The Predictive Effect of Quantitative Analysis of Signal Intensity Heterogeneity on T2-Weighted MR Images for High-intensity Focused Ultrasound Treatment of Uterine Fibroids

Rationale and Objectives To investigate whether the quantitative index of signal intensity (SI) heterogeneity on T2-weighted (T2W) magnetic resonance images can predict the difficulty and efficacy of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids. Materials and Methods The standard deviation (SD) of T2W image (T2WI) SI was used to quantify SI heterogeneity. The correlation between SD and the non-perfused volume ratio (NPVR) in 575 patients undergoing HIFU treatment was retrospectively analyzed, and the efficacy of SD in predicting NPVR was discussed. Three classifications were made based on the SD, and the ablation difficulty and ablation effect of different grades were compared. A total of 65 cases from another center were used as an external validation set to verify the classification performance of SD. Results The SD of SI was negatively correlated with NPVR (r = −0.460, p < 0.001). The predictive efficiency of SD for the ablation effect was higher than that of the scaled signal intensity (0.767 vs. 0.701, p = 0.006). Univariate and multivariate logistic regression analyses showed that SD was an independent predictor of ablation effect. Based on SD, the three classifications were divided into SD I: SD < 101.0, SD II: 101.0 ≤ SD < 138.7, and SD III: SD≥ 138.7. The treatment time, sonication time, treatment intensity, and total energy of SD I were lower than those of SD II and III (p < 0.05). Conclusion The heterogeneity of T2WI SI of uterine fibroids is negatively correlated with NPVR. The SD of SI can be used to predict the ablation difficulty and ablation effect of HIFU.