MRI、超声显像在乳腺良性结节微波消融治疗中的应用  

Magnetic resonance imaging and ultrasound in evaluation of microwave ablation therapy for breast benign nodules

作　　者：张巍[1] 李建民[1] 潘小明[2] 张晖[2] 梁婷[1] 梁海云[1] 陆伟[3] 王大成[4] 

机构地区：[1]广西医科大学第三附属医院介入超声科,南宁530031 [2]广西医科大学第三附属医院乳腺甲状腺外科,南宁530031 [3]广西医科大学第三附属医院病理科,南宁530031 [4]广西医科大学第三附属医院放射科,南宁530031

出　　处：《磁共振成像》2015年第12期932-936,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨磁共振成像(magnetic resonance imaging,MRI)和超声(ultrasound,US)显像评价乳腺良性结节微波消融治疗的价值。材料与方法选择超声引导下穿刺活检经病理证实的乳腺良性结节患者20例共41个结节,微波消融治疗前分别行US和MRI检查,观察结节的位置、大小、边界、内部回声、血流分布及造影增强等情况,超声引导定位,精确地将微波电极穿入结节内行微波消融,治疗后利用MRI和US显像判断消融治疗的效果。结果消融治疗前后结节平均大小分别为(17.5±5.6)mm和(15.9±6.9)mm,差异有统计学意义(t=2.752,P=0.012)。消融治疗前,灰阶超声结节表现为低回声,边界多清楚(83%);超声造影(contrast-enhanced ultrasound,CEUS)和MRI增强扫描显示结节内均有不同程度增强。消融治疗后,灰阶超声显示原结节区域呈不均匀高回声,边界不清;CEUS检查结节呈无增强35个(85%),结节边缘少量星点状增强6个,经再次消融治疗后结节内无增强;MRI显示结节内均呈无增强,消融区域周边见水肿带。超声引导下穿刺活检,消融区呈凝固样坏死。结论MRI有助于全面了解结节的大小、空间结构及血流分布;US显像术前了解结节情况,实时引导和监测消融过程,两者联合应用对制定正确的消融策略和远期疗效的评价有重要作用。Objective：To discuss the value of magnetic resonance imaging（MRI） and ultrasound（US） in assessing the effi cacy of microwave ablation（MWA） therapy for breast benign nodules. Materials and Methods： Selected 20 patients with 41 benign breast nodules which was confirmed by pathology, before and after MWA therapy, performed US and MRI on those respectively. The following features of the nodule, such as location, number, longest diameter, boundary, internal echoic, etc were observed. Results： The longest diameter of nodules were（17.5±5.6） mm and（15.9±6.9） mm, respectively, they have statistical difference（t=2.752, P=0.012）. Before MWA therapy, nodules were all hypoechoic with clearly boundary on gray-scale US, all nodules presented enhancement partly on both contrast-enhanced ultrasound（CEUS） and enhanced MRI imaging. After MWA therapy, therapic region of the nodules were hyperechoic with blur boundary, CEUS presented nodules as non-enhancement in 35（85%） nodules and sparsely punctate enhancement in 6 nodules, which was undergone further MWA therapy. All nodules were non-enhanced with a area of edema beside the nodules on enhanced MRI. Internal region of the nodule was presented coagulative necrosis on pathology after MWA therapy. Conclusion： MRI can contribute tounderstand the size, spatial structures and blood fl ow distribution and US can monitor and assess the process of MWA therapy, they play an important role in designing accurate strategy and evaluating long-term effi cacy of MWA therapy.

关 键 词：乳腺疾病 乳腺结节 超声检查 乳房 磁共振成像 微波消融 

分 类 号：R445.2[医药卫生—影像医学与核医学] R655.8[医药卫生—诊断学]