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Objective: To investigate the changes of immunological status and imaging evaluation of high intensity focused ultrasound(HIFU) in the treatment of adenomyosis(AM). Methods: 186 patients with AM admitted to Shijiazhuang People’s Hospital from December 2020 to December 2021 were selected. Before and after HIFU ablation, serum complement C3, C4, the ratio of helper T cell17 to regulatory T cell(Th17/Treg) and magnetic resonance imaging(MRI) were detected.Compare the differences of ultrasound characteristics, MRI measurement parameters, serum complement C3, C4, Th17/Treg levels in AM patients before and after treatment; Spearman correlation was used to analyze the correlation between the levels of serum complement C3, C4, Th17/Treg and the ablation rate and MRI parameters of the non-perfusion area after treatment. Results: Before HIFU treatment in AM patients, ultrasound showed that the echo of the myometrium of the uterine wall was uneven, the blood flow signal of the myometrium was rich, and the blood flow of the focus was rich; MRI showed that the uterus was non-uniformly enlarged, the uterine wall was significantly thickened, the boundary with the uterine junction was unclear, and the signal was uneven. The dynamic enhancement scan showed that the focus was non-uniformly enhanced, and the degree of enhancement was slightly lower than that of the normal myometrium nearby. VAS score of AM patients after HIFU treatment was significantly lower than that before treatment(P＜0.05); Ultrasound showed that the echo of the myometrium of the uterus was uneven, and the blood supply of the myometrium was significantly reduced. MRI showed that the thickening of the uterine wall was reduced, and the signal was uneven. The enhancement scan showed that the central perfusion area was not enhanced, and the peripheral nodular or irregular enhancement was the residual focus, and the ablation rate was about 90%. After HIFU treatment, the levels of serum complement C3 and C4, ADC value and MSI value of residual lesions increased significantly(P＜0.05), while Th17/Treg,ADC value and MSI value of non-perfusion zone decreased significantly(P＜0.05). After HIFU treatment, serum complement C3 and C4levels were significantly negatively correlated with ablation rate, ADC value and MSI value in non-perfusion zone(P＜0.05), while Th17/Treg was significantly positively correlated with ablation rate, ADC value and MSI value in non-perfusion zone(P＜0.05). Conclusion: The changes of immunologic status and MRI evaluation after HIFU treatment of AM patients can help predict the prognosis of AM patients, and guide clinicians to provide objective and realistic basis for the choice of follow-up treatment plan for AM patients. [ABSTRACT FROM AUTHOR]