高强度聚焦超声消融子宫腺肌症的临床剂量学研究

Clinical dosimetry research on high-intensity focused ultrasound ablating adenomyosis

目的根据MRI评价的高强度聚焦超声(HIFU)消融结果,探索HIFU消融子宫腺肌症的剂量学特征,建立以能效因子(EEF)为基础的剂量学模型,指导临床剂量的投放。方法对45例临床诊断为子宫腺肌症的患者(45个腺肌病灶)行HIFU治疗,治疗前、后均行平扫和动态增强MRI检查,评价子宫和病灶情况,记录HIFU治疗时间、辐照时间及辐照能量。以EEF为因变量,相关影响因素为自变量进行多重线性回归分析,建立以EEF为基础的剂量学模型。结果 45例患者均顺利完成一次性超声消融治疗;多重线性回归分析提示腺肌病灶腹侧面到皮肤距离、病灶最大径、年龄及MRI上病灶强化程度与EEF存在线性相关关系。结论以EEF作为消融子宫腺肌症的剂量学指标,病灶腹侧面到皮肤的距离、病灶最大径、年龄及MRI上病灶强化程度可作为预测消融剂量投放的因素。

Objective Based on the results of High-intensity focused ultrasound （HIFU） ablation evaluated by MRI,to investi- gate dosimetry model of HIFU ablating adenomyosis and establish dosimetry model based on energy efficiency factor （EEF） ,in or- der to guide clinical treatment. Methods 45 patients （45 lesions） with symptomatic adenomyosis were treated by HIFU. The plane scan and dynamic contrast enhanced MRI were performed to evaluate the status of uterus and lesion before and after treatment in all patients. The treatment time,sonication time and sonication energy were recorded. Logistic regression analysis was carried out tak- ing EEF as dependent variable and related factor as independent variable,in order to establish dosimetry model. Results All Pa- tients completed single HIFU ablation procedure safely. Logistic regression analysis demonstrated that the distance between abdo- men side of adenomyosis and skin,maximum diameter of adenomyosis,age and enhanced degree of adenomyosis on MRI were obvi- ously related to EEF. Conclusion Based on EEF,the distance between abdomen side of adenomyosis and skin,maximum diameter of adenomyosis,age and enhanced degree of adenomyosis on MRI could be factors for prediction of ultrasound ablation dose.