超声造影评价高强度聚焦超声治疗子宫肌瘤早期疗效的临床研究

Clinical study on assessment of the early curative effects of the high intensity focused ultrasound in treatment of uterine leiomyoma by contrast-enhanced ultrasound

目的 探讨超声造影对高强度聚焦超声（HIFU）治疗子宫肌瘤早期疗效评价的应用价值.方法 选择50例HIFU治疗子宫肌瘤的连续病例,共检出肌瘤65枚,于治疗前和治疗后2～5 d行常规超声、彩色多普勒血流显像及超声造影检查,观察瘤体大小、内部及周边组织回声和血流灌注变化.结果 HIFU治疗前常规超声示肌瘤内部为不均匀性低回声或中等回声,治疗后2～5 d内肌瘤内部回声不均匀性增强占 92.3%,回声无明显变化占 7.7%,治疗前后肌瘤大小变化差异无统计学意义（P＞0.05）;治疗前彩色多普勒血流显像示肌瘤内部均可见点状、条状或网状血流信号,治疗后肌瘤内部血流信号消失占95.4%,肌瘤周边有少许点状血流信号占 3.1%;HIFU治疗前超声造影能清晰显示肌瘤大小及边界且瘤体内造影剂强度高于子宫肌壁,治疗后肌瘤内无造影剂显示占 92.3%,瘤体边缘有散在造影剂增强占 6.2%;HIFU治疗前肌瘤内时间强度曲线幅度明显高于子宫肌壁;治疗后肌瘤内时间强度曲线幅度为零占 92.3%,瘤体边缘有散在造影剂增强的时间强度曲线幅度也较治疗前明显降低（P＜0.05）.结论 超声造影能准确评价HIFU治疗子宫肌瘤的消融范围及程度,为子宫肌瘤HIFU治疗后的早期疗效判断提供依据,并可在短期内修订HIFU的治疗方案.

Objective To assess the value of contrast enhanced ultrasound in evaluating the therapeutie efficary of utcrine leionmyonma treared by high intensity of focused ultrasound（HIFU）.Methods Fifty patients with 65 uterine leiomyomas were treated by HIFU from November 2004 to March 2005 .Routine uttrasonography,color Doppler ultrasound and contrat enhanced ultrasound examinations were performed before and 2-5 days after HIFU treatment.Contrast enhanced image was compared with sonography image and color Doppler image.Results Sixty hyperechoic leiomyomas were deteeted by sonography 2-5days after HIFU treatment,and 5 no change.The mean diameter of the leiomyoms was（5.3±1.7）cm before HIFU treatment,and （5.1±1.7）cm ,2-5days after the treatment （P〉0.05）.The blood flow signal of uterine leiomyoma decreased or disappcared immediately with color Doppler ultrasound 2-5 days after HIFU treatment.After the administration of SonoVue,the intensity of uterine letomyoma was stronger than that of adjacent uterine parenchyma,and there was a well-defined border between tumor and the adjacent parnchyma.Two to five days after HIFU treatment,there was not any contrast agent signal in 60 uterine leiomyomas during contrast-enhanced examination.The amplitude of time intensity curves was zero.Enhanced echo was found in the brim of 4 uterine leiomyomas,but the amplitude of time intensity curves became lower（P〈0.05）.Conclusions Contrast enhanced ultrasound can help to assess the therapeutie efficacy of HIFU treatment,and indicate the ablation area.So it is useful to establish proper protocol in the further treatment.