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Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis

View Article: PubMed Central - PubMed

ABSTRACT

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.

A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.

Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.

USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.

No MeSH data available.


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A 44-year-old woman who underwent twice USgHIFU ablation for symptomatic adenomyosis. (A1-A2) Sagittal view of MR image obtained before the first USgHIFU ablation showed diffuse junctional zone thickening of the uterus (arrows). The volume of the uterus was 581 cm3. (B1–B2) Sagittal view of MR image obtained 3 months after first USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 371 cm3. Arrows indicate nonperfusion area (183 cm3) after USgHIFU. (C1–C2) Sagittal view of MR image obtained 48 months after first USgHIFU ablation (before second USgHIFU ablation) showed enhancement of the treated area (arrows). The volume of the uterus was 319 cm3. (D1–D2) Sagittal view of MR image obtained 12 months after second USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 150 cm3. Arrows indicate the nonperfusion area (54 cm3) after treatment. (E1–E2) Sagittal view of MR image obtained 24 months after second USgHIFU ablation showed enhancement of the treated area (arrows). The volume of the uterus was 122 cm3. After twice USgHIFU, the patient was asymptomatic until she was menopausal. MR = magnetic resonance, USgHIFU = ultrasound-guided high-intensity focused ultrasound.
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Figure 3: A 44-year-old woman who underwent twice USgHIFU ablation for symptomatic adenomyosis. (A1-A2) Sagittal view of MR image obtained before the first USgHIFU ablation showed diffuse junctional zone thickening of the uterus (arrows). The volume of the uterus was 581 cm3. (B1–B2) Sagittal view of MR image obtained 3 months after first USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 371 cm3. Arrows indicate nonperfusion area (183 cm3) after USgHIFU. (C1–C2) Sagittal view of MR image obtained 48 months after first USgHIFU ablation (before second USgHIFU ablation) showed enhancement of the treated area (arrows). The volume of the uterus was 319 cm3. (D1–D2) Sagittal view of MR image obtained 12 months after second USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 150 cm3. Arrows indicate the nonperfusion area (54 cm3) after treatment. (E1–E2) Sagittal view of MR image obtained 24 months after second USgHIFU ablation showed enhancement of the treated area (arrows). The volume of the uterus was 122 cm3. After twice USgHIFU, the patient was asymptomatic until she was menopausal. MR = magnetic resonance, USgHIFU = ultrasound-guided high-intensity focused ultrasound.

Mentions: A total of 31 patients whose dysmenorrhea recurred received additional treatments: of whom 7 had partial or complete hysterectomy, 3 had the levonorgestrel-releasing intrauterine system, another 7 had GnRH agonists or painkillers and the rest 14 patients had retreatment with USgHIFU ablation (Figure 3). Among the 14 patients treated with USgHIFU ablation, 12 (85.7%) achieved clinical success.


Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis
A 44-year-old woman who underwent twice USgHIFU ablation for symptomatic adenomyosis. (A1-A2) Sagittal view of MR image obtained before the first USgHIFU ablation showed diffuse junctional zone thickening of the uterus (arrows). The volume of the uterus was 581 cm3. (B1–B2) Sagittal view of MR image obtained 3 months after first USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 371 cm3. Arrows indicate nonperfusion area (183 cm3) after USgHIFU. (C1–C2) Sagittal view of MR image obtained 48 months after first USgHIFU ablation (before second USgHIFU ablation) showed enhancement of the treated area (arrows). The volume of the uterus was 319 cm3. (D1–D2) Sagittal view of MR image obtained 12 months after second USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 150 cm3. Arrows indicate the nonperfusion area (54 cm3) after treatment. (E1–E2) Sagittal view of MR image obtained 24 months after second USgHIFU ablation showed enhancement of the treated area (arrows). The volume of the uterus was 122 cm3. After twice USgHIFU, the patient was asymptomatic until she was menopausal. MR = magnetic resonance, USgHIFU = ultrasound-guided high-intensity focused ultrasound.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4998251&req=5

Figure 3: A 44-year-old woman who underwent twice USgHIFU ablation for symptomatic adenomyosis. (A1-A2) Sagittal view of MR image obtained before the first USgHIFU ablation showed diffuse junctional zone thickening of the uterus (arrows). The volume of the uterus was 581 cm3. (B1–B2) Sagittal view of MR image obtained 3 months after first USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 371 cm3. Arrows indicate nonperfusion area (183 cm3) after USgHIFU. (C1–C2) Sagittal view of MR image obtained 48 months after first USgHIFU ablation (before second USgHIFU ablation) showed enhancement of the treated area (arrows). The volume of the uterus was 319 cm3. (D1–D2) Sagittal view of MR image obtained 12 months after second USgHIFU ablation showed decreased size of the uterus. The volume of the uterus was 150 cm3. Arrows indicate the nonperfusion area (54 cm3) after treatment. (E1–E2) Sagittal view of MR image obtained 24 months after second USgHIFU ablation showed enhancement of the treated area (arrows). The volume of the uterus was 122 cm3. After twice USgHIFU, the patient was asymptomatic until she was menopausal. MR = magnetic resonance, USgHIFU = ultrasound-guided high-intensity focused ultrasound.
Mentions: A total of 31 patients whose dysmenorrhea recurred received additional treatments: of whom 7 had partial or complete hysterectomy, 3 had the levonorgestrel-releasing intrauterine system, another 7 had GnRH agonists or painkillers and the rest 14 patients had retreatment with USgHIFU ablation (Figure 3). Among the 14 patients treated with USgHIFU ablation, 12 (85.7%) achieved clinical success.

View Article: PubMed Central - PubMed

ABSTRACT

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.

A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.

Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.

USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.

No MeSH data available.


Related in: MedlinePlus