基于融合图像的导航技术在子宫肌瘤射频消融术中的初步应用

Preliminary application of navigation technology based on fusion image in radiofrequency ablation of uterine fibroids

目的探讨子宫肌瘤射频消融术中三维超声造影图像与实时二维超声图像融合实现导航的可行性。方法对30例子宫肌瘤患者进行超声造影,分析时间-强度曲线以确定开始采集三维超声造影图像的最佳时间点。再次行超声造影,在最佳时间点处采集三维超声造影图像并与实时二维超声图像融合,以子宫轮廓线重合度、融合图像肌瘤回声及肌瘤边缘清晰度对融合图像质量进行评价。应用基于融合图像的导航技术对子宫肌瘤进行穿刺消融,记录穿刺成功率。结果 30例患者开始采集三维超声造影图像的平均时间点为(75.5±9.5)s,即造影晚期。图像融合过程中子宫轮廓线完全重合者28例,完全重合率为93.3%。二维超声图像肌瘤均呈低或等回声,肌瘤边缘显示清晰者占70.0%;融合图像肌瘤均呈稍强回声,肌瘤边缘显示清晰者占93.3%,两种图像肌瘤边缘显示清晰度差异有统计学意义(P<0.05)。图像融合成功28例,成功率为93.3%。应用基于融合图像的导航技术对肌瘤进行消融,穿刺成功率为100%。结论图像融合过程中开始采集肌瘤三维超声造影图像的最佳时间点为(75.5±9.5)s,即造影晚期。融合图像质量可选用子宫轮廓线重合度、融合图像肌瘤回声及肌瘤边缘清晰度作为评价指标。子宫肌瘤射频消融术中将肌瘤三维超声造影图像与实时二维超声图像融合实现导航是可行的。

Objective To investigate the feasibility of applying navigation technology based on fusion image with 3-D CEUS and real-time 2-D ultrasound for the uterine fibroids treatment using radiofrequency ablation.Methods Thirty patients with uterine fibroids were enrolled in this study.The collect point of time for the acquisition of 3-D CEUS images was determined according to the characteristics of time-intensity curve during the procedure of the first 3-D CEUS for patients.3-D CEUS was repeated and images of uterine fibroids were acquired at the time of＂collect point＂.The 3-D images were fused with the real-time2-D ultrasound images.The fused images were evaluated using the uterine contour line overlap ratio,fibroid echo,and sharpness of the edge definition on fused images.The navigation technology based on image fusion was used to treat uterine fibroids,the success rate of puncture was recorded.Results The average collect point of time of 30 cases of acquiring 3-D CEUS image was（75.5 ± 9.5）s（late phase）.Out of all cases,28 cases of uterine contour line were completely overlapped（93.3%）,2 cases were incompletely overlapped.The fused images looked much brighter than that of the 2-D images.The rate of fibroid edge sharpness in fused image and 2-D ultrasound images were 93.3% and 70.0%,respectively.The difference of edge sharpness between fused image and 2-D ultrasound images was significant（P0.05）.The success rate of puncture under the guidance of the navigation technique based on the fusion image was 100%.Conclusion In the process of image fusion,the best time point to acquire 3-D CEUS image is（75.5±9.5）s（late phase）.The quality of fusion images can be evaluated by uterine contour line overlap ratio,fibroid echo degree and fibroid edge sharpness of fusion image.It is feasible to apply navigation technology based on fusion image with 3-D CEUS and real-time2-D ultrasound to treat uterine fibroids using radiofrequency ablation.