磁共振成像对超声引导经皮微波消融治疗子宫肌瘤近期效果的预测研究

Prediction on short-term outcome of ultrasound-guided percutaneous microwave ablation therapy of uterine fibroids by magnetic resonance imaging

目的利用磁共振成像(MRI)研究超声引导下经皮穿刺微波消融疗法(PMAT)治疗子宫肌瘤的近期消融效果及MRI呈不同信号特点对治疗效果的影响,以期为临床治疗提供参考信息。方法选择2007年6月至2010年3月解放军总医院门诊及住院患者中经超声检查诊断,且有压迫症状的子宫肌瘤患者46例(49个肌瘤)行PMAT治疗。消融前、后3 d对患者行盆腔MRI平扫+增强检查。按照消融前MRI T2WI肌瘤信号强度将肌瘤分为低(A)、等(B)、高(C)信号3组。通过增强MRI图像测量消融前、后子宫体及肌瘤体积、消融率。比较不同组别间肌瘤的消融率。结果 A、B、C组的肌瘤个数分别为28、17、4;各组消融前肌瘤体积差异无统计学意义(P>0.05)。与消融前比较,消融治疗后3 d,A、B组肌瘤及子宫体体积均明显减小(t=5.644、5.998;t=6.725、4.678,P值均<0.001),患者的压迫症状明显改善;C组肌瘤及子宫体体积的体积减小,但差异无统计学意义(P>0.05)。消融治疗后,各组肌瘤消融率组间比较差异无统计意义(F=0.852,P>0.05)。结论 PAMT对MRI T2WI呈不同信号的肌瘤均可达到满意的消融效果,但与T2WI呈低等信号肌瘤相比,PAMT对高信号肌瘤反应较弱。

Objective To study the short-term outcome of the uterine fibroids treated with ultrasound-guided percutaneous microwave ablation therapy （PMAT） by magnetic resonance imaging （MRI）. Methods PMAT was performed in 46 symptomatic patients with a total of 49 uterine fibroids. Pre-and post-contrast MRI was scanned at 3 days before treatment and 3 days after treatment to assess image changes of both fibroids and surrounding tissues. The fibroids were divided into group A （low signal）, B （iso-signal）, C （high signal） by the signal intensity on T2WI. According to the volume changes of fibroids and uterine, ablation rate and the reduction rate of the fibroids after treatment were calculated. Results There were 28, 17 and 4 fibroids in the group A, B and C respectively. Before the treatment the volume of the fibroids showed no statistical difference between the group A, B and C （P＆gt;0.05）. Fibroids and uterine showed shrinkage after the treatment in the group A and B （t=5.644, 5.998, 6.725 and 4.678, all P〈0.001）. The fibroids ablation rate showed no statistical difference between the groups （F=0.852, P〉0.05）. Fibroids and uterine showed shrinkage after the treatment in the group C, but there was no obvious statistical difference. Conclusion The outcome of PAMT is good for the fibroids with different signal intensity on T2WI. But the fibroids with high signal intensity are not as sensitive as those with low or iso intensity to achieve the same ablation level.