Three-dimensional Power Doppler Ultrasound Assessment of Fibroid Volume and Vascularity following Ulipristal Acetate Therapy: A Retrospective Observational Cohort Study

Background: Use transvaginal three-dimensional (3D) power Doppler ultrasound to evaluate the effects of ulipristal acetate (UPA) on fibroid and uterine volumes and vascular indices in premenopausal women with symptomatic uterine fibroids. Methods: This retrospective study included 59 premenopausal women with symptomatic uterine fibroids who received oral UPA (5 mg/day) for 12 weeks. Transvaginal 3D power Doppler ultrasound was performed before and after treatment to evaluate fibroid and uterine volumes, the vascularization index (VI), vascularization flow index (VFI), pulsatility index (PI), and resistance index. Results: Three months of UPA therapy significantly reduced dominant fibroid volume (69.5 → 34.4 cm 3 , P = 0.008), uterine volume (156.6 → 78.0 cm 3 , P = 0.035), fibroid VI (1.47 → 0.44, P = 0.016), and VFI (0.62 → 0.26, P = 0.028). A lower baseline fibroid PI, reflecting lower vascular resistance, was associated with greater reductions in dominant fibroid volume (ρ = 0.73, P = 0.011) and uterine volume (ρ = 0.62, P = 0.044). Hemoglobin levels increased significantly, whereas liver enzyme levels and endometrial thickness remained unchanged. Conclusion: UPA therapy significantly reduced fibroid size and vascularity as measured by 3D power Doppler ultrasound. Baseline fibroid PI was associated with treatment response, suggesting its potential as a noninvasive predictive marker. These findings indicate that 3D power Doppler ultrasound may be useful for monitoring treatment response in women with uterine fibroids, although validation in larger and longer-term studies is warranted.