二维及三维超声造影评估子宫肌瘤射频消融早期疗效的临床价值

Application value of two-dimensional and three-dimensional contrast-enhanced ultrasound in assessment of the early therapeutic efficacy of hysteromyomas treated with the radiofrequency ablation

目的 探讨二维和三维超声造影技术在评估射频消融（RFA）治疗子宫肌瘤早期疗效中的应用价值.方法 接受RFA治疗的子宫肌瘤患者90例,共150枚肌瘤,其中肌壁间肌瘤138枚,黏膜下肌瘤12枚（5枚为细蒂肌瘤）.在RFA前后1 d内进行二维及三维超声造影,观察病灶区血供变化,测量肌瘤体积、消融范围,计算灭活率.结果 5例细蒂黏膜下肌瘤完整取出.145枚在体肌瘤射频治疗后二维超声造影表现为：137枚肌瘤原部位无造影剂灌注,提示消融完全,8枚肌瘤边缘线性增强或瘤内片状增强区,考虑治疗不全;三维超声造影表现为：132枚肌瘤消融后瘤体血管网消失,达到完全凝固,其余13枚肌瘤中7枚病灶内缘有细小枝状低增强,6枚内部不均匀低增强,为肌瘤组织残留.139枚肌瘤消融灭活率达（97.1±12.9）%,另6枚灭活率仅为（46.4±7.0）%.结论 三维超声造影能够显示子宫肌瘤的血管构筑及空间关系,是对二维超声造影的补充,两者联合应用能直观、准确地评估射频治疗子宫肌瘤的早期疗效.

Objective To evaluate the clinical value and the early therapeutic efficacy of hysteromyomas treated with the radiofrequency ablation （RFA） by two-dimensional contrast-enhanced ultrasound（2D-CEUS） and three-dimensional contrast-enhanced ultrasound（3D-CEUS）. Methods A total of 90 patients with 150 hysteromyomas were treated with RFA, including 138 intramural myomas and 12 submucous myomas （in which 5 had micr-pedicles）. 2D-CEUS and 3D-CEUS were performed within one day before and after RFA treatment, respectively. The blood supply of focal zone（FZ） was observed by 2D-CEUS and 3D-CEUS. The volume of hysteromyomas and the coagulation necrosis range were measured by 3D-CEUS. The average necrotic rates of hysteromyoma were calculated. Results The 5 submucous myomas with micr-pedicles were removed completely after the RFA treatment. The 2D-CEUS appearances of other 145 hysteromyomas were diverse after the RFA treatment, in which 137 FZs had no contrast infusion,indicating complete ablation, 8 FZs appeared peripheral linear or small flaky enhancement, considering incomplete treatment. The 3D-CEUS performances were variant too, in which 132 FZs vascular network displayed as a ＂cavity＂, indicating complete tumor necrosis, the other 7 FZs appeared ＂branch shape＂ low enhancement and another 6 FZs showed nonuniform low enhancement, considering residual tumor tissue. The average necrotic rate of the 139 hysteromyomas was （97.1 ± 12. 9）% ,another 6 hysteromyomas was only （46. 4 ± 7. 0） %. Conclusions 3D-CEUS can display vascular structure and spatial relationship of the hysteromyomas, which can be used as the complement of 2D-CEUS. The combination of the two techniques can evaluate the earlier therapeutic efficacy of hysteromyomas by RFA more timely, intuitively and accurately.