Combined Assessment of the Junctional Zone and Depth of Myometrial Infiltration on MRI for Predicting Symptom Recurrence After Ultrasound-Guided High-Intensity Focused Ultrasound Ablation in Adenomyosis

BACKGROUND: This study explored the correlation of the junctional zone, depth of myometrial invasion (DMI), and their combination (COJD) with symptom recurrence after ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS) in patients diagnosed with intrinsic adenomyosis. METHODS: A total of 326 patients undergoing FUAS between June 2017 and March 2024 were enrolled in this retrospective analysis. Symptom recurrence was defined as the return of menorrhagia or dysmenorrhea after ≥ 3 months of relief. Risk factors for recurrence were identified by logistic regression and Cox proportional hazards models. The receiver operating characteristic (ROC) analysis was conducted to determine the optimal cutoffs for maximal junctional zone thickness (JZmax) and DMI, which were utilized for constructing the COJD score. RESULTS: Symptom recurrence was observed in 58 patients (17.8%). Multivariate logistic regression identified JZmax as an independent predictor of recurrence (OR = 1.060, 95% CI: 1.026-1.095, P < 0.001). The optimal cutoffs were 23.1 mm for JZmax and 51.4 mm for DMI. Besides, COJD was significantly related to recurrence in Cox regression (HR = 6.004, 95% CI: 1.125-32.054, P = 0.036). Median recurrence-free survival reduced progressively with the increasing COJD score: 53.0 months for COJD = 0, 45.8 months for COJD = 1, and 38.7 months for COJD = 2 (P = 0.046). CONCLUSION: The COJD score, combining JZmax with DMI, was an independent predictor of symptom recurrence after FUAS, with a score of two identifying patients at the highest risk of early recurrence.