常规MRI在子宫肌瘤超声消融疗效评价及随访中的价值

High-intensity focused ultrasound ablation for hysteromyoma:Role of routine MR techniques in evaluation the therapeutic effect and follow up

目的探讨常规MRI在评价超声消融治疗子宫肌瘤疗效及随访中的价值。方法回顾性分析158例经超声消融治疗后6个月内接受MR检查的子宫肌瘤患者。所有患者均接受FS TSE T2 W序列及增强前后T1 WVIBE FS序列成像。分析超声消融后肌瘤的MR平扫图像信号改变,并与增强图像进行比较,观察信号变化规律,计算信号变化区域的体积及其相关性。结果超声消融治疗后,VIBE FS T1 WI上子宫肌瘤高信号区域与增强后所测坏死区域一致,二者间体积差异无统计学意义。单变量分析发现平扫VIBE FS T1 WI上高信号区域的体积与增强图像上坏死区域的体积呈高度相关(r=0.99,P<0.001)。FS TSE T2 WI可以确定子宫肌瘤的边界、大小。结论常规MR平扫可准确评价超声消融治疗子宫肌瘤的疗效,T2 WI可确定子宫肌瘤的边界、大小,T1 WI可准确测量肌瘤坏死区域的体积。

Objective To observe the value of curative evaluation and follow up of ultrasound imaging-guided high-intensity focused ultrasound（HIFU） ablation for hysteromyoma.Methods MR images of 158 patients with uterine fibroids who underwent HIFU ablation were reviewed retrospectively within 6 months after operation.Images of FS TSE T2W,plain and contrast-enhanced T1W VIBE FS were obtained in all patients.The signal changes of hysteromyoma in plain MR images after treatment were analyzed,and compared with enhanced MR images.The volumes of signal change areas were calculated.Results After HIFU ablation,hyperintense areas in plain MR images were consistent with the areas of necrosis in enhanced MR images（VIBE sequence）.High correlation was observed in volume between hyperintense areas in plain MR images and the areas of necrosis in enhanced MR images with univariate analysis（r=0.99,P0.001）.The border and size of hysteromyoma were observed in FS TSE T2WI.Conclusion Conventional plain MRI is useful in evaluating the response of uterine fibroids to HIFU ablation.T2WI is useful in defining the margin of uterine fibroids,while T1WI is accurate in defining the ablated volume.