子宫肌瘤HIFU消融术后骶神经磁共振神经成像价值研究  

Magnetic Resonance Neuroimaging in Sacral Nerve after HIFU Ablation of Uterine Fibroids

作　　者：陈娇[1] 张茂春[1] 肖如辉 杨汉丰[2] CHEN Jiao;ZHANG Maochun;XIAO Ruhui(Department of Obstetrics and Gynecology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan Province 637000,P.R.China)

机构地区：[1]川北医学院附属医院妇产科,南充637000 [2]川北医学院附属医院放射科,南充637000

出　　处：《临床放射学杂志》2023年第9期1393-1398,共6页Journal of Clinical Radiology

基　　金：南充市市校合作科研专项(编号:19SXHZ0275)。

摘　　要：目的采用DTI、MATRIX成像技术显示子宫肌瘤HIFU消融术前、术后骶神经的变化特征,并分析相关因素。方法招募行子宫肌瘤HIFU消融术的42例患者,在术前1周内及术后1天行S_(1)~S_(3)神经DTI及MATRIX扫描。以骶神经在骶孔出口处作为感兴趣区,对比分析术前、术后骶神经FA值与ADC值的变化。同时对术前、术后骶神经行多平面重组,观察神经信号及形态的改变。分析骶神经改变与患者一般资料及治疗参数的相互关系。结果(1)术前、术后左侧同节段S_(1)~S_(3)神经FA、ADC值分别进行比较时,差异有统计学意义(P<0.05);术前、术后右侧同节段S1~S3神经FA、ADC值分别相比时,差异有统计学意义(P<0.05);(2)术后同节段S1~S3神经左右侧FA及ADC值分别进行对比,差异均不存在统计学意义(P>0.05)。(3)术后所有骶神经形态未发生明显改变,但部分神经出现了不同程度的信号增强,其中神经信号增强者22例,无神经信号增强者20例。(4)单因素分析中肌瘤背面与骶骨间距离、消融总时间及总能量与骶神经信号增强有统计学意义(P值均<0.05)。在Logistic回归分析中肌瘤背面和骶骨间距离与神经损伤呈负相关(P<0.05),消融的总能量与神经损伤呈正相关(P<0.05)。结论DTI及MATRIX技术可评估超声引导的HIFU消融术在消融子宫肌瘤过程中骶神经损伤的情况。肌瘤背面与骶骨间距离及消融总能量是骶神经信号增高的两个独立影响因素。Objective To show the changes of sacral nerve after HIFU ablation of uterine fibroids by DTI and MATRIX imaging,and to analyze the factors causing the changes.Methods Forty⁃two patients who underwent HIFU ablation of u⁃terine fibroids in our hospital were recruited and underwent S1-S3 nerve DTI and MATRIX scanning within one week be⁃fore surgery and one day after surgery.The signal changes of the sacral nerve before and after HIFU ablation of fibroids were compared and analyzed using the sacral nerve at the foraminal outlet as the region of interest.At the same time,multiplanar reconstruction of the sacral nerve was performed before and after HIFU ablation to observe the changes in nerve signal and morphology.The relationship between sacral nerve signal changes and patients'general data and treatment parameters were also analyzed.Results(1)There were significant differences in FA and ADC values of S_(1)-S_(3) nerve between the left same segment before and after operation(P﹤0.05).The FA and ADC values of S1-S3 nerve in the right same segment before and after surgery were significantly different(P﹤0.05).(2)Postoperative FA and ADC values of the left and right sides of the S_(1)-S_(3) nerve were compared,respectively,and there were no significant differences(P﹥0.05).(3)The morphology of all sacral nerves did not change significantly after surgery,but some nerves showed varying degrees of signal enhancement,including 22 cases with nerve signal enhancement and 20 cases without nerve signal enhancement.(4)The distance between the dorsal surface of the fibroid and the sacrum,the total ablation time and the total energy and sacral nerve signal enhancement were statistically significant in univariate analysis(P﹤0.05).In logistic regression analysis the distance between the dorsal surface of the fibroid and the sacrum was negatively correlated with nerve injury,and the total energy of ablation was positively correlated with nerve injury.Conclusion DTI and MATRIX techniques can assess sacral plexus injury duri

关 键 词：子宫肌瘤 高强度聚焦超声消融术 骶神经 扩散张量成像 

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