超声造影与增强磁共振成像评估高强度聚焦超声治疗子宫肌瘤疗效的比较  

Comparison of Contrast-Enhanced Ultrasound and Enhanced MRI to Evaluate the Efficacy of HIFU Treatment for Uterine Fibroids

作　　者：张梅莹[1] 程杰军[2] 万晓燕[1] 狄文[1] ZHANG Meiying;CHENG Jiejun;WAN Xiaoyan(Department of Obstetrics and Gynecology,Shanghai Key Laboratory of Gynecologic Oncology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Department of Radiology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海市妇科肿瘤重点实验室,上海200127 [2]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《实用妇产科杂志》2022年第1期37-42,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:比较超声引导下高强度聚焦超声(HIFU)治疗前后超声造影(CEUS)检查与增强磁共振成像(MRI)检查,对子宫肌瘤患者治疗疗效的评估效果,为HIFU治疗患者的选择和疗效评估提供临床指导。方法:收集上海交通大学医学院附属仁济医院收治的249例子宫肌瘤患者(288个子宫肌瘤),分别用CEUS和增强MRI检查对HIFU治疗前子宫肌瘤的血供进行预估;并在HIFU治疗后通过两名观察者CEUS评估即刻疗效,以排除人为干扰;对HIFU治疗后即刻CEUS与增强MRI检查的疗效评估进行比较;采用受试者工作特征(ROC)曲线,通过术前增强MRI检查中子宫肌瘤病灶最大血管直径,预估HIFU治疗疗效。结果:(1)HIFU治疗前,增强MRI和CEUS评估子宫肌瘤血供的AUC分别为0.717和0.769,一致性好(Kappa 0.738,P<0.001);但在T2WI低信号的病例中仍可见CEUS血供丰富的Ⅲ级(23例)和Ⅳ级(4例)肌瘤。(2)HIFU治疗后,两名观察者CEUS疗效评估的一致性非常好(Kappa 0.933,P<0.001)。(3)HIFU治疗后,两种方法评估的符合率86.11%(248/288),疗效评估的一致性好(Kappa 0.716,P<0.001);但在评估有差异的40个子宫肌瘤中,有31个CEUS评估值高于MRI、9个CEUS评估值低于MRI。(4)HIFU治疗前增强MRI病灶中血管最大直径的Youden指数为1.75 mm,直径<1.75 mm时,肌瘤完全消融率高(AUC 0.990,P<0.001)。结论:HIFU治疗前评估病灶时,可采用增强MRI结合CEUS的方法以达到全面准确地评估,且在增强MRI病灶中血管最大直径<1.75 mm的肌瘤完全消融率高;HIFU治疗后,CEUS可随时进行情况观察,而增强MRI检查更能全面显示消融后的图像。Objective: To compare the efficacy evaluation of contrast-enhanced ultrasound( CEUS) and enhanced MRI( which is recommended by current expert consensus) for uterine fibroids patients before and after USg HIFU treatment,so as to provide clinical guidance for the selection and efficacy evaluation of patients with uterine fibroids. Methods: A total of 249 patients with 288 uterine fibroids treated in Renji Hospital were collected.The blood supply of uterine fibroids before HIFU treatment were estimated by CEUS and enhanced MRI respectively. After HIFU treatment,the immediate efficacy was evaluated by CEUS of two observers to eliminate human interference. The efficacy evaluation of CEUS and enhanced MRI immediately after HIFU treatment was compared. ROC curve was used to estimate the maximum vessel diameter of fibroids lesions on preoperative enhanced MRI. Results:(1)Before HIFU treatment,the area under the ROC curve for the evaluation of uterine fibroid blood supply by enhanced MRI and CEUS were 0. 717 and 0. 769,respectively( Kappa 0. 738,P < 0. 001). However,there were still grade Ⅲ( 23 cases) and grade Ⅳ( 4 cases) with abundant CEUS blood supply in fibroids with low signal in T2-weighted images.(2)After HIFU treatment,the consistency of CEUS efficacy evaluation between the two observers was very good( Kappa 0. 933,P < 0. 001).(3)After HIFU treatment,the coincidence rate of the two methods was 86. 11%( 248/288),and the consistency of efficacy evaluation was good( Kappa 0. 716,P <0. 001). However,among the 40 uterine fibroids with different evaluation,31 CEUS evaluation values were higher than MRI and 9 CEUS evaluation values were lower than MRI.(4)Before HIFU treatment,the Youden index of the maximum diameter of blood vessels in enhanced MRI lesions was 1. 75 mm. When the diameter was less than1. 75 mm,the complete ablation rate of fibroids was high( AUC 0. 990,P < 0. 001). Conclusions: In pre-HIFU evaluation of uterine fibroids,enhanced MRI combined with CEUS should be used to achieve comprehensive and accura

关 键 词：子宫肌瘤 高强度聚焦超声治疗 超声造影 增强磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤]