超声造影灌注特征与HIFU消融子宫腺肌病量效关系相关性研究

发布时间：2018-04-03 08:21

  本文选题：高强度聚焦超声　切入点：子宫腺肌病　出处：《重庆医科大学》2015年硕士论文

【摘要】：研究背景：子宫腺肌病是常见的妇科疾病之一,由于其病灶与正常肌层组织之间无包膜及明确边界,导致保留子宫的治疗方法面临困境,使其成为现代妇产科学的难题。高强度聚焦超声(High Intensity Focused Ultrasound, HIFU)是近年来兴起的一种微无创治疗技术,已应用于子宫腺肌病治疗,可有效缓解子宫腺肌病患者痛经、经量增多等症状。腺肌病灶的血流灌注是超声能量在靶组织内沉积的不利因素,故术前了解子宫腺肌病灶血流灌注特征对于临床超声消融治疗子宫腺肌病具有重要意义。微泡超声造影剂(Ultrasound Contrast Agent, UCA)在血管中的运动行为特征与红细胞相仿,其到达器官的数量及速度可反映该组织微循环血流灌注状态,上述条件为评估子宫腺肌病灶微循环血流灌注特征提供了可能。本课题利用超声造影时间强度曲线(Time-Intensity Curve, TIC)量化评估子宫腺肌病超声造影(Contrast Ehanced Ultrasonography, CEUS)灌注特征,初步探讨超声造影灌注特征定量指标与高强度聚焦超声消融子宫腺肌病量效关系的相关性,为超声消融子宫腺肌病术前制定治疗计划提供依据。目的：定量分析子宫腺肌病超声造影灌注特征,探讨超声造影灌注特征定量指标与高强度聚焦超声消融子宫腺肌病的量效关系的相关性。资料与方法：2014年10月至2015年3月于重庆海扶医院确诊为子宫腺肌病并接受HIFU治疗患者24例。术前行超声造影检查并存储图像,定量分析超声造影TIC并记录增强时间及增强强度；术后行增强MRI检查评价消融效果,计算出能效因子(Energy Effect Factor, EEF)、无灌注体积(Non-perfused Volume, NPV)。分析EEF与增强时间及增强强度的线性相关性；以EEF=10J/mm3为标准分组,比较分析A组(EEF10J/mm3)与B组(EEF≥10J/mm3)的辐照时间、治疗时间、总能量、平均功率、治疗强度、消融体积、消融效率、能效因子、增强时间、增强强度及术后并发症发生率的情况。结果：所有接受超声造影检查及超声消融治疗的病例均未出现严重并发症及不良反应。能效因子与增强时间呈负相关相,Pearson相关系数为-0.788,具有统计学意义(P0.01)；能效因子与增强强度呈正相关,Pearson关系数为0.744,具有统计学意义(P0.01)。EEF10J/mm3的患者共13例(A组),EEF≥10J/mm3的患者共11例(B组),两组相比较,平均功率、治疗强度及并发症发生率差异无统计学意义(P0.05),增强时间、增强强度、辐照时间、治疗时间、总能量、消融体积、消融效率、能效因子差异具有统计学意义(P0.05)。结论：1.超声造影TIC可安全有效地反映子宫腺肌病灶的血流灌注特征,超声造影增强时间及增强强度可定量描述子宫腺肌病的灌注特征。2.子宫腺肌病灶的超声造影灌注增强时间越短、增强强度越强,高强度聚焦超声消融单位体积子宫腺肌病灶所需的超声能量越大。
[Abstract]:Background: adenomyosis is one of the most common gynecological diseases. Because there is no capsule and clear boundary between the lesion and the normal myometrium, the treatment method of preserving uterus is faced with difficulties, which makes it a difficult problem in modern obstetrics and gynecology.High intensity focused ultrasound (HIFU) is a micro-noninvasive treatment technique developed in recent years. It has been used in the treatment of adenomyosis, which can effectively relieve dysmenorrhea and increase the amount of menstruation in patients with adenomyosis.The perfusion of adenomyoma is the unfavorable factor of ultrasonic energy deposition in the target tissue, so it is important to understand the characteristics of blood perfusion of adenomyosis before operation for clinical treatment of adenomyosis by ultrasound ablation.The movement behavior of ultrasound Contrast agent in blood vessel is similar to that of red blood cell, and the quantity and speed of reaching organ can reflect the perfusion state of microcirculation in the blood vessel.These conditions may be used to evaluate the characteristics of microcirculation perfusion in uterine adenomyoma.In this study, time-Intensity Curveity (TICs) was used to quantitatively evaluate the perfusion characteristics of Contrast Ehanced Ultrasonography (Ceus) in adenomyosis.To explore the relationship between the quantitative index of perfusion characteristics of ultrasound and the dose-effect relationship of high intensity focused ultrasound ablation of uterine adenomyosis, and to provide the basis for making the treatment plan before ultrasound ablation of uterine adenomyosis.Objective: to quantitatively analyze the perfusion characteristics of ultrasound in adenomyosis and to explore the relationship between the quantitative index of perfusion and the dose-response of high intensity focused ultrasound ablation of adenomyosis.Materials and methods: from October 2014 to March 2015, 24 patients with adenomyosis were diagnosed and treated with HIFU in Haifu Hospital of Chongqing.The enhancement time and intensity of TIC were quantitatively analyzed, and the ablation effect was evaluated by enhanced MRI after operation. The energy efficiency factors (Energy Effect Factor, EEFN, Non-perfused Volume, Non-perfused Volume, Non-perfused Volume, TIC) were calculated.The linear correlation between EEF and enhancement time and enhancement intensity was analyzed, and the irradiation time, treatment time, total energy, mean power, therapeutic intensity, ablation volume, ablation efficiency were compared between group A and group B (EEF 鈮，

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