Efficacy Study Of Focused Ultrasound Ablation For Adenomyosis Based On Magnetic Resonance Imaging Classification

Objective:To research the safety and efficacy of focused ultrasound ablation(FUA)in the treatment of different types of adenomyosis based on magnetic resonance imaging(MRI)features.Methods:227 patients with adenomyosis treated by FUA in Suining Central Hospital from January 2014 to December 2019 were enrolled.Patients were divided into four subtypes according to Kishi,s classification,including 82 cases in type I(endogenous),75 in type Ⅱ(exogenous),34 in type Ⅲ(intramural)and 36 in type Ⅳ(heterogeneity).The adverse effects of four subtypes of adenomyoosis were recorded.Results:(1)Adverse events: All patients successfully were treated by FUA under conscious sedation.The adverse effects of grade A were observed in 51(22.5%)patients and grade B in 3(1.3%)patients,and no grade C-F adverse effects occurred.There were no significant differences in the incidence of adverse effects on grade A and grade B among the different groups,(2)Ablation situation: The average non-perfused volume ratio(NPVR)of type Ⅲ was(74.7±20.3)% which was significantly higher than that of the other three types.There was no significant difference in NPVR between type I,type Ⅱ,and typeⅣ(P<0.05).(3)The adenomyotic lesion volume significantly decreased compared with the volume before FUA,and the reduction rate gradually increased in six months after FUA.The reduction rate of adenomyotic lesion of type Ⅲ was(70.8±14.8)% and significantly greater than that of the other three types,but no significant difference was observed between the type I,type Ⅱ,and type Ⅳ(P<0.05).(4)Alleviations of mennorrhagia: Before FUA,133 patients increased menstruation volume which from type I to type Ⅳ was 45(54.9%),44(58.7%),18(52.9%)and 26(72.2%).the menstruation volume score decrease-d at 3 and 6 months after FUA for all patients.At 6 months after FUA,the complete relief rate of type Ⅲ was 61.1% and it was significantly higher than that of the other three types(P<0.05).Simultaneously,the clinical effective rate was 100%(18/18).(5)Reliefs of dysmenorrhea: In this study,207 patients had dysmenorrhea which from type I to type Ⅳ was 73(89.0%),69(92.0%),31(91.2%)and 34(94.4%).The score of dysmenorrhea decreased at 3 and 6 months after FUA.At 6 months after FUA,the complete relief rate in patients with type Ⅲ of adenomyosis was 58.1% and significant higher than that of patients with the other three types of adenomyosis(P<0.05).Meanwhile,the clinical effective rate of type Ⅲ was 100%(31/31).Conclusion : FUA is safe and effective in treating patients with different types of adenomyosis,but the efficacy varies between different types of adenomyosis,the treatment efficacy is best in type Ⅲ.