .05; ^bCompared with 3 months after operation, p < .05; ^cp < .0083, compared with type III at this time point (Bonferronin method adjusted level of 0.05).

Table 6. The constituent ration of menorrhagia remission at 6 month after HIFU ablation in four groups [n(%)].

Classification	Complete remission	Obvious remission	Partial remission	Invalid	Valid
Type I (n = 45)	8 (17.8)^a	21 (46.7)	11 (24.4)	5 (11.1)	40 (88.9)^b
Type II (n = 44)	9 (20.5)^a	18 (41.9)	12 (27.3)	5 (11.4)	39 (88.6)^b
Type III (n = 18)	11 (61.1)	4 (26.7)	3 (16.7)	0 (0)	18 (100)^b
Type IV (n = 26)	3 (11.5)^a	7 (26.9)	7 (26.9)	9 (34.6)	17 (65.4)

Kruskal–Wallis Wails H test (H = 17.789, p < .001) was used for the constituent ratio of the remission of the menorrhagia in each group. Pearson chi-square test was used for remission rate between each two groups: ^aComplete remission rate of other three types patients compared with type III patients respectively, p < .05; ^beffective rate of other three types patients compared with type IV patients respectively, p < .05.

Table 7. The constituent ratio of dysmenorrhea relief at 6 month after HIFU ablation in four groups [n(%)].

Classification	Complete remission	Obvious remission	Partial remission	Invalid	Valid
Type I (n = 73)	15 (20.5)^a	28 (38.4)	20 (27.4)	10 (13.7)	63 (86.3)
Type II (n = 69)	13 (18.8)^a	23 (33.3)	26 (37.7)	7 (10.2)	62 (89.8)
Type III (n = 31)	18 (58.1)	8 (25.8)	5 (16.1)	0 (0)	31 (100)
Type IV (n = 34)	7 (20.6)^a	13 (38.2)	8 (23.5)	6 (17.7)	28 (82.3)

The constituent ratio of dysmenorrhea relief in each group was analyzed by Kruskal–Wails H test (H = 18.113, p < .001). The Pearson chi-square test for response between each two groups.

^aComplete remission of other three types patients compared with type III patients respectively, p < .05.

Table 8. The constituent ratio of SIR scale after HIFU ablation in four groups [n(%)].

SIR scale	Type I (n = 82)	Type II (n = 75)	Type III (n = 34)	Type IV (n = 36)	χ²	p value
A-grade	17 (20.73)	16 (21.33)	8 (23.53)	10 (27.78)	0.802	.849
B-grade	1 (1.22)	1 (1.33)	0	1 (2.78)	1.42	.752

Table 9. The constituent ratio of after HIFU ablation in 227 patients.

SIR scale	Adverse effects	Case (n) and Proportion (%)	Duration (h or d)
A-grade	Lower abdominal pain	26 (11.45)	1–24 h
	Sacrococcygeal pain	7 (3.08)	1–24 h
	Lower limb sensorimotor dysfunction	2 (0.88)	1–7 d
	Vaginal discharge	4 (1.76)	2–5 d
	First degree scald injuries	5 (2.2)	3–7 d
	Nausea and vomiting	5 (2.2)	2–12 h
	Hematuria	2 (0.88)	2–24h
B-grade	Neurotoxicity	2 (0.88)	2–9 d
	Pelvic inflammation	1 (0.44)	3–11 d
C-grade	No symptom	0	–