Long-term outcomes of ultrasound guided high intensity focused ultrasound ablation for patients with uterine fibroids classified by T2WI: a multicenter retrospective study

Abstract

Objective

To evaluate the long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids classified by T2-weighted magnetic resonance imaging (T2WI-MRI).

Materials and methods

The data of 1427 premenopausal women with symptomatic uterine fibroids who underwent USgHIFU at four teaching hospitals in China were analyzed retrospectively. The uterine fibroids were classified based on their T2WI-MRI signal intensities relative to that of skeletal muscle, myometrium and endometrium as: hypointense, isointense, heterogeneous hyperintense fibroids (HHF), slightly HHF (sHHF) and markedly HHF (mHHF), respectively. The rates of symptom relief and reintervention post-USgHIFU ablation were compared between the classified groups.

Results

A total of 1303 patients were followed up for 44 (40, 49) months. The symptom relief rate of the hypointense and isointense fibroids was 83.3% and 79.5%, respectively, which were significantly higher (p < .05) compared to that of HHF, sHHF and mHHF (58.3%, 44.2% and 60.4%), respectively. sHHF had the lowest symptom relief rate (p < .05). The cumulative reintervention rate for hypointense, isointense, HHF, sHHF and mHHF types were 8.8%, 10.8%, 21.4%, 39.9% and 19.8%, respectively. The reintervention rate of hypointense/isointense fibroids was significantly lower than that of HHF/mHHF/sHHF (p < .01), while sHHF had the highest re-intervention rate (p < .01). Thus, reintervention rate is inversely correlated to the rate of symptom relief.

Conclusions

USgHIFU ablation is effective for hypointense, isointense, HHF and mHHF with acceptable long-term follow-up outcomes. However, sHHF is associated with a higher reintervention rate.

Keywords:

• Uterine fibroids
• ultrasound guided high-intensity focused ultrasound (USgHIFU)
• T2-weighted MRI
• reintervention
• long-term followed-up outcomes

Ethical approval

This study was performed according to the guidelines of the Helsinki declaration and was approved by the Ethics Committee of Southwest Medical University (No.: KY2021005).

Author contributions

All authors contributed to the study conception and design. The integrity of the entire study was overseen by Jinyun Chen and H. Rosie Xing. Ping Zhan and Jian Shu provide supervision and guarantee for the implementation of study executing and data collection. Yuan Yuan, Zhenjiang Lin, Mali Liu and Fan Xu executed the study and collected the data. Qiuling Shi and Wei Xu performed the data analysis. Yuan Yuan wrote the first draft of the manuscript which was reviewed by all the other authors. Huangpin Shen participated in the data analysis and interpretation and play an important role in revising the manuscript according to the reviewer’s suggestions. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are not available due to ethical restrictions.

Additional information

Funding

This research was supported by the Luzhou Science and Technology Bureau under Grant [Fund code: 2022-SYF-57].