Perfusion response to treatment outcome: CEUS links oxytocin to HIFU efficacy prediction for uterine fibroids.

چکیده اصلی

OBJECTIVES: To evaluate oxytocin-induced perfusion changes in uterine fibroids using contrast-enhanced ultrasound(CEUS) and determine their predictive value for high-intensity focused ultrasound (HIFU) ablation efficacy. METHODS: Fifty-five patients (mean age 42.15 ± 5.34 years). with 78 uterine fibroids underwent oxytocin-enhanced HIFU therapy. CEUS was performed before and after intravenous oxytocin infusion (0.10 U/ml over 10 min). Perfusion changes were assessed using two parameters:(1) Arterial-phase Perfusion Delay Time difference (APDTΔt), defined as the time difference in enhancement onset of fibroids before and after oxytocin exposure; (2) Visual Perfusion Grading (VPG), based on relative contrast perfuse reduction of fibroids at the end of the arterial phase(Grade1:≤30%;Grade2:30-70%;Grade3:≥70%). Post-treatment contrast-enhanced pelvic MRI was used to calculate fibroid volume and non-perfused volume(NPV),from which ablation ratio was derived. Fibroids were dichotomized by ablation efficacy (≥70%vs < 70%), and correlation analyses and ROC curves were used to evaluate predictive performance. RESULTS: Fibroids in the <70% ablation group showed a mean APDT(Δt) of 8.32 ± 5.61s and 52.2%(12/23) VPG as Grade1. In the ≥70% group, APDT(Δt) was significantly longer (16.76 ± 12.12 s), and 54.5%(30/55) VPG were Grade3. Both APDT(Δt) and VPG differed significantly between groups (p < 0.05), Showing strong correlations with ablation ratio (r = 0.577 and r = 0.585; both p < 0.001). Thresholds of APDT(Δt) >3.5 s and VPG >1.5 yielded sensitivities of 83.6% and 87.3%, specificity of 65.2% and 52.3%, with AUCs of 0.791 and 0.725, respectively. CONCLUSION: CEUS can effectively detect oxytocin-mediated perfusion changes in uterine fibroids. These changes are strongly associated with HIFU ablation outcomes, and in particular, Arterial-phase Perfusion Delay Time demonstrates robust predictive value for treatment efficacy.

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