Association between HIFU ablation extent and symptom relief and quality of life benefits in uterine fibroids: a retrospective analysis based on imaging and clinical indicators

To evaluate the association between achieved non-perfused volume ratio (NPVR) and subsequent imaging, symptom, and quality-of-life outcomes after high-intensity focused ultrasound (HIFU) treatment for uterine fibroids. This single-center retrospective cohort study included 168 patients with symptomatic uterine fibroids who underwent HIFU and completed 6 months of follow-up. For descriptive comparisons, patients were categorized into three NPVR groups: <80%, 80% to < 90%, and ≥ 90%. Longitudinal changes in Symptom Severity Scale (SSS) and health-related quality of life (HRQoL) were assessed using linear mixed-effects models, and multivariable regression analyses evaluated the associations of achieved NPVR with 6-month outcomes after adjustment for baseline outcome measures, fibroid anatomical characteristics, and other prespecified covariates. Exploratory receiver operating characteristic (ROC) analysis was used to assess discrimination for clinically meaningful symptom response. Higher achieved NPVR was associated with greater fibroid volume reduction and more favorable symptom and quality-of-life outcomes during follow-up. In continuous-NPVR longitudinal analyses, significant time-by-NPVR interactions were observed for both SSS (F = 32.953, P < 0.001) and HRQoL ( F = 19.324, P < 0.001). In baseline- and anatomy-adjusted multivariable analyses, higher NPVR remained associated with a lower 6-month SSS score (β = -0.426, 95% CI: −0.547 to − 0.305, P < 0.001) and a higher 6-month HRQoL score (β = 0.356, 95% CI: 0.241 to 0.471, P < 0.001). At 6 months, 119 of 168 patients (70.83%) achieved the prespecified clinical-response criterion of an SSS reduction of at least 20 points. Higher NPVR was also associated with greater odds of clinical response (OR = 1.102, 95% CI: 1.059 to 1.150, P < 0.001). NPVR alone showed moderate discrimination in exploratory ROC analysis (AUC = 0.745, 95% CI: 0.659 to 0.831). Higher achieved NPVR was associated with greater symptom improvement, better quality of life, and greater fibroid volume reduction at 6 months after HIFU. NPVR may therefore provide useful post-treatment information on achieved ablation extent and subsequent clinical outcomes. However, these findings are observational, and NPVR should not be interpreted as a therapeutic target to be maximized irrespective of procedural safety.