Magnetic Resonance Imaging‐Based Classification Systems for Informing Better Outcomes of Adenomyosis After Ultrasound‐Guided High‐Intensity Focused Ultrasound Ablating Surgery

Ying Tang, Wen-Hao Hu, Wenhao Hu, Hang Wang, Jia Wu, Ming‐bo Wen, Ming-Bo Wen, Bin Su, Zhijun Jiang, Zhi-Jun Jiang, Xiao Jiang, Li-Juan Zhu, Li‐juan Zhu, Na Ding, Ming‐tao Yang, Ming-Tao Yang, Shu Yin, Huiquan Hu, Hui-Quan Hu, Fan Xu, Jun Li, Qiuling Shi
Journal of magnetic resonance imaging : JMRI · 2023 · vol. 59(5) , pp. 1787–1797 · doi:10.1002/jmri.28943 · PMID:37671487 · W4386466873
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Classification 2 (C2) for adenomyosis on MRI best predicts dysmenorrhea relief and recurrence after focused ultrasound ablation surgery, with its extrinsic subtype associated with earlier recurrence.

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Abstract

BACKGROUND: A referenced MRI-based classification associated with focused ultrasound ablation surgery (FUAS) outcomes is lacking in adenomyosis. PURPOSE: To identify an MRI-based classification system for informing the FUAS outcomes. STUDY TYPE: Retrospective. POPULATION: Patients with FUAS for adenomyosis, were divided into a training set (N = 643; 355 with post-FUAS gonadotropin-releasing hormone/levonorgestrel, 288 without post-FUAS therapy) and an external validation set (N = 135; all without post-FUAS therapy). FIELD STRENGTH/SEQUENCE: 1.5 T, turbo spin-echo T2-weighted imaging and single-shot echo-planar diffusion-weighted imaging sequences. ASSESSMENT: Five MRI-based adenomyosis classifications: classification 1 (C1) (diffuse, focal, and mild), C2 (intrinsic, extrinsic, intramural, and indeterminate), C3 (internal, adenomyomas, and external), C4 (six subtypes on areas [internal or external] and volumes [<1/3 or ≥2/3]), and C5 (internal [asymmetric or symmetric], external, intramural, full thickness [asymmetric or symmetric]) for FUAS outcomes (symptom relief and recurrence). STATISTICAL TESTS: The optimal classification was significantly associated with the most subtypes of FUAS outcomes. Relating to the timing of recurrence was measured using Cox regression analysis and median recurrence time was estimated by a Kaplan-Meier curve. A P value <0.05 was considered statistically significant. RESULTS: Dysmenorrhea relief and recurrence were only associated with C2 in training patients undergoing FUAS alone. Compared with other subtypes, the extrinsic subtype of C2 was significantly associated with dysmenorrhea recurrence in the FUAS group. Besides, the median dysmenorrhea recurrence time of extrinsic subtype was significantly shorter than that of other subtypes (42.0 months vs. 50.3 months). In the validation cohort, C2 was confirmed as the optimal system and its extrinsic subtype was confirmed to have a significantly shorter dysmenorrhea recurrence time than other subtypes. DATA CONCLUSION: Classification 2 can inform dysmenorrhea relief and recurrence in patients with adenomyosis undergoing FAUS only. Itsextrinsic subtype was associated with an earlier onset of dysmenorrhea recurrence after treatment. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 5.

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Condition tags

mesh:D004412adenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation High-Intensity Focused Ultrasound Ablation

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