Introduction
Adenomyosis, a benign gynecological disease observed in women in their reproductively active years, is characterized by invasion of endometrial glands and stroma within the myometrium 1. Current treatments for adenomyosis, especially uterine sparing therapy, have limited efficacy and high recurrence rates due to the estrogen-dependent nature2. Hence, hysterectomy is considered the optimal option for women with adenomyosis, except for those who would like to preserve fertility. As a non-invasive technique, focused ultrasound ablation surgery (FUAS) has become a popular option for patients with adenomyosis, especially for those who hope to preserve fertility3. Previous studies have shown that FUAS is a safe and effective treatment for adenomyosis2-4; however, dysmenorrhea and/or menorrhagia may relapse in 12 months after treatment4. Several predisposing factors, such as phenotypes and morphological characteristics, have been reported to be potentially associated with either FUAS efficacy or symptom recurrence after FUAS, nevertheless few of them were proved to be clinically applicable5-7.
Several phenotypes based on magnetic resonance imaging (MRI) classification were reported to be associated with clinical features of adenomyosis in recent years5,7-9. However, a consensus classification has yet to be reached, and data from previous studies are heterogeneous and not fully comparable. Thus, it is imperative to confirm a standard classification criterion MRI for evaluating FUAS efficacy.
We retrospectively reviewed a cohort of 643 adenomyosis patients treated with FUAS in our center over the past four years, aiming to identify an optimal MRI-based classification for evaluating the efficacy of FUAS, and to explore the factors associated with the recurrence of adenomyosis after FUAS.