Safety and efficacy of magnetic resonance-guided high-intensity focused ultrasound surgery (MRgFUS) in adenomyosis with dysmenorrhea

Qi Zhang, Haicheng Li, Li H, Haoxiong Li, Linghui Xu, Xu L, Shen Y, Yujia Shen, W. Y. Fok, Mao Lai, Lai M, Guo X, Xiongrui Guo, Yiting Wang, Wang Y, Jamie Jiangmin Hou, Xin WY, Woo Yuan Xin, Junhai Zhang, Xiaohong Ruan, Ruan X
Abdominal radiology (New York) · 2026 · doi:10.1007/s00261-026-05772-y · PMID:42701971 · W7210274491
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Abstract

PURPOSE: To evaluate the safety and short-term efficacy of magnetic resonance-guided high-intensity focused ultrasound surgery (MRgFUS) for adenomyosis-associated dysmenorrhea. MATERIALS AND METHODS: This retrospective single-center cohort included 62 patients with MRI-confirmed adenomyosis and dysmenorrhea who underwent MRgFUS between October 2018 and March 2021. Uterine volume, adenomyosis lesion volume, and non-perfused volume (NPV) were measured on MRI. The non-perfused volume ratio (NPVR) was calculated as NPV divided by lesion volume. Dysmenorrhea severity was assessed using the visual analogue scale (VAS). Follow-up data were analyzed as available cases at 3, 6, and 12 months. RESULTS: All 62 patients completed MRgFUS. The mean immediate NPVR was 69.12% ± 17.64%. MRI follow-up was available in 53/62 patients (85.5%) at 3 months, 38/62 (61.3%) at 6 months, and 13/62 (21.0%) at 12 months. Mean uterine volume decreased from 201.38 ± 126.17 cm3 at baseline to 174.97 ± 108.32 cm3 at 3 months and 164.86 ± 108.58 cm3 at 6 months, but was 205.45 ± 125.76 cm3 in the small 12-month subgroup. Mean adenomyosis lesion volume decreased from 83.72 ± 84.02 cm³ at baseline to 62.66 ± 66.31 cm3, 56.09 ± 66.67 cm3, and 68.53 ± 87.04 cm3 at 3, 6, and 12 months, respectively. Mean VAS score decreased from 6.68 ± 2.13 at baseline to 3.69 ± 1.95 at 3 months, 2.72 ± 1.40 at 6 months, and 3.38 ± 1.45 at 12 months. No serious procedure-related complications occurred. CONCLUSION: MRgFUS was technically feasible and appeared safe in this retrospective cohort, with encouraging short-term improvement in dysmenorrhea and early reduction in adenomyosis lesion volume. Because 12-month follow-up was available for only 21.0% of patients and no control group was included, long-term efficacy should be interpreted cautiously and confirmed in prospective controlled studies.

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