MR引导下高强度聚焦超声消融子宫肌瘤温度曲线参数与治疗效果的关系

Relationship of therapeutic effect of uterine fibroids with different intraprocedural thermal parameters during MR-guided high-intensity focused ultrasound ablation

目的观察MR引导下高强度聚焦超声(HIFU)消融子宫肌瘤温度曲线参数与治疗效果的关系。方法对31例子宫肌瘤患者行MR引导下高强度聚焦超声消融子宫肌瘤,通过HIFU消融子宫肌瘤过程中的热量分布情况获得温度曲线,然后利用Matlab语言编程计算以下温度曲线参数:温度上升斜率、温度下降斜率、曲线下面积、加热时间、最高平均温度和温度达峰时间。应用Spearman秩相关性检验分析HIFU治疗前与治疗后6个月子宫肌瘤体积变化与治疗过程中温度曲线参数的关系。结果治疗后6个月,子宫肌瘤体积平均缩小率为(39.43±27.01)%;子宫肌瘤HIFU消融过程中,温度曲线示温度上升斜率为(0.97±0.84)℃/s,温度下降斜率为(-0.56±0.39)℃/s,曲线下面积为(2 240.03±455.93)℃·s,加热时间为(28.34±12.88)s,最高平均温度为(47.01±4.63)℃,温度达峰时间为(22.79±9.47)s。温度下降斜率与子宫肌瘤体积缩小率呈正相关(r_s=0.473,P=0.007)。结论 MR引导下HIFU消融后子宫肌瘤温度下降越慢,治疗效果越好。

Objective To explore the relationship of therapeutic effect of uterine fibroids with different intraprocedural thermal parameters during MR-guided high-intensity focused ultrasound（HIFU）ablation.Methods Totally 31 patients with uterine fibroids underwent MR scanning.Thermometry obtained during the treatment was used to create temperature curves.Matlab software was used to analyze the temperature curve to generate several parameters,including heating slope,decay slope,area under heating curve（AUC）,heating time,max temperature and time to peak.Spearmancorrelation test was used to observe the relationship between the shrinkage rate of uterine fibroids 6 months after ablation and the intraprocedural thermal parameters of ablation.Results Six months after ablation,the fibroid volume shrinkage rate was（39.43±27.01）%.The temperature curve showed the mean heating slope was（0.97±0.84）℃/s,the mean decay slope was（-0.56±0.39）℃/s,the mean AUC was（2 240.03±455.93）℃·s,the mean heating time was（28.34±12.88）s,the mean max temperature was（47.01±4.63）℃,while the mean time to peak was（22.79±9.47）s.The decay slope showed positive correlation with volume shrinkage rate 6 months after treatment（rs=0.473,P=0.007）.ConclusionSlower postsonication temperature decay rate predicts better therapeutic effect of MR-guided HIFU ablation.