A predictive model combining conventional and contrast-enhanced ultrasound for predicting complete microwave ablation of uterine fibroids: a multi-centre study

To develop a pre-percutaneous microwave ablation (PMWA) model combining conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) for predicting non-perfused volume ratio (NPVR) ≥ 80% in patients with uterine fibroids. This multicentre, retrospective study enrolled 276 patients with pathologically confirmed uterine fibroids (training/validation = 140/136). CUS features (maximum diameter, pre-operative volume, location, echo), CEUS parameters (maximum intensity: IMAX), and ablation parameters (energy, time, energy per unit volume [EPV], and time per unit volume [TPV]) were analysed. Multivariate logistic regression identified predictors, and model performance was assessed using the area under the receiver operating characteristic curve (AUC) and clinical decision curve analysis. Multivariate analysis identified four independent predictors: maximum diameter (odds ratio [OR] = 0.47, p < 0.001), IMAX (OR = 0.34, p = 0.013), energy (OR = 1.01, p = 0.002), and TPV (OR = 0.69, p < 0.001). The prediction model performed well in both the training (AUC = 0.79, 95% confidence interval [CI] = 0.71–0.87) and validation (AUC = 0.70, 95%CI = 0.61–0.79) datasets. P values for the Hosmer–Lemeshow test were 0.263 and 0.980, respectively, and the Brier Score was 0.184. This study established a prediction model based on CUS features, CEUS perfusion parameters, and ablation parameters to evaluate the efficacy of PMWA for uterine fibroids; NPVR ≥ 80% can be predicted using the nomogram. This model enables accurate prediction of the efficacy of PMWA for uterine fibroids, providing profound guidance for pre-operative assessment and intraoperative management in clinical practice and facilitating personalised, precision treatment.