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.