三维彩色能量图在高强度聚焦超声治疗子宫肌瘤疗效评价中的应用价值

Value of 3D color power angiography in evaluating the efficacy of high intensity focused ultrasound in treatment of uterine leiomyomas

目的探讨常规超声及三维彩色能量图在高强度聚焦超声(HIFU)治疗子宫肌瘤疗效评价中的应用价值。方法HIFU治疗前及治疗后24h内分别对17例患者(21个肌瘤)行常规超声及三维彩色能量图检查,根据子宫肌瘤血供状态对血流进行分级。HIFU治疗后每个月随访1次,共随访6个月,观察子宫肌瘤体积变化及患者临床症状改善情况。结果HIFU治疗前超声显示17例(21个肌瘤)肌瘤内呈低回声或以低回声为主的不均质回声,三维彩色能量图多方位显示肌瘤血管呈球体网架结构。治疗后肌瘤回声均增强,三维彩色能量图观察9个子宫肌瘤血流完全消失,10个子宫肌瘤血流减少,2例(2个子宫肌瘤)与治疗前相比血流无明显变化,行HIFU补充治疗后超声随访显示,患者肌瘤内无血流信号显示。HIFU治疗前21个子宫肌瘤平均体积为(100.4±62.1)cm3,随访6个月,末次随访子宫肌瘤平均体积明显缩小为(45.3±35.8)cm3,缩小率为14%～95%。17例中6例治疗后临床症状完全消失,11例症状有不同程度改善。不良反应:治疗后17例中3例治疗部位皮肤出现小水泡,1例治疗后手术瘢痕处肿胀,经临床对症治疗后症状消失,其余13例无不良反应。结论三维彩色能量图是HIFU治疗子宫肌瘤疗效评价的简捷方法。

Objective To evaluate value of 3D color power angiography for the efficacy of high intensity focused ultrasound （HIFU） in treatment of uterine leiomyomas. Methods Seventeen patients with 21 leiomyomas were treated with HIFU. The 3D color power angiography combined with conventional ultrasound was performed within twenty-four hours before and after application of HIFU treatment. The vascularity of leiomyomas was classified by 3D color power angiography. The volumes of leiomyomas and patients＇ symptoms were observed within a 6-month follow-up （one time/one month）. Results Before treatment, conventional ultrasound showed that 21 uterine leiomyomas in 17 cases appeared as hypoechoic or hypoechoic with heterogeneous sound, while 3D color power angiography showed the blood flow signs in all uterine leiomyomas as a spherical net structure. After treatment, all uterine leiomyomas became hyperechoic in conventional ultrasound images. The blood flow signs disappeared in 9 tumors and reduced in 10 ones by 3D color power angiography. Two tumors （in 2 cases）, without any changes of flow signs after therapy in 3D color power angiographic images, were treated with HIFU. Seventeen patients （21 leiomyomas） were treated by HIFU. After 6-month treatment, the mean volume in all uterine leiomyomas decreased by 14%-95% （P 〈 0. 05 ） from （ 100.4 ± 62.1 ） cm^3 before treatment to （45.3 ± 35.8 ） cm^3 after treatment. The symptoms were disappeared in 6 cases and improved in 11 after HIFU treatment. No outstanding adverse event was in 13 eases, skin vesicles in 3 cases and local swelling at skin scar in one case. Conclusions The 3D color power angiography is a new and practical tool to assess the efficacy of HIFU in treatment of uterine leiomyomas.