Factors influencing USgHIFU ablation for adenomyosis with NPVR ≥ 50%

Figures & data

Figure 1. Sagittal T2-weighted images of adenomyosis and enhanced MR images with different non-perfused volume ratios (NPVR) after HIFU treatment. In a 38-year-old patient, the volume of the adenomyotic lesion was 61.2 cm³ (A1) and the non-perfused volume (NPV) was 45.3 cm³ (A2). The NPVR was 74.0%. In a 32-year-old patient, the volume of the adenomyotic lesion was 57.4 cm³ (B1) and the non-perfused volume (NPV) was 20.6 cm³(B2). The NPVR was 35.9%.

Table 1. Comparison of intraprocedural adverse effects between NPVR ≥50% group and NPVR < 50% group.

Variable	%, n	NPVR <50% (n = 140)	NPVR ≥50% (n = 159)	p Value
Lower limb radiation pain	24.1 (72)	23.6 (33)	24.5 (39)	0.847
Sacrococcygeal pain^a	48.8 (146)	58.6 (82)	40.3 (64)	0.002
Skin burning pain	30.8 (92)	34.3 (48)	27.7 (44)	0.216
Treatment area pain^a	68.6 (205)	74.3 (104)	63.5 (101)	0.045
Groin pain	7.7 (23)	10.7 (15)	5.0 (8)	0.066
Discomfort in hip folds	6.4 (19)	5.7 (8)	6.9 (11)	0.670
Straining feeling in anus	1.7 (5)	2.1 (3)	1.3 (2)	0.552
Urethral pain	0.3 (1)	0.7 (1)	0	0.286
Vomiting	0.3 (1)	0	0.6 (1)	0.347

^aStatistically significant, p < 0.05.

Table 2. Comparison of postprocedural complications between NPVR ≥ 50% group and NPVR < 50% group.

Variable	%, n	NPVR <50% (n = 140)		NPVR ≥50% (n = 159)
		SIR grade A	SIR grade B	SIR grade A	SIR grade B
Fever	0.7 (2)	0	0.7 (1)	0	0.6 (1)
Lower abdominal pain	73.2 (219)	56.4 (79)	18.6 (26)	57.2 (90)	14.5 (24)
Sacral tail or hip pain^a	19.4 (58)	19.3 (27)	5.7 (8)	14.5 (23)	0
Numbness and pain in the lower limb	2.0 (6)	0.7 (1)	1.4 (2)	1.3 (2)	0.6 (1)
Vaginal discharge	18.4 (55)	17.1 (24)	0	19.5 (31)	0
Skin burn	0.3 (1)	0	0.7 (1)	0	0
Pain and distension of anus	0.7 (2)	0.7 (1)	0	0.6 (1)	0
Nausea or vomiting	0.7 (2)	0.7 (1)	0	0.6 (1)	0
Dysuria	0.3 (1)	0	0	0	0.6 (1)

^aStatistically significant, p < 0.05.

Table 3. Comparison of characteristics and ultrasound ablation results between two groups.

Variable	NPVR < 50% (n = 140)	NPVR ≥ 50% (n = 159)	p Value
General patient data
Age (years)	37.2 (9.0)	39.0 (6.0)	0.050
BMI (kg/m^2)	22.6 (3.0)	22.1 (3.7)	0.086
History of childbirth (yes/no) (n)^d	91/49	129/30	0.002
History of abortion or miscarriage (yes/no) (n)	106/34	132/27	0.118
Scar in the lower abdominal wall (yes/no) (n)	52/88	60/99	0.916
MR imaging
Volume of uterus (cm^3)	230.8 (118.7)	245.2 (141.0)	0.826
Volume of adenomyosis (cm^3)	75.1 (67.8)	70.8 (73.6)	0.391
Abdominal wall thickness (cm)^d	2.5 (1.4)	2.3 (1.1)	0.030
Adenomyosis ventral side to skin (cm)	5.4 (3.6)	4.9 (4.0)	0.629
Adenomyosis dorsal side to sacrum (cm)	1.4 (1.5)	1.3 (1.7)	0.315
Location of uterus (A/M/R)^a (n)	67/22/51	81/19/59	0.631
Location of adenomyosis (A/P/L/F)^b (n)	32/99/17/32	43/95/19/38	0.632
Type of adenomyosis (I/II/III/IV)^c (n)	47/31/11/51	45/33/19/62	0.550
SI value of adenomyosis on T2WI^d	259.8 (195.0)	231.7 (133.3)	0.011
SD value of adenomyosis on T2WI	53.9 (46.8)	46.7 (35.5)	0.107
SI difference between adenomyosis and myometrium	49.5 (96.3)	53.0 (83.3)	0.661
SI difference between adenomyosis and rectus abdominis muscle^d	114.3 (136.5)	95.7 (103.6)	0.023
SI difference between adenomyosis and endometrium	272.0 (191.8)	245.3 (183.7)	0.318
Enhancement type on T1WI (slight/ irregular/regular/) (n)^d	31/56/53	72/51/36/	<0.001
Laboratory test data
Leukocyte count (10^9/L)^d	5.8 (2.0)	5.4 (1.5)	0.024
Red blood cell count (10^12/L)	4.4 (0.5)	4.4 (0.5)	0.683
Hemoglobins (g/L)^d	123.0 (23.0)	118.1 (24.0)	0.046
Platelet count (10^9/L)	255.6 (90.0)	255.0 (86.0)	0.433
Ultrasound ablation results
Power (W)	400.0 (17.5)	400.0 (2.0)	0.162
Treatment time (min)^d	85.0 (69.8)	64.0 (51.0)	<0.001
Sonication time (s)	870.0 (899.0)	666.0 (702.0)	0.037
Dose (kJ)	322.5 (378.6)	244.8 (295.0)	0.113
EEF (J/mm^3)^d	9.4 (12.8)	3.6 (4.8)	<0.001

^aLocation of uterus: A, anteverted; M, mid position; R, retroverted.

^bLocation of adenomyosis: A, Anterior Wall; P, Posterior Wall; L, Lateral Wall; F, fundus of uterus.

^cType of adenomyosis: I, intrinsic adenomyosis; II, extrinsic adenomyosis; III, intramural adenomyosis; IV, indeterminate adenomyosis.

^dStatistically significant, p < 0.05.

Data are median value; interquartile range in brackets.

Figure 2. Comparison of the degree among the factors influencing the non-perfused volume ratio (NPVR) ≥50%. AWT: Abdominal wall thickness; T1WI: Enhancement type on T1WI; T2WI: SI difference on T2WI between adenomyosis and rectus abdominis.

Table 4. The binary logistic regression analysis of variance.

Variable	β	S.E.	Wald	OR (95% CI)	p Value
(Intercept)	3.352	1.028	10.635	28.554	0.001
History of childbirth	1.054	0.300	12.314	2.868 (1.592, 5.167)	<0.001
Abdominal wall thickness	−0.368	0.163	5.117	0.692 (0.503, 0.952)	0.024
Enhancement type on T1WI	−0.731	0.163	20.145	0.482 (0.350, 0.663)	<0.001
SI difference on T2WI between adenomyosis and rectus abdominis	−0.004	0.001	7.184	0.996 (0.993, 0.999)	0.007

SE: standard error; OR: odd ratio; CI: confidence interval.

Figure 3. The receiver operating characteristic (ROC) curves of the prediction model in predicting the non-perfused volume ratio (NPVR) ≥ 50%.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.