MRI联合治疗参数对高强度聚焦超声治疗后残余子宫肌瘤复生长的危险因素分析  

Analysis of risk factors for regrowth of residual uterine fibroids after high-intensity focused ultrasoundtreatment using a magnetic resonance imaging combined with therapeutic parameters

作　　者：刘洋[1] 肖智博[1] 邱雪珂 罗远利 邓勇斌 吕发金[1] LIU Yang;XIAO Zhi-bo;QIU Xue-ke(State Key Laboratory of Ultrasound in Medicine and Engineering,College of Biomedical Engineering,Chongqing Medical University,Department of Radiology,The First Affiliated Hospital of Chongqing Medical University,Chongqin 400016,China)

机构地区：[1]重庆医科大学超声医学工程国家重点实验室/生物医学工程学院/重庆医科大学附属第一医院放射科,重庆400016 [2]重庆海扶医院肿瘤科,重庆401121

出　　处：《放射学实践》2025年第4期535-542,共8页Radiologic Practice

摘　　要：目的:探讨临床-MRI联合模型对高强度聚焦超声(HIFU)治疗后残余子宫肌瘤复生长的预测价值。方法:回顾性将2016年1月-2021年12月在重庆海扶医院接受HIFU治疗且治疗后一天及1年行MRI检查(T_(2)WI和CE-MRI序列)、治疗后随访2年及以上的116例子宫肌瘤患者纳入本研究。根据治疗1年后MRI复查显示残余子宫肌瘤的体积增大或缩小将患者分为复生长组(73例)和无复生长组(43例)。搜集每例患者的基本临床信息及治疗剂量、治疗时间、辐照时间和能效因子(EEF)等治疗参数,分析和记录子宫肌瘤的术前MRI特征,并将上述3类变量通过曼-惠特尼U检验或卡方检验进行单因素分析,有显著性差异的参数纳入逻辑回归分析,筛选出残余子宫肌瘤复生长的独立危险因素并建立预测模型,并采用ROC曲线分析模型的预测效能。结果:单因素分析和多因素逻辑回归分析结果显示,影响残余子宫肌瘤复生长的3个独立危险因素分别是残余肌瘤最大厚度、能效因子(EEF)和CE-MRI图像上残余子宫肌瘤与子宫肌层信号强度比(SI残余肌瘤/SI子宫肌层)。临床-影像联合模型的AUC为0.925(95%CI:0.873~0.967)。随访24~30(中位数26)个月发现,残余子宫肌瘤复生长组的再干预率明显高于无复生长组(45.21%vs.6.98%)。结论:影响残余子宫肌瘤复生长的独立危险因素为残余子宫肌瘤最大厚度、EEF和CE-MRI图像上SI残余肌瘤/SI子宫肌层;临床-影像联合模型可以对残余子宫肌瘤复生长进行有效预测。Objective:The purpose of this study was to analyze the value of clinical-MRI combined model for predicting regrowth of residual uterine fibroids after high-intensity focused ultrasound(USgHIFU)treatment.Methods:A retrospective analysis was conducted on 116 patients with uterine fibroids who accepted HIFU treatment in Chongqing Haifu Hospital from January 2016 to December 2021.All patients underwent MRI examination(including T_(2)WI and contrast-enhanced sequences)one day and one year after treatment,and accepted two or more years of post treatment follow-ups.All patients were divided into regrowth group(n=73)and non-regrowth group(n=43)based on whether the volume of residual fibroids increased or decreased one year after treatment,which were indicated by follow-up MRI examination.Basic clinical information and treatment parameters including sonication energy,treatment time sonication time,and energy efficiency factor(EEF)were collected for each patient.The pre-treatment MRI characteristics of uterine fibroids were also analyzed and recorded.These three categories of variables were subjected to univariate analysis using the Mann-Whitney U-test or chi-square test.Parameters with significant differences were included in the logistic regression analysis to identify independent risk factors for the regrowth of residual uterine fibroids,and a predictive model was established.The predictive performance of the models was assessed using the ROC curve analysis.Additionally,all the follow-up data of the patients were gathered.Results:Through univariate and multivariate logistic regression analysis,three independent risk factors of the regrowth of residual uterine fibroids were identified,namely the maximum thickness of the residual fibroid,the EEF,and the signal intensity(SI)ratio of the residual fibroid(RF)to the myometrium(abbreviated as SI RF/SI My)on CE-MRI images.The combined clinical-imaging model achieved an AUC of 0.925(95%CI:0.873~0.967).During a median period follow-up of 26 months(ranged from 24 to 30 months),the

关 键 词：子宫肌瘤 磁共振成像 高强度聚焦超声消融 残余肿瘤复生长 

分 类 号：R814.42[医药卫生—影像医学与核医学] R737.33[医药卫生—放射医学]