Polidocanol augments high-intensity focused ultrasound efficacy for hyperintense fibroids on T2WI: a retrospective cohort study

Objective To compare the immediate efficacy and safety of high-intensity focused ultrasound (HIFU) monotherapy with the combination of ultrasound-guided intratumoral polidocanol injection and HIFU for the treatment of uterine fibroids with high T2-weighted imaging (T2WI) signal intensity.Methods In this retrospective study, 116 patients with T2-hyperintense uterine fibroids treated between January 2024 and May 2025 were enrolled. Patients were allocated to either HIFU monotherapy (the H group, n = 63) or combined polidocanol and HIFU therapy (the H + P group, n = 53). Thereafter, therapeutic parameters, the non-perfused volume ratio (NPVR), and adverse events were compared between the two groups after propensity score matching.Results The matched cohort comprised 53 patients per group. The median NPVR was significantly higher in the H + P group than in the H group (92.57% vs. 77.81%, p < 0.001). Additionally, a significantly greater proportion of patients in the H + P group achieved an NPVR ≥ 80% (87% vs. 43%, p < 0.001) and an NPVR ≥ 90% (60% vs. 9%, p < 0.001). The H + P group also required significantly less sonication time and lower total energy delivery (both p < 0.05). Furthermore, the overall incidence of adverse events was similar between the two groups (73.6% vs. 69.8%, p = 0.506). However, the H + P group exhibited a markedly lower incidence of sacrococcygeal pain (5.7% vs. 45.3%, p < 0.001).Conclusion Pretreatment with ultrasound-guided intratumoral polidocanol injection may improve the immediate ablation efficacy of HIFU in T2-hyperintense uterine fibroids, reducing energy requirements and mitigating procedure-related sacrococcygeal pain. These findings highlight the potential of this combined therapy and underscore the need for prospective studies to confirm its long-term clinical benefits.