Objective: To evaluate the correlation of magnetic resonance (MR) T2-weighted image (T2WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation.
Methods: Based on the presence or absence of patchy hyperintense foci on preoperative MR T2WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups.
Results: A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05).
Conclusion: The signal characteristics of adenomyosis on T2WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.
目的: 通过评估子宫腺肌病MR T2WI信号特征，探讨其对高强度聚焦超声（HIFU）消融疗效的影响。
方法: 分析接受HIFU治疗的子宫腺肌病患者资料，根据术前MR T2WI信号内有无点片状高信号灶将病灶分为均质组和不均质组，再根据病灶信号强度将不均质组进一步分为不均质低信号组和不均质等信号组。将不均质组的患者按照1∶1的比例运用倾向性评分匹配的方法与均质组患者进行匹配；同理，不均质低信号组的患者按照1∶1的比例与不均质等信号组患者进行匹配。以病灶体积消融率（NPVR）和术后痛经评分作为评估四组消融疗效的指标。
结果: 299例患者入选，术前中位痛经评分为7.0（6.0，8.0），中位NPVR为53.5%（35.4，70.1）%。倾向性评分匹配后，均质组NPVR明显高于不均质组（[60.3±21.8）% vs（44.6±21.6）%，P < 0.05]。术后3、6、12月随访，均质组痛经缓解率均大于不均质组，其中在术后12个月时两组比较差异有统计学意义（91.1% vs 76.8%，P < 0.05）。不均质低信号组NPVR高于不均质等信号组（[54.0±22.0）% vs（47.3±22.9）%，P < 0.05]。术后6个月不均质低信号组痛经缓解率高于不均质等信号组（91.5% vs 80.9%，P < 0.05）。
结论: 子宫腺肌病MRI T2WI信号特征与HIFU消融密切相关，均质信号病灶的治疗效果优于不均质病灶，不均质病灶中低信号强度的病灶的治疗效果优于不均质等信号病灶。
Keywords: adenomyosis; high-intensity focused ultrasound; magnetic resonance imaging; signal characteristics.