Nomogram for predicting HIFU efficacy in uterine fibroids: based on oxytocin-induced arterial-phase perfusion delay and ultrasound features
This study aimed to develop and validate a nomogram for predicting high-intensity focused ultrasound (HIFU) ablation efficacy in uterine fibroids, based on the Oxytocin-Induced Arterial-phase Perfusion Delay Time(APDT) on contrast-enhanced ultrasound (CEUS), combined with ultrasound features. A retrospective analysis was performed on 53 patients (76 fibroids) who underwent oxytocin-assisted HIFU treatment. All patients underwent abdominal ultrasound before HIFU, with APDT on CEUS recorded pre- and post-oxytocin challenge. Predictive factors were identified via univariate and multivariate logistic regression analyses. A clinical efficacy prediction model for HIFU treatment was established using R software and visualized as a nomogram. Its discriminative ability, calibration performance, and clinical utility were evaluated. The final predictive factors included the number of intratumoral attenuation bands, oxytocin-induced APDT, peripheral blood flow grade, and location/type of fibroids. The nomogram's calibration curve demonstrated excellent agreement between observed and predicted values (absolute error = 0.034). The discriminative ability, assessed by the area under the receiver operating characteristic curve (AUC), was 0.884 (95% CI: 0.803-0.965). The model achieved a sensitivity of 92.7% and specificity of 76.2%, indicating strong predictive value for ablation outcomes. Decision curve analysis revealed high clinical utility with a maximum net benefit threshold probability range of 0%-97%. The HIFU ablation efficacy prediction model, integrating oxytocin-induced Arterial-phase Perfusion Delay Time and ultrasound features, demonstrated robust predictive performance and may assist clinicians in selecting suitable candidates for HIFU treatment.