Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

Abstract

Objectives To assess the predictive significance of quantitative perfusion parameters from contrast‐enhanced ultrasound (CEUS) for the therapeutic response to high‐intensity focused ultrasound (HIFU) ablation in patients with uterine fibroids. Methods A total of 263 patients with single uterine fibroids were treated with HIFU ablation under ultrasound guidance. The arrival time, peak time, enhancement time, enhancement intensity, and enhancement rate were evaluated with pretreatment CEUS. According to a nonperfused volume ratio evaluation by posttreatment magnetic resonance imaging, all patients were assigned to groups with volume ratios of 70% or higher and lower than 70%. Then the predictive performances of different parameters for ablation efficacy were studied. Results The arrival time, peak time, and enhancement time in the group with a nonperfused volume ratio of 70% or higher were longer than those in the group with a volume ratio lower than 70% (mean ± SD, 16.7 ± 3.5, 26.5 ± 4.9, and 10.2 ± 2.6 seconds, respectively, versus 13.3 ± 4.2, 20.8 ± 5.4, and 7.6 ± 2.3 seconds), whereas patients with a volume ratio of 70% or higher had a lower mean enhancement intensity and enhancement rate than those with a volume ratio lower than 70% (29.7 ± 16.7 dB and 3.2 ± 1.5 dB/s versus 63.2 ± 26.3 dB and 8.6 ± 4.3 dB/s; P < .05). The nonperfused volume ratio was negatively correlated with the enhancement intensity and enhancement rate (r = –0.631 and –0.712) but positively correlated with the arrival time, peak time, and enhancement time (r = 0.322, 0.456, and 0.477; P < .05). The areas under the receiver operating characteristic curve for the enhancement time, enhancement intensity, and enhancement rate were 0.73, 0.79, and 0.81 (P < .05). Conclusions Quantitative parameters from CEUS are potentially useful for evaluating the therapeutic effect of HIFU ablation for uterine fibroids.

Comparative Study of Pulsed Versus Continuous High‐Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models

“…Studies have shown that blood flow in vessels feeding the target tissue can disperse US energy and affect heat deposition . For PHIFU at a lower DC to achieve the same effective irradiation time as CHIFU, an increase in the total irradiation time is required.…”

Comparison of Contrast‐Enhanced Ultrasound Versus Magnetic Resonance Imaging in the Detection and Characterization of Uterine Leiomyomas

“…A few studies have reported the potential utility of CEUS during or immediately after a UAE procedure 17–19 . A recent study in China demonstrated the utility of quantitative parameters from CEUS for evaluating the therapeutic effect of high‐intensity focused US ablation of fibroids 20 . However, none of these studies compared CEUS to MR, which is the reference standard diagnostic tool for uterine fibroids.…”

Contrast-Enhanced Ultrasound Imaging of Uterine Disorders: A Systematic Review

“…CEUS for monitoring ablation therapies. The predictive value of quantitative perfusion parameters obtained by CEUS for the therapeutic response to HIFU was assessed by Wang et al 39 They showed that fibroids with lower perfusion time parameters and higher intensity parameters, that is, "quickrise-quick-decline" blood flow profile, had poor ablation efficacy. Table 4 provides an overview of the studies using CEUS pre-and post-treatment to image changes in perfusion.…”

“…The side-effects were transient and disappeared 1 to 4 hours post-procedure, all pain scores were mild (<4). 20,[27][28][29][30][31][32][33][34][35][36][37][38][39]41,[43][44][45][46][47][48]55 The differences in side-effects between "HIFU" and "HIFU + CEUS" are listed in Supplemental Appendix B.…”