Safety and Efficacy of Intratumoral Ethanol Injection Followed by High-intensity Focused Ultrasound Ablation for Hyperintense Uterine Fibroids on T2-weighted Magnetic Resonance Images.

OBJECTIVES

The objective of this study was to evaluate the safety and efficacy of intratumoral ethanol injection followed by high-intensity focused ultrasound (HIFU) for hyperintense uterine fibroids on T2-weighted magnetic resonance images (T2WI).

MATERIALS AND

METHODS

Patients with hyperintense uterine fibroids who received intratumoral ethanol injection followed by HIFU in our hospital from January 2022 to February 2024 were retrospectively reviewed.

RESULTS

A total of 195 patients with 209 fibroids were pretreated with intratumoral ethanol injection before HIFU. The median volume of anhydrous ethanol injected in each patient was 10.0 (interquartile range: 5.0, 13.0) ml. During the procedure of intratumoral ethanol injection, 1 patient experienced facial flushing and 7 patients experienced coughing. The median sonication time of HIFU was 800.0 (interquartile range: 499.5, 1300) s. Significant grayscale change was observed in 133 (63.6%) fibroids, and homogeneous grayscale change was observed in 76 (36.4%) fibroids. The average nonperfused volume ratio (NPVR) of fibroids was 81.2% ±13.0%. No significant difference was observed in NPVR between fibroids using different volumes of ethanol (P > 0.05). The frequent adverse effects during HIFU were lower abdominal pain and sacrococcygeal region pain, with a median pain score of 3.0 (interquartile range: 2.0, 3.0) points. The frequent adverse effects after HIFU included vaginal discharge, lower abdominal pain, or sacrococcygeal pain. All adverse effects were minor. No severe adverse effects occurred.

CONCLUSION

Intratumoral ethanol injection followed by HIFU treatment is safe and effective for hyperintense uterine fibroids. This strategy offers a new option for patients with hyperintense uterine fibroids who want to avoid surgery.