Feasibility Study on Predicting the Energy and Time Requirements for Microwave Ablation of Uterine Fibroids Using Contrast-Enhanced Ultrasound Perfusion Parameters: A Cross-Sectional, Multicenter Study
To investigate the correlation between the quantitative perfusion parameters of contrast-enhanced ultrasound (CEUS) and the energy and time required per unit volume (EPV/TPV) for the treatment of uterine fibroids (UFs) via percutaneous microwave ablation (PMWA). This retrospective study included 263 patients from five centers with UFs who underwent PMWA treatment between December 2023 and October 2024. All patients underwent conventional ultrasound and CEUS prior to PMWA. Time-intensity curves for CEUS were recorded and the derived perfusion parameters - including maximum intensity (IMAX), rise time, time to peak and mean transit time - were obtained. Ablation power and duration were recorded during the procedure. Post-treatment CEUS was used to determine non-perfused volumes. The relationship between CEUS-derived quantitative perfusion parameters and EPV and TPV was evaluated. A total of 263 patients (272 UFs) were included, with 176 UFs achieving complete ablation and 96 achieving majority ablation. The mean age of the patients was 44.50 ± 5.58 y (range: 23-62 y). Logistic regression analysis revealed that the ablation rate was correlated with between IMAX and both EPV and TPV (all p < 0.001). Restricted cubic spline (RCS) analysis revealed a U-shaped nonlinear correlation between IMAX and both EPV and TPV (p IMAX of CEUS correlates non-linearly (U-shaped) with the energy and time requirements of PMWA for UFs. This finding supports the development of a clinically applicable ablation prediction model that provides a reliable pre-operative tool to optimize PMWA planning.