增强MRI和超声造影评估HIFU治疗子宫肌瘤的比较研究

发布时间：2018-06-10 10:02

本文选题：高强度聚焦超声 + 增强MRI　；参考：《重庆医科大学》2014年硕士论文

【摘要】：研究背景子宫肌瘤是育龄女性生殖系统中的最常见的良性肿瘤[1]，约占妇科良性肿瘤的52%[2]。其治疗方法各具优势，包括药物（类固醇），手术治疗（子宫切除术，子宫肌瘤切除术，腹腔镜手术），宫腔镜及子宫动脉栓塞术，但均为有创治疗，术后并发症较多，从生理、心理和社会角度切除子宫对患者有着不同程度的影响。高强度聚焦超声（high intensity focused ultrasound，HIFU）是一种非侵入性的局部治疗肿瘤的治疗技术，已经较多的运用于子宫肌瘤[3-5]治疗。有研究[6-7]超声造影能准确地评价子宫肌瘤的HIFU治疗的疗效报告，而研究报道[8]常规平扫MRI T1W1和T2W1相结合能准确地评价HIFU治疗子宫肌瘤的疗效。目的比较增强MRI和超声造影评估高强度聚焦超声（HIFU）治疗子宫肌瘤的消融情况。资料和方法 1.回顾性分析上海市徐汇区中心医院临床诊断为子宫肌瘤并行HIFU治疗的子宫肌瘤患者，采用随机抽样，患者30例，单发肌瘤27例，多发肌瘤3例，共治疗肌瘤36个。所选择肌瘤总计30个，27个来自于单发肌瘤，另外3个来自于多发肌瘤患者的前壁肌瘤。 2.所有患者治疗前、治疗后一天内采用西门子3.0T超导高场强磁共振扫描仪行常规MRI成像序列采集，扫描横断位、矢状位、冠状位T1WI和T2WI并加压脂相，增强MR扫描采用T1WI-vibe3D扫描，造影剂使用钆喷替酸葡甲胺（Gd-DTPA）。所有患者在治疗前、治疗后即刻行超声造影检查，监控超声（EsaoteMyLab70, Italy）。治疗前、治疗后即可均静脉推注声诺维造影剂，观察肌瘤周边及血流灌注情况。 3.聚焦超声治疗设备为JC-200型聚焦超声肿瘤治疗系统（重庆海扶医疗科技股份有限公司生产），监控超声（Esaote MyLab70, Italy）与该肿瘤治疗系统结合。术前胀尿后于机载超声定位，根据定位情况预设好治疗参数，治疗中为使患者处于镇静镇痛状态，在实时超声引导下进行超声消融治疗。 4.分别在增强MRI和超声造影图像中测量术前肌瘤大小，，包括肌瘤长径（D1）、前后径（D2）、左右径（D3）和术后无灌注区（NPV）。计算肌瘤体积大小、无灌注区体积大小和消融率，体积计算方法：V=0.5233×D1×D2×D3，无灌注体积消融率（消融率）=无灌注区体积/靶肌瘤体积×100%。采用肌瘤瘤体显示级别评估标准对增强MRI、超声造影图像按1-4分进行质量评分，肌瘤瘤体显示的图像质量按清晰可见（4分），可见（3分），模糊可见（2分），不可见（1分）评分。结果 1.在图像质量评分中，CE-MRI总评分和平均分分别为113和3.8±0.4高于CEUS的63和2.1±0.8，差异有显著性（P0.05）。增强MRI测量得出的肌瘤平均消融率为80.6±18.5%，高于超声造影所测量得出72.9±20.0%的平均消融率，统计学处理有显著性意义（P=0.00）。 2.治疗前增强MRI肌瘤体积与超声造影肌瘤体积比较，无显著差异（P0.05）；HIFU治疗后肌瘤NPV在增强MRI上测得为82.5±83.5cm3，明显高于超声造影测得的66.0±66.2cm3，统计学处理有显著性意义（P0.01）。 3.30个肌瘤，增强MRI和超声造影图像质量显示存在明显差异，增强MRI上可以明确显示肌瘤大小、边界，与周围组织的毗邻关系；超声造影上对肌瘤的边界显示相对模糊，甚至有5例无法准确确定肌瘤的边界，使其大小的准确测量受到影响，更无法判断周围组织结构。结论 1. CEUS可能低估肌瘤HIFU治疗后的消融程度，同时由于边界无法清晰显示，无法确定HIFU消融后残留肌瘤组织是否存在，尤其对肌瘤深面后层CEUS无法确定准确的边界，从而其评估HIFU治疗子宫肌瘤消融程度的客观性受到影响。 2.增强MRI在显示子宫肌瘤大小、边缘和评估HIFU治疗子宫肌瘤的无灌注区等方面优于超声造影，它可以更准确地、客观地显示肌瘤的消融情况，为HIFU治疗子宫肌瘤疗效以及临床治疗方案提供可靠的依据。
[Abstract]:Research background
Uterine leiomyoma is the most common benign tumor of reproductive age in women's reproductive system, which accounts for about 52%[2]. of benign gynecologic tumors, including drugs (steroids), surgical treatment (hysterectomy, hysteromyomectomy, laparoscopy), intrauterine mirror and uterine artery embolization, but all are invasive and postoperative complications. The removal of uterus from physiological, psychological and social perspectives has different effects on patients.
High intensity focused ultrasound (high intensity focused ultrasound, HIFU) is a noninvasive treatment for local tumor treatment. It has been used more in the treatment of uterine myoma [3-5]. There is a study of the efficacy of [6-7] sonography to accurately evaluate the curative effect of HIFU therapy for uterine myoma, and the study is reported in [8] routine plain scan MRI T1W1 and T2W1. The combination can accurately evaluate the efficacy of HIFU in the treatment of uterine fibroids.
objective
Contrast enhanced MRI and contrast-enhanced ultrasound were used to evaluate the ablation of uterine fibroids by high intensity focused ultrasound (HIFU).
Information and methods
1. retrospective analysis of the uterine myoma in Central Hospital of Shanghai Xuhui District, which was clinically diagnosed as uterine myoma and HIFU, using random sampling, 30 patients, 27 single myoma, 3 myoma and 36 myoma. The total selection of myoma was 30, 27 from single myoma, and 3 in the anterior wall of multiple myoma. Myoma.
2. before treatment, the routine MRI imaging sequence was collected by SIEMENS 3.0T superconducting high field magnetic resonance scanner, scanning transversal, sagittal, coronal T1WI and T2WI and pressure lipid phase, enhanced MR scan using T1WI-vibe3D scan, and contrast agent using gadolinium gadolinium acid methylamine (Gd-DTPA).
Before treatment, all patients were treated with sonography (EsaoteMyLab70, Italy) immediately after treatment. Before treatment, the sonoveno contrast agent was injected intravenously to observe the peripheral and blood flow of the myoma.
3. focused ultrasound therapy equipment is JC-200 focused ultrasound tumor treatment system (Chongqing Haifu medical Polytron Technologies Inc production), monitoring ultrasound (Esaote MyLab70, Italy) combined with the tumor treatment system. Pre operation onboard ultrasound positioning, according to the location of the presupposition of the treatment parameters, in the treatment of the patient in the town of sedative town. Pain state was treated by real-time ultrasound guided ultrasound ablation.
4. the size of the preoperative myoma was measured in the enhanced MRI and ultrasound contrast images, including the length of the myoma (D1), the anterior and posterior diameter (D2), the left and right diameter (D3) and the postoperative instillation area (NPV). The volume of myoma, the volume of the instillation area and the ablation rate, the volume calculation method: V=0.5233 * D1 x D2 x D3, the perfusion free volume (ablation rate) = no perfusion zone Volume / target myoma volume * 100%.
The quality of MRI was enhanced with the evaluation criteria of the leiomyoma, and the image quality was scored at 1-4 points. The image quality of the myoma body was clearly visible (4 points), visible (3), blurred visible (2), and invisible (1 points).
Result
1. in the image quality score, the total score and the average score of CE-MRI were 113 and 3.8 + 0.4 higher than that of CEUS 63 and 2.1 + 0.8. The difference was significant (P0.05). The average ablation rate of myoma measured by enhanced MRI was 80.6 + 18.5%, higher than that measured by contrast ultrasound, and the average ablation rate was 72.9 + 20%, statistically significant (P=0.00).
2. before treatment, there was no significant difference between the volume of enhanced MRI myoma and the volume of contrast-enhanced ultrasound (P0.05). The NPV of the myoma after HIFU was 82.5 + 83.5cm3 on the enhanced MRI, which was significantly higher than the 66 + 66.2cm3 measured by contrast ultrasound, and statistically significant (P0.01).
3.30 myoma, enhanced MRI and ultrasound contrast image quality showed significant difference, enhanced MRI can clearly show the size of the myoma, boundary, adjacent to the surrounding tissue; ultrasound contrast on the boundary of myoma is relatively blurred, and even 5 cases can not accurately determine the boundary of myoma, so that the accurate measurement of the size of its influence, It is more impossible to judge the surrounding structure.
conclusion
1. CEUS may underestimate the degree of ablation of myoma after HIFU treatment. At the same time, it is impossible to determine whether the residual myoma tissue exists after HIFU ablation, especially for the deep posterior layer of myoma, and CEUS cannot determine the exact boundary, so that the objectivity of the treatment of HIFU for the treatment of uterine fibroids is affected.
2. enhanced MRI is better than contrast-enhanced ultrasound in showing the size of uterine myoma, edge and evaluation of the non perfusion area of HIFU for the treatment of hysteromyoma. It can more accurately and objectively show the ablation of myoma, providing a reliable basis for the treatment of uterine myoma by HIFU and the clinical treatment scheme.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

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