动态增强MRI定量参数与高强度聚焦超声消融子宫肌瘤疗效的相关性研究

US-Guided High-Intensity Focused Ultrasound Surgery for Uterine Fibroids: Correlation Between Therapeutic Effect and Quantitative Parameters of Dynamic Contrast-Enhanced MRI

目的探讨动态增强MRI(DCE-MRI)定量参数与高强度聚焦超声(HIFU)子宫肌瘤消融术疗效的相关性。方法 HIFU术前对65例子宫肌瘤患者(82个子宫肌瘤)行DCE-MRI检查,经后处理软件获得子宫肌瘤定量参数K^(trans)、V_e、K_(ep)、V_p值以及子宫肌层定量参数K^(trans)值,分析子宫肌瘤定量参数与其HIFU术后消融率的相关性。将子宫肌瘤按其K^(trans)值高(或低)于相应子宫肌层分为高K^(trans)肌瘤及低K^(trans)肌瘤,比较两组肌瘤K^(trans)以及消融率的差异。结果肌瘤消融率与肌瘤K^(trans)值呈负相关(r=-0.411),具有统计学意义(P<0.01)。肌瘤消融率与肌瘤V_e、K_(ep)、V_p值的相关性无统计学意义(P>0.05)。高K^(trans)肌瘤与低K^(trans)肌瘤间消融率及K^(trans)值差异具有统计学意义(P均<0.01),前者K^(trans)值较后者高,而消融率较后者低。结论子宫肌瘤K^(trans)值越高,其HIFU消融效果越差。对照相应子宫肌层K^(trans)值能够初步判断子宫肌瘤的消融效果。DCE-MRI可为子宫肌瘤HUFI消融术选择患者提供依据。

Objective To determine whether quantitative parameters of dynamic contrast-enhanced MR imaging（ DCEMRI） are associated with therapeutic effect of US-guided high-intensity focused ultrasound（ HIFU） ablation of uterine fibroids. Methods sixty-five patients with 82 uterine fibroids underwent DCE-MRI before HIFU surgery. The correlation between the quantitative parameters（ K^trans,Ve,K（ep）,Vp） and the ablation rate was evaluated. According to the K^transvalue of myometrium,these uterine fibroids were divided into high and low K^transgroup,respectively. Statistical analysis was carried out in K^transvalue and ablation rate of fibroids between high and low K^transgroups. Results In the quantitative parameters（ K^trans,Ve,K（ep）,Vp） of uterine fibroids,only the K^transvalue was statistically correlated with the ablation rate（ r =-0. 411,P〈0. 01）. Significant difference of ablation rate and K^transvalue was found between high and low K^transgroup（ all P〈0. 01）. The K^trans value was higher in the high K^trans group than in the low K^trans group but the ablation rate was lower in the high Krans group than in the low K^trans group. Conclusion A higher K^transvalue of uterine fibroids may suggest a poor efficacy of US-guided HIFU ablation. It could be helpful to estimate the efficacy of US-guided HIFU ablation by comparing K^trans value of a fibroid to that of its corresponding myometrium. DCE-MRI can provide useful information for selecting patients with uterine fibroids to treat with US-guided HIFU ablation.