{"id":216,"title":"MRI-Based Analysis of Post-HIFU Efficacy in Uterine Adenomyosis and Personalized Treatment Strategies","title_zh":"基于MRI分型的子宫腺肌症HIFU治疗后疗效分析及个体化治疗策略","url":"https://pubmed.ncbi.nlm.nih.gov/42993146","doi":"10.1159/goi/aczag021","pmid":"42993146","journal":"Gynecol Obstet Invest","kind":"paper","lang":"en","published_at":"2026-11-06T00:00:00+00:00","fetched_at":"2026-11-08T03:44:00+00:00","authors":["Chen Y","Zhang F","Wu H","Wang Y","He Y","Zhou H","Jiang J"],"primary_topic":"endometrium","topics":[{"slug":"endometrium","score":7.0,"hits":["adenomyosis","uterine"]}],"topic_score":7.0,"preference_score":0.0,"preference_labels":[],"llm_score":62.0,"final_score":62.0,"score_dims":{"novelty":58,"rigor":65,"impact":55,"relevance":58,"translation":66},"recommend_reason":"对子宫腺肌症HIFU治疗的亚型分层与临床决策有一定参考价值，但属回顾性、短期随访研究，且不直接涉及ART或胚胎多组学核心问题，适合相关临床方向浏览。","keywords":["子宫腺肌症","高强度聚焦超声","MRI分型","个体化治疗","痛经","月经过多"],"selected":1,"story_id":24,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-uterus-pregnancy","source_name":"PubMed · 内膜/植入/早孕","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该回顾性队列纳入447例子宫腺肌症患者，按Kishi MRI标准分为I–IV型，均接受高强度聚焦超声（HIFU）消融，比较治疗参数、无灌注体积（NPV）比例及3、6个月痛经和月经过多改善情况。结果示IV型病灶更大、治疗时间更长且能量更高；I型NPV比例最高，所有亚型症状均显著持续改善，IV型综合治疗成功率最高。结论提示MRI分型有助于预判HIFU技术难点并指导个体化治疗，但回顾性设计和仅6个月随访限制证据强度。","summary":"Objectives To evaluate the clinical outcomes of high-intensity focused ultrasound (HIFU) ablation in patients with different subtypes of adenomyosis as classified by preoperative magnetic resonance imaging (MRI), and to explore the implications for personalized treatment planning. Design A retrospective cohort study. Participants 447 patients with adenomyosis who underwent HIFU treatment were classified according to the Kishi MRI criteria into Type I (intrinsic, n=195), Type II (extrinsic, n=92), Type III (intramural, n=50), and Type IV (full-thickness, n=110). Methods All 447 patients underwent HIFU ablation under standardized procedural protocols.Treatment parameters, non-perfused volume (NPV) ratio, relief of dysmenorrhea (assessed by NRS score), and improvement in menstrual blood volume (assessed by FPS score) were analyzed and compared across subtypes at 3 and 6 months post-treatment. Results Patients with Type IV adenomyosis had significantly larger lesion volumes and required longer treatment durations with higher energy delivery (p<0.001). The NPV ratio was highest in Type I (74.91% ± 28.34%), followed by Type III (70.34% ± 26.12%), both significantly higher than in Type II (60.01% ± 2.9%) and Type IV (65.93% ± 25.41%) (p<0.05). All subtypes demonstrated significant and sustained improvement in both dysmenorrhea and menorrhagia at follow-up (p<0.05). The comprehensive treatment success rate was highest for Type IV at both 3 (21.82%) and 6 months (27.27%). Limitations This study has several limitations. First, the retrospective design inherently introduces selection bias and limits causal inference. Second,long-term follow-up beyond 6 months was not available, precluding assessment of durability of symptom relief and recurrence rates. Conclusions High-intensity focused ultrasound (HIFU) provides effective symptom relief for all MRI-classified subtypes of adenomyosis. Treatment parameters and efficacy, however, vary by subtype. MRI classification is therefore crucial for guiding treatment and anticipating technical challenges. A personalized approach based on subtype may further optimize therapeutic outcomes.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}