3.0 T MRI定量参数对子宫肌瘤高强度聚焦超声射频消融早期效果评估价值  

Evaluation of quantitative parameters with 3.0 T MRI in ablation of hysteromyoma by high intensity focused ultrasound

作　　者：王亚[1] 郑晓林[3] 王忠[1] 王强[1] 唐莉[2] WANG Ya;ZHENG Xiao-lin;WANG Zhong;WANG Qiang;TANG Li(Department of Radiology,Dongguan Maternal and Child Health Care Hospital,Dongguan 523000,Guangdong,China;Department of HIFU,Dongguan Maternal and Child Health Care Hospital,Dongguan 523000,Guangdong,China;Department of Radiology,Dongguan People’s Hospital,Dongguan 523059,Guangdong,China)

机构地区：[1]东莞市妇幼保健院放射科,广东东莞523000 [2]东莞市妇幼保健院HIFU中心,广东东莞523000 [3]东莞市人民医院放射科,广东东莞523059

出　　处：《生物医学工程与临床》2020年第4期404-410,共7页Biomedical Engineering and Clinical Medicine

基　　金：东莞市科技局立项课题资助项目(2014105101080)。

摘　　要：目的探讨3.0 T MRI定量评估高强度聚焦超声(HIFU)射频消融对子宫肌瘤消融早期效果的可行性及对相关因素分析。方法选择2018年3月至9月在东莞市妇幼保健院行HIFU射频消融32例子宫肌瘤患者,年龄24~48岁,平均年龄38.3岁。分析HIFU射频消融前后(消融后24 h内)MRI资料,将子宫肌瘤消融效果分3种,即完全消融、部分消融和增强信号减低。采用配对样本t检验比较各消融效果的HIFU射频消融前后T1加权成像(T1WI)、T2加权成像(T2WI)及增强序列信号强度差异。采用卡方检验分析子宫肌瘤大小、位置等因素对消融效果的影响。结果32例患者共56个子宫肌瘤,51个为实性,5个合并变性。肌瘤直径5~70 mm。位于子宫前壁36个,后壁20个。56个肌瘤中完全消融35个,部分消融12个,增强信号减低9个。完全消融:表现为全瘤信号发生上述改变,即T1WI呈等、稍高信号,T2WI呈稍高、高信号,增强无明显强化。部分消融:肌瘤的40%~90%发生上述信号改变。增强信号减低:T1WI、T2WI信号无明显变化,增强信号不同程度降低。射频消融前3种消融效果的T1WI信号强度与消融后比较,差异无统计学意义(P>0.05)。射频消融前3种消融效果的T2WI信号强度、增强序列信号强度与消融后比较,差异有显著统计学意义(P<0.01)或统计学意义(P<0.05)。消融效果与子宫肌瘤大小无相关性,差异无统计学意义(r=0.216,P>0.05),与子宫肌瘤前后壁位置有相关性,差异有统计学意义(r=0.389,P<0.05)。结论T2WI、增强序列信号强度的改变能评估子宫肌瘤的早期消融效果,为子宫肌瘤HIFU射频消融效果提供定量参考依据。子宫前壁射频消融效果优于后壁,提示临床对于后壁子宫肌瘤HIFU射频消融需要改进方法。Objective To investigate the value of 3.0 T MRI quantitative evaluation of high intensity focused ultrasound(HIFU)radiofrequency ablation on early effect of hysteromyoma ablation,and analyze related factors.Methods From March to September in 2018,32 hysteromyoma patients performed HIFU radiofrequency ablation were enrolled,which aged 24-48 years old with mean age of 38.3 years old.The MRI data before and after HIFU radiofrequency ablation(within 24-hour after ablation)were analyzed,and ablation effects of uterine fibroids were divided into 3 types complete ablation,partial ablation and reduced signal enhancement.The paired sample t test was used to compare T1 weighted imaging(T1WI),T2 weighted imaging(T2WI)and enhanced signal intensity before and after HIFU in each group by correlation analysis,and evaluated ablation effect.The differences between size,location of fibroids and ablation effect were analyzed.Results There were 56 uterine fibroids in 32 cases,51 of which were parenchymal and 5 combined with degeneration.The tumor diameter was 5-70 mm,and36 in uterus anterior and 20 in uterus posterior.Among 56 fibroids,35 were completely ablated,12 were partially ablated and9 were reduced signal enhancement.The complete ablation group showed whole tumor signal was changed,which was T1WI in isointense and hyperintense slightly signal,T2WI in slightly-hyperintense and hyperintense signal,and there was no obvious enhancement.The partial ablation group showed 40%-90%of uterine fibroids signal changed.T1WI and T2WI signal had no obvious changes and enhanced signals decreased with different degrees in reduced signal enhancement group.The ablation effect of 3 types had no statistically significant difference in T1WI signal intensity between before and after ablation(P>0.05).The T2WI signal intensity and enhanced sequence signal intensity of 3 ablation effects were statistically significant before and after ablation(P<0.05).The ablation effects had no statistically significant association with the size of myoma(R=0.216,P>0.

关 键 词：子宫肌瘤 子宫纤维瘤 磁共振成像(MRI) 高强度聚焦超声(HIFU) 射频消融 消融效果 影像评价 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]