OBJECTIVES: The study aimed to develop a non-enhanced MRI-based radiomics model for the preoperative prediction of the efficacy of adenomyosis after high-intensity focused ultrasound (HIFU) treatment. METHODS: The data of 130 patients with adenomyosis who underwent HIFU treatment were reviewed. Based on a non-perfused volume ratio (NPVR) of 50%, the patients were assigned to high ablation rate and low ablation rate groups. A radiomics model was constructed from the screened radiomics features and its output probability was calculated as the radiomics score (Radscore). The clinical-imaging model was constructed from the independent predictors of clinical-imaging characteristics. The combined model was constructed by integrating Radscore and clinical-imaging independent predictors. Receiver operating characteristic (ROC) curves, the Delong test, and decision curve analysis (DCA) were used to evaluate the models. RESULTS: The combined model had the best overall performance among the three models. The AUC (95% CI), specificity, sensitivity, accuracy, and precision of the combined model were 0.860 (0.786-0.935), 0.780, 0.756, 0.769, 0.738 in the training set, and 0.878 (0.774-0.983), 0.859, 0.667, 0.769, 0.800 in the test set, respectively. The Delong test showed that the performance of both the radiomics and combined models differed significantly from the clinical-imaging model. But the performance of the combined and the radiomics model was statistically equivalent. The DCA indicated that the combined model had better clinical net benefit. CONCLUSION: The combined model based on non-enhanced MRI radiomics was effective in predicting the outcome of HIFU ablation of adenomyosis before surgery.