Factors Influencing Early-Stage Seromuscular Layer Lesions in Focused Ultrasound Ablation for Adenomyosis

Corresponding author: PU yuanfang, Pyfxx_123456@163.com

DOI: 10.12201/bmr.202602.00004

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  Abstract: Objective Adenomyosis (AM) is a benign condition that resembles endometriosis; its pathogenesis remains elusive, and it most commonly presents with abnormal uterine bleeding and subfertility. Reported prevalence rates vary widely (5–70%), and the condition is increasingly diagnosed in younger women. High-intensity focused ultrasound (HIFU) has shown favourable efficacy across all KISHI subtypes of adenomyosis. However, early post-contrast MRI occasionally reveals ring-like non-enhancing defects, underscoring the need for additional strategies to minimise collateral tissue damage and enhance the safety profile of HIFU.Methods This retrospective cohort study enrolled 233 patients with magnetic resonance–confirmed adenomyosis who underwent high-intensity focused ultrasound (HIFU) ablation at Nanchuan Hospital, Chongqing Medical University, between 2015 and 2025. Early post-contrast MRI was used to assess the integrity of the junctional zone and outer myometrium. A total of 57 women showing ring-like non-enhancing defects were classified as the “injury” group, whereas the remaining 176 constituted the “no-injury” group. Univariable and multivariable logistic regression analyses were performed to identify predictors of myometrial injury.Results The total injury rate was 24.4%. Univariate analysis indicated that maximum lesion location, KISHI classification, lesion volume, ablation rate, sonication time, and distance from the anterior abdominal wall were associated with injury (P<0.05). Multivariate regression analysis identified ablation rate, maximum lesion location, and KISHI classification as independent factors (P<0.05). Specifically, higher ablation rates (OR=7.963, 95% CI: 1.100–57.648) and exophytic types in KISHI classification (OR=4.514, 95% CI: 1.779–11.453) were independent risk factors. Conversely, lesions located on the posterior wall conferred a protective effect (OR=0.274, 95% CI: 0.120–0.626).Conclusion Post-HIFU early myometrial injury in AM is independently correlated with ablation rate and lesion type, while posterior wall location appears to exert a protective effect. Enhanced safety protocols are warranted for patients with high ablation rates or exophytic KISHI classifications.

  Key words: High-intensity?focused?ultrasound?ablation?; Adenomyosis; Seromuscular layer; Tissue injury; Safety；Influencing?factors

  Submit time: 3 February 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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