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.