使用扩散加权成像实现在治疗床上即刻评估磁共振引导聚焦超声治疗消融子宫肌瘤的效果  

Value of Diffusion-Weighted Imaging for Immediate Assessment of Ablation Result of Uterine Fibroids on the MRgFUS Treatment-Table

作　　者：蔡世华[1] 马富强 林永强[1] 周守国[1] 黄耀渠[1] CAI Shihua;MA Fuqiang;LIN Yongqiang(Department of Radiology,Foshan Hospital of Traditional Chinese Medicine,Foshan,Guangdong Province 528000,P.R.China)

机构地区：[1]佛山市中医院医学影像科,广州中医药大学第八临床医学院,528000

出　　处：《临床放射学杂志》2025年第4期678-683,共6页Journal of Clinical Radiology

基　　金：佛山市医学类科技攻关项目(编号:2020001005371、2320001006633)。

摘　　要：目的 探讨扩散加权成像(DWI)在治疗床上即刻评估子宫肌瘤的磁共振引导聚焦超声治疗(MRgFUS)消融效果的可行性和价值。方法 回顾性分析47例接受子宫肌瘤MRgFUS消融并在治疗床上即刻行DWI(b值为800 s/mm^(2))和增强MR成像的患者资料。对DWI的图像质量进行Likert 5分量表主观评分,分析消融坏死病变的DWI表现,同时与增强MR比较其最大面积的差异和一致性。结果 95.7%(45/47)DWI图像评分≥3分。67个目标肌瘤的消融后坏死灶均在DWI上显示出与增强MR对应的异常信号,表现为“牛眼征”和“亮斑征”。观察者内和观察者间测量DWI上坏死病灶最大面积的组内相关系数(ICC)均为0.98(P均<0.001)。使用DWI和增强MR测量消融坏死面积的ICC为0.92~0.98(P均<0.001)。DWI和增强MR测量消融坏死区平均面积分别为(19.09±12.66) cm^(2)和(18.47±12.57) cm^(2)(P<0.05)。结论 DWI可作为一种非增强的替代方法,在治疗床上即刻评估MRgFUS消融子宫肌瘤的效果。评估时需要注意DWI存在轻度高估非灌注区的可能。Objective To investigate the feasibility and value of diffusion-weighted imaging(DWI) for immediate assessment of magnetic resonance-guided focused ultrasound(MRgFUS) ablation result of uterine fibroids on the MRgFUS treatment-table.Methods Data from 47 patients who underwent MRgFUS ablation of uterine fibroids and underwent DWI(b-value was 800 s/mm~2) and enhanced MR imaging immediately on the treatment-table were retrospectively analyzed.The image quality of DWI was scored by a Likert scale.The DWI performance of ablated necrotic lesions was analyzed,the difference and consistency of area measurements were compared with enhanced MR.Results 95.7%(45/47) of the DWI images were scored ≥3.All 67 ablated necrotic lesions of the targeted uterine fibroids showed abnormal signals on DWI that corresponded to contrast-enhanced MR,manifested as the “bull's eye sign” and the “bright patch sign”.The intra-and interobserver intraclass correlation coefficients for the maximum area of necrotic lesions measured on DWI were 0.98(both P< 0.001).The intraclass correlation coefficients for ablated necrosis measured by DWI and enhanced MR ranged from 0.92 to 0.98(all P< 0.001).The average areas of ablated necrotic lesions measured by DWI and enhanced MR were(19.09±12.66) cm~2 and(18.47±12.57) cm~2,respectively(P< 0.05).Conclusion DWI can be used as a non-enhanced alternative method to assess the effect of MRgFUS ablation of uterine fibroids directly on the treatment-table.The possibility of slight overestimation of non-perfused areas by DWI should be taken into account in the evaluation.

关 键 词：磁共振引导聚焦超声治疗 子宫平滑肌瘤 热消融 扩散加权成像 增强成像 

分 类 号：R73[医药卫生—肿瘤]