Fig 1.
Flow diagram of the study population.
MRI = magnetic resonance imaging, FSH = follicular stimulating hormone, HIFU = high-intensity focused ultrasound.
Table 1.
Inclusion and exclusion criteria.
Fig 2.
Examples of quantitative assessment of treatment efficacy on MR images of a 50-year-old woman.
(A, B) Pre-HIFU sagittal and axial T2-weighted images show an adenomyotic lesion at the posterior wall of the uterus. The volume of the adenomyotic lesion was calculated as 0.523 × length × width × height (lines) and was equal to 60.8 cm3. (C–F) Three-month follow-up images of the same participant. (C, D) Sagittal and axial T2-weighted images show shrinkage of the adenomyotic lesion. The adenomyosis volume was calculated as 12.0 cm3, and the adenomyosis volume shrinkage rate was 80.3%. (E, F) Contrast-enhanced T1-weighted images demonstrate nonperfused volume, which was equal to 8.3 cm3. The calculated nonperfused volume ratio in this participant was 69.1%.
Table 2.
Characteristics of the participants.
Table 3.
Qualitative measurement of treatment efficacy between groups.
Fig 3.
A representative case of adenomyosis in a 50-year-old woman in group B.
(A) Sagittal T2-weighted image obtained at screening show a uterine adenomyosis (arrow) (5.7 cm × 5.1 cm × 4.0 cm) at the uterine posterior body. (B, C) One-month and three-month follow-up sagittal T2-weighted images, respectively. The volume of the adenomyosis (arrowheads) further shrunken, and the adenomyosis volume shrinkage ratios were 67.0% and 80.3%, respectively.
Table 4.
Quantitative measurement of treatment efficacy between groups.
Table 5.
SIR classification and distribution of adverse events.
Fig 4.
An adverse event after high-intensity focused ultrasound treatment.
Sagittal T2-weighted images (A, B, E) and contrast-enhanced T1-weighted images (C, D) of a 46-year-old woman with adenomyosis (arrowhead). (A) Before HIFU treatment. (B, C) Increased signal intensity and enhancement along the anterior wall of the upper rectum adjacent to the adenomyosis was detected in the immediate posttreatment images (arrows). Her symptoms improved after conservative management, and she was discharged. (D, E) At the 1-month follow-up, the signal intensity of the rectal wall was normalized (arrow). Note the shrinkage of the treated adenomyosis (arrowhead).