微泡对比剂应用于高强度聚焦超声治疗子宫肌瘤疗效观察

The clinical application of microbubble contrast agent in high intensity focused ultrasound treatment for uterine fibroids

目的探讨六氟化硫微泡应用于高强度聚焦超声(HIFU)对不同T_2WI信号强度子宫肌瘤疗效。方法 64例行HIFU治疗的子宫肌瘤患者依据术前MR检查结果分为T_2WI低信号组(n=24)、等信号组(n=22)、高信号组(n=18),术后1 d行MR检查评估消融效果,记录并比较各组治疗相关参数(治疗功率、辐照时间、治疗剂量)和疗效相关指标(体积消融率、能效因子、治疗时间)。结果 T_2WI低信号组、等信号组、高信号组体积消融率分别为(84.83±18.49)%、(78.72±17.76)%、(71.11±23.87)%,能效因子分别为(6.87±7.77)J/mm^3、(7.99±6.58)J/mm^3、(12.93±9.38)J/mm^3,治疗时间分别为(102.12±54.45)min、(153.86±66.04)min、(141.50±69.56)min,T_2WI高信号子宫肌瘤与低信号、等信号子宫肌瘤体积消融率、能效因子、治疗时间差异均有统计学意义。3组患者共出现下腹痛6例(6/64,9.4%),全身酸麻3例(3/64,4.7%),下肢麻木1例(1/64,1.6%),所有患者未发生治疗区皮肤烧伤等严重并发症。结论六氟化硫微泡联合HIFU对T_2WI低信号、等信号子宫肌瘤疗效优于高信号子宫肌瘤,低信号子宫肌瘤治疗时间较等信号、高信号子宫肌瘤短,六氟化硫微泡是HIFU安全有效的增效剂。

Objective To investigate the clinical utility of SonoVue, a microbubble-enhancing contrast agent, in the treatment of uterine fibroids carrying different signal intensities on T2WI with high-intensity focused uhrasound（HIFU）. Methods Based on the preoperative MRI signal intensity on T2WI, a total of 64 patients with uterine fibroids, who were scheduled to receive HIFU, were divided into low-intensity group （n=24）, iso-intensity group （n=22） and high-intensity group （n=lS）. MRI check-up examination was performed one day after HIFU treatment to evaluate the ablation effect. The parameters related to HIFU, including therapeutic power, irradiation time and therapeutic dose, and the indexes related to therapeutic effect, including volume ablation rate （non-perfusion volume ratio, NPVR）, energy-efficiency factor, treatment time, were recorded, and the results were compared between each other among the three groups. Results In the low-intensity group, iso-intensity group and high-intensity group, the volume ablation rates were （84.83＋18.49）%, （8.72~17.76）% and （71.11~23.87）% respectively, the energy-efficiency factors were （6.87_＋ 7.77） J/mm3 （7.99~6.58） J/mm3 and （12.93＋9.38） J/mm3 respective/y, the treatment time were （102.12＋ 54.45） rain, （153.86~66.04） min and （141.50~69.56） min respectively. Single factor analysis indicated that statistically significant differences in volume ablation rate, energy-efficiency factor and treatment time existed between each other among the three groups. Among the total 64 patients, 3 patients developed lower abdominal pain （6/64, 9.4%）, 3 patients complained of general aches with numb （3/64, 4.7%）, and no severe complications, such as skin burn in treatment area, etc., occurred in all patients. Conclusion The curative effect of SonoVue combined with HIFU for low-intensity and iso-intensity uterine fibroids is better than that for high-intensity uterine fibroids; the treatment time for low-intensity uterine fibroids is shorter than that for iso-intensity and high-intensity uterine fibroids. SonoVue is a safe and effective synergist for HIFU treatment. （J Intervent Radiol, 2018, 27： 71-76）