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Contrast-enhanced ultrasound performance of endometrioma treated with high-intensity focused ultrasound (HIFU)

Yan Zhang, Xiaoxiang Fan, Meiwu Zhang, Dafeng Mao

Objective: This study is to investigate the application of contrast-enhanced ultrasound in assessment of High-Intensity Focused Ultrasound (HIFU) in treating endometrioma.

Methods: Totally 60 patients with endometrioma were included in this study, who underwent HIFU in our hospital from June 2014 to July 2016. At 3 d before treatment, and at 1, 3, 6, and 12 months after treatment, contrast-enhanced ultrasound were performed to assess the HIFU treatment effects.

Results: Contrast-enhanced ultrasound showed that, 49 (81.67%) and 11 (18.4%) cases exhibited dendritic and gradual enhancement patterns, respectively. After peak, there was no clear boundary between adenomyoma lesion and surrounding tissue. Totally 38 (63.34%) and 22 (36.67%) cases exhibited non-uniform and uniform enhancement, respectively. Along with contrast agent dissipation, the lesion area and surrounding myometrium showed synchronous regression in 60 cases (100%). Timeintensity curve analysis showed that, there was no significant difference in AT, while compared with control, TTP and RT were significantly shorter, and I_max was significantly higher, in the adenomyoma group. ROC analysis showed that, AUC values for TTP, I_max, and RT were 0.88, 0.89, and 0.87, respectively. Compared with 3 d before treatment, the maximum diameter was decreased, while the nonperfusion volume was significantly increased, at 6 and 12 months post-operation. In the follow-up period, significant differences were observed in the tumor ablation rate and tumor residual rate.

Conclusion: Real-time perfusion monitoring during HIFU with contrast-enhanced ultrasound contributes to diseases diagnosis and ablation assessment in the disease treatment.