高强度聚焦超声治疗子宫肌瘤难易程度的预测及评分系统的建立

发布时间：2018-06-11 10:12

本文选题：评分系统 + 高强度聚焦超声　；参考：《重庆医科大学》2017年硕士论文

【摘要】：高强度聚焦超声(High Intensity Focused Ultrasound,HIFU)是近年发展起来的一种非侵入性肿瘤治疗方式。由于其创伤小、治疗后患者恢复快、不损害卵巢功能、无辐射、无手术切口等特点,其治疗子宫肌瘤的临床疗效已受广泛认可。HIFU消融治疗子宫肌瘤的原理是将体外低能量的超声波聚焦于子宫肌瘤病灶内,通过机械效应、热效应和空化效应等使病灶发生不可逆性凝固性坏死,从而使子宫肌瘤失去生长功能,达到治疗目的同时却没有损伤靶区周围组织。在临床应用过程中发现多种因素与消融难易程度有关。研究表明:磁共振T2加权像(T2-weighted Imaging,T2WI)高信号和磁共振T1加权像(T1-weighted Imaging,T2WI)增强明显强化的肌瘤消融治疗更加困难;声通道上的组织结构和肌瘤大小也可影响消融效率。但是目前对各种影响因素尚未量化,也缺乏预测HIFU消融子宫肌瘤难易程度的评分系统。本文拟以能效因子(Energy Efficiency Factor,EEF)、辐照时间为因变量,通过分析影响EEF及辐照时间的因素,建立预测HIFU消融子宫肌瘤难易程度的评分系统,并预测HIFU消融子宫肌瘤的辐照时间,为HIFU治疗子宫肌瘤的适应症优化及治疗方案的完善提供依据。目的建立预测HIFU消融子宫肌瘤难易程度的评分系统,预测HIFU消融治疗子宫肌瘤的辐照时间。材料和方法(1)本研究纳入2011年2月至2016年6月重庆市海扶医院接受HIFU治疗的422例子宫肌瘤患者,以EEF和辐照时间为因变量,可能影响EEF和辐照时间的因素包括年龄、体重指数、肌瘤体积、子宫位置、肌瘤类型、T2WI信号强度、T1WI强化类型、腹直肌厚度、脂肪厚度、肌瘤腹侧面到皮肤的最小距离、肌瘤背侧面到皮肤的最大距离、下腹壁瘢痕被设定为自变量建立最佳尺度回归方程。(2)2016年7月-2017年3月在重庆海扶医院接受高强度聚焦超声治疗的56例子宫肌瘤患者纳入验证研究。治疗前从核磁共振图像上得到相应变量值,然后量化变量,把量化值代入方程求出预测EEF和预测辐照时间的量化值,根据量化值查出对应的预测值,通过比较预测EEF和预测辐照时间与真实值之间的相关性,验证最佳尺度回归方程的预测效能。结果(1)肌瘤体积、T2WI信号强度、T1WI强化类型、肌瘤腹侧面到皮肤的最小距离与EEF之间存在显著相关性。T2WI信号强度、T1WI强化类型、肌瘤体积、肌瘤背侧面到皮肤的最大距离与辐照时间之间存在显著相关性。建立了能够预测超声消融子宫肌瘤难易程度的模型:预测EEF,y′=0.338X’_1-0.231X’_2+0.156X’_3+0.167X’_4;预测辐照时间y=0.227X_1+0.321X_2+0.157X_3+0.194X_4。(2)预测EEF量化值与EEF之间的相关性系数为0.574,预测辐照时间的量化值与辐照时间之间的相关性系数为0.665,说明能够预测超声消融子宫肌瘤难易程度的模型:预测EEF,y′=0.338X’1-0.231X’2+0.156X’3+0.167X’4;预测辐照时间y=0.227X1+0.321X2+0.157X3+0.194X4具有较好的预测效能。结论(1)研究结果显示T2WI信号强度、T1WI强化类型、肌瘤体积、肌瘤腹侧面到皮肤的最小距离、肌瘤背侧面到皮肤的最大距离与HIFU消融子宫肌瘤难易程度相关,这些因素的量化,可以预测HIFU治疗子宫肌瘤难易程度并预测消融子宫肌瘤需要的辐照时间。(2)研究结果表明建立的预测超声消融子宫肌瘤难易程度的系统具有较好的预测效能。
[Abstract]:High Intensity Focused Ultrasound (HIFU) is a noninvasive method of cancer treatment developed in recent years. Because of its small trauma, the patients recover quickly after treatment without damaging the ovarian function, no radiation, no surgical incision and so on. The clinical efficacy of the treatment of uterine myoma has been widely accepted by.HIFU ablation therapy. The principle of uterine myoma is to focus on the uterine leiomyoma with low energy ultrasound in vitro. It causes irreversible coagulative necrosis by mechanical effect, heat effect and cavitation effect, which causes the hysteromyoma to lose its growth function. It can not damage the surrounding tissue around the target area at the same time. It is found in the clinical application process. A variety of factors are related to the degree of ease of ablation. Studies have shown that magnetic resonance T2 weighted imaging (T2-weighted Imaging, T2WI) high signal and magnetic resonance T1 weighted image (T1-weighted Imaging, T2WI) enhanced obviously enhanced myoma ablation treatment is more difficult; the tissue structure and the size of the myoma on the acoustic channel can also affect the ablation efficiency. The influencing factors have not been quantified and there is a lack of scoring system for predicting the difficulty of HIFU ablation of uterine myoma. This paper aims to establish a scoring system for predicting the difficulty degree of the HIFU ablation of uterine myoma by using the Energy Efficiency Factor (EEF) and the irradiation time as the dependent variable, and to predict the degree of HIFU ablation and the prediction of HIFU ablation. The irradiation time of uterine myoma provides a basis for the optimization of HIFU for the treatment of uterine myoma and the improvement of the treatment scheme. Objective to establish a scoring system for predicting the difficulty of HIFU ablation of uterine myoma and to predict the irradiation time of HIFU ablation for the treatment of uterine myoma. (1) this study was included in Haifu from February 2011 to June 2016. 422 patients with uterine myoma treated by HIFU, with EEF and irradiation time as dependent variables, may affect EEF and irradiation time factors including age, body mass index, myoma volume, uterus position, myoma type, T2WI signal intensity, T1WI strengthening type, rectus abdominis thickness, fat thickness, minimal distance from the ventral side to skin of myoma, myoma, myoma The maximum distance from the dorsal side to the skin, the lower abdominal wall scar was set as the independent variable to establish the optimal regression equation. (2) 56 cases of uterine myoma received high intensity focused ultrasound in Chongqing Haifu hospital in March, July 2016, were included in the validation study. The corresponding variable values were obtained from the MRI images before treatment, and then the variables were quantified. The quantized values are replaced by the quantized values to predict the quantized values of EEF and the predicted irradiation time, and the corresponding prediction values are detected according to the quantized values. The prediction efficiency of the optimal scaling regression equation is verified by comparing the prediction of the correlation between the EEF and the predicted radiation time and the true value. Results (1) the volume of the myoma, the intensity of T2WI signal, the type of T1WI strengthening, the abdomen of the myoma. There was a significant correlation between the minimum distance from the side to the skin and EEF, and there was a significant correlation between the intensity of.T2WI signal, the type of T1WI enhancement, the volume of myoma, the maximum distance from the dorsal side of the myoma to the skin and the irradiation time. A model to predict the refractory degree of uterine myoma was established: the prediction of EEF, y '=0.338X' _1-0.231X '_2+ 0.156X '_3+0.167X' _4; prediction of irradiation time y=0.227X_1+0.321X_2+0.157X_3+0.194X_4. (2) predicted that the correlation coefficient between EEF quantization value and EEF was 0.574, and the correlation coefficient between the quantified value of irradiation time and irradiation time was 0.665, indicating a model for predicting the difficult degree of uterine fibroids with ultrasonic melting: prediction of EEF, y '=0. 338X '1-0.231X' 2+0.156X '3+0.167X' 4; prediction of irradiation time y=0.227X1+0.321X2+0.157X3+0.194X4 has good predictive efficiency. Conclusion (1) the results showed that the intensity of T2WI signal, the type of T1WI enhancement, the volume of myoma, the minimum distance from the ventral side to the skin of the myoma, the maximum distance from the lateral to the skin of the myoma, and the ablation of the uterine myoma with HIFU. The quantification of these factors can predict the difficulty of HIFU in the treatment of uterine myoma and predict the irradiation time needed for the ablation of uterine myoma. (2) the results of the study show that the system established to predict the difficulty of uterine myoma with ultrasound ablation has good predictive efficiency.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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