Objective:To evaluate the performance differences of three common novel quantitative ultrasound（QUS）imaging methods-Nakagami-Gamma parametric imaging，ultrasound attenuation intercept imaging，and weighted Shannon entropy imaging-in monitoring high-intensity focused ultrasound（HIFU）therapy.Methods:On a clinical HIFU therapy system， ex vivo pork loin tissue and in vivo rabbit leg tissue were treated with HIFU at different acoustic power levels（77-174 W）. Ultrasound monitoring radiofrequency（RF）data were acquired online，and the three QUS images were reconstructed based on identical raw data. Performance was compared through quantitative analysis of tissue damage contrast-to-noise ratio（CNR）and damage area assessment relative to true histological damage. Results:During HIFU therapy，all three QUS imaging methods outperformed B-mode ultrasound in characterizing HIFU-induced damage，with significantly higher CNR values. Among the images，Nakagami-Gamma images showed the highest increase in CNR values before and after treatment，with an improvement of 22.5%- 60.3%；meanwhile，the damage area assessed by weighted Shannon entropy images exhibited the highest correlation with the true damage area（ r=0.81， P<0.000 1）. Conclusions:By characterizing tissue microstructure features，QUS imaging can more reliably monitor HIFU thermal damage than conventional B-mode ultrasound. Among the methods，Nakagami imaging was the most sensitive to damage characterization，entropy parameter imaging showed the strongest correlation with the true damage area，and attenuation intercept imaging achieved the best damage area matching. This study may provide references for developing next-generation clinical HIFU therapy monitoring systems.

Objective:To evaluate the performance differences of three common novel quantitative ultrasound（QUS）imaging methods-Nakagami-Gamma parametric imaging，ultrasound attenuation intercept imaging，and weighted Shannon entropy imaging-in monitoring high-intensity focused ultrasound（HIFU）therapy.Methods:On a clinical HIFU therapy system， ex vivo pork loin tissue and in vivo rabbit leg tissue were treated with HIFU at different acoustic power levels（77-174 W）. Ultrasound monitoring radiofrequency（RF）data were acquired online，and the three QUS images were reconstructed based on identical raw data. Performance was compared through quantitative analysis of tissue damage contrast-to-noise ratio（CNR）and damage area assessment relative to true histological damage. Results:During HIFU therapy，all three QUS imaging methods outperformed B-mode ultrasound in characterizing HIFU-induced damage，with significantly higher CNR values. Among the images，Nakagami-Gamma images showed the highest increase in CNR values before and after treatment，with an improvement of 22.5%- 60.3%；meanwhile，the damage area assessed by weighted Shannon entropy images exhibited the highest correlation with the true damage area（ r=0.81， P<0.000 1）. Conclusions:By characterizing tissue microstructure features，QUS imaging can more reliably monitor HIFU thermal damage than conventional B-mode ultrasound. Among the methods，Nakagami imaging was the most sensitive to damage characterization，entropy parameter imaging showed the strongest correlation with the true damage area，and attenuation intercept imaging achieved the best damage area matching. This study may provide references for developing next-generation clinical HIFU therapy monitoring systems.