Magnetic resonance-guided focused ultrasound surgery for adenomyosis: current evidence and future directions.

Adenomyosis (AM) is a common gynecological disorder with high prevalence among women of childbearing age. Although hysterectomy is the definitive treatment, it is considered unsuitable for patients who wish to preserve fertility, creating an urgent need for effective, minimally invasive alternatives. Despite emerging evidence, no comprehensive synthesis comparing ablation techniques and guidance modalities specifically for AM currently exists. Currently used thermal ablation techniques include high-intensity focused ultrasound (HIFU), radiofrequency ablation, and percutaneous microwave ablation. Among these, HIFU has gained increasing attention as a non-invasive, uterus-sparing treatment option. Focused ultrasound procedures can be performed under ultrasound or magnetic resonance imaging (MRI) guidance. Magnetic resonance-guided focused ultrasound surgery (MRgFUS), leveraging the high resolution of MRI, enables more precise lesion targeting, real-time temperature monitoring, and immediate postoperative assessment. MRgFUS can effectively reduce lesion size and alleviate symptoms, while lesion-specific MRI features and radiomics models show predictive value for treatment outcomes. By integrating adjuvant hormonal therapies and advanced imaging evaluations, MRgFUS is expected to not only evolve into a more individualized and precise therapeutic strategy but also help establish standardized frameworks for patient selection and outcome prediction. This review summarizes recent advances in MRgFUS for the treatment of AM, focusing on its unique advantages, safety, and efficacy, and emphasizes the critical role of MRI-based imaging biomarkers in predicting therapeutic outcomes.