3.0T MRI功能成像评估HIFU治疗子宫肌瘤的价值

发布时间：2018-06-13 14:14

  本文选题：磁共振成像 + 高强度聚焦超声　； 参考：《川北医学院》2014年硕士论文

【摘要】：目的：探讨3.0T MRI功能成像（functional magnetic resonanceimaging,fMRI）对高强度聚焦超声（High intensity focused ultrasound,HIFU）治疗子宫肌瘤疗效判断与预后评估的价值。 材料与方法：采用GE3.0T磁共振成像仪，对行子宫肌瘤HIFU治疗的192例病人共522个肌瘤分别在治疗前一天、治疗后一天进行常规MRI扫描、动态增强（Dynamic contrast-enhanced magnetic resonance, DCE-MR）扫描、多b值弥散加权成像（diffusion-weighted imaging,DWI）扫描。其中，对48例患者共111个肌瘤定期随访复查，在术后三个月、六个月、一年行相同序列及参数MRI扫描。观察并记录肌瘤在治疗前后的数目、体积、位置、类型、无灌注区率、多b值平均ADC值、T1WI增强扫描、T1WI及T2WI绝对信号强度改变，患者临床症状用症状严重程度评分（symptom severity scoress,SSS）表示。 结果：本研究收集192例患者共522个子宫肌瘤，其中486个肌瘤完成了高强度聚焦超声消融治疗，其余病灶因体积小，位置靠后无法进行机载超声定位而未进行治疗。所有患者在术中术后未出现严重并发症，术后一天增强磁共振显示所有消融灶均出现明显无灌注区，边缘轻度环形强化，肌瘤血供阻断。在定期随访的48例患者共111个肌瘤中：1、肌瘤位于底壁、前壁、后壁、侧壁分别占15.3%（17/111）、39.6%（44/111）、24.3%（27/111）、20.7%（23/111），术后肌瘤消融率与肌瘤位置有显著相关，前壁肌瘤疗效更好，后壁、底壁、侧壁肌瘤疗效无显著差异。2、HIFU治疗前肌瘤平均体积值为96.75cm3，术后一天、三个月、六个月、一年平均体积分别为93.25cm3、48.62cm3、28.88cm3、20.75cm3；缩小率分别为3.6%、49.7%、70.1%、78.6%，分别进行两两比较SNK检验，除术前与术后一天、术后六个月与术后一年比较差异无统计学意义外，其余两两比较均有统计学意义。对不同消融体积分组，再与术后不同时间随访SSS评分进行重复测量方差分析，结果表明消融体积大于75%，患者恢复情况最好。3、子宫肌瘤HIFU治疗前T2WI呈低信号72个，等信号7个，高信号4个，，高低混杂信号28个，肌瘤在不同T2WI信号强度上疗效有统计学意义，T2WI呈低信号的肌瘤疗效最好，部分T2WI呈高信号的肌瘤疗效较好。4、子宫肌瘤HIFU治疗前，T1WI、T2WI、DCE-MRI增强扫描的平均绝对信号强度分别为996.45±190.99、480.18±162.20、1954.56±238.84，治疗后一天分别为1107.67±214.94、429.41±139.16、1249.07±159.77，T1WI绝对信号强度在治疗后明显升高，T2WI轻度下降，DCE-MRI绝对信号强度明显下降。5、子宫肌瘤HIFU治疗前，多b值平均ADC值为（1.018±0.177）×10 3mm2/s，术后一天、三个月、六个月、一年平均ADC为(0.965±0.172)×10 3mm2/s、(0.870±0.136)×10 3mm2/s、(0.773±0.091)×10 3mm2/s、(0.862±0.035)×10 3mm2/s，结果表明平均ADC值术后明显下降，后持续降至六个月，一年后ADC稍回升。 结论：1、HIFU治疗子宫肌瘤疗效显著，无创又安全，患者接受度高。2、3.0T MRI功能成像能有效判断高强度聚焦超声治疗子宫肌瘤的疗效，评估预后转归，可用于长期随访观察，对临床有很好的指导意义。3、子宫肌瘤的位置、信号强度对消融疗效有影响。
[Abstract]:Objective : To evaluate the diagnostic value of high intensity focused ultrasound ( HIFU ) in the treatment of uterine fibroids with high intensity focused ultrasound ( HIFU ) .

Materials and Methods : Two hundred and twenty - one hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred forty - eight ( 48 ) patients were followed up for three months , six months , one year with same sequence and parameter MRI scans .

Results : A total of 522 uterine fibroids were collected in 192 patients , 486 of them completed high intensity focused ultrasound ablation . All patients had no serious complications after operation . All the patients had no significant complications after operation . The average volume of myomas was 96.75 cm3 , the postoperative day was 3 months , and the average volume was 93.25 cm3 , 48.62 cm3 , 28.88 cm3 and 20.75 cm3 respectively .
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本文编号：2014292