超声造影在经皮微波消融治疗子宫肌瘤疗效观察中的应用价值

The application value of contrast-enhanced ultrasound in percutaneous microwave ablation treatment of uterine leiomyoma

目的探讨超声造影在经皮微波消融治疗子宫肌瘤疗效观察中的应用价值。方法对32例子宫肌瘤患者,肌瘤瘤体共52个,采用经皮微波消融治疗,于治疗前及治疗后6个月行常规超声及超声造影检查,观察肌瘤大小、内部回声及血流变化,比较子宫肌瘤缩小程度和临床症状改善情况,同期行增强MRI检查。结果 1)常规超声检查发现子宫肌瘤45个(阳性率86%),超声造影发现子宫肌瘤50个(阳性率96%),增强MRI发现子宫肌瘤52个; 2)微波消融治疗子宫肌瘤后,常规超声检查显示肌瘤体积缩小48个,4个体积变化不明显,其中49个瘤体无明显血流信号,3个周边有少许血流信号;超声造影显示瘤体体积缩小52个,其中42个瘤体无造影剂增强,10个瘤体周边有造影剂增强;增强MRI显示瘤体体积缩小52个,40个瘤体无对比剂增强,12个瘤体周边有对比剂增强,超声造影与同期增强MRI相比差异无统计学意义(P> 0. 05),与常规彩色超声相比差异有统计学意义(P <0. 05); 3)临床疗效:患者月经周期和月经量明显减少,贫血症状改善,下腹坠胀缓解,临床疗效明显。结论超声造影对子宫肌瘤能直接进行定位,明确病灶大小,观察肌瘤血流灌注,指导局部消融治疗方案的实施及有效的评价经皮微波消融治疗子宫肌瘤的术后疗效。

Objective To evaluate the value of contrast-enhanced ultrasound （CEUS） in the treatment of uterine leiomyoma by pereutaneous microwave ablation. Methods 32 patients with 52 uterine leiomyomas were treated by pereutaneous microwave ablation. The size, internal echo and blood flow signals in ultrasound and CEUS before and after 6 months of the treatment were observed. The changes of uterine leiomyoma and clinical symptoms were compared. At the same time, all of the uterine leiomyomas were examined by enhanced magnetic resonance imaging （MRI）. Results 1 ） 45 uterine leiomyomas were found with the conventional ultrasound （ positive rate 86% ）, 50 uterine leiomyomas with CEUS （ positive rate 96% ）, 52 uterine leiomyomas with enhanced MRI; 2） The volume of 48 leiomyoma nodules shrinked, 4 lesions were not obvious in leiomyoma volume, and 49 leiomyoma nodules had no obvious blood flow signals, 3 presented lesions with a little blood flow signals after MWA 6 months by evaluation of ultrasound ; The volume of 52 leiomyoma nodules shrinked, 42 nodule had no-enhancement, a little enhancement was found in 10 nodule after MWA 6 months by CEUS; The volume of 52 leiomyoma nodules shrinked, 40 nodule had no-enhancement, a little enhancement was found in 12 nodule after MWA 6 months by enhanced MRI. The difference of CEUS and enhanced MRI was not statistically significant （ P 〉 0.05 ）, but was statistically significant compared with the conventional ultrasound （ P 〈 0.05 ） ; 3 ） The clinical curative effect ： menstrual cycle shorten and menstrual volume decreased, anemia symptom improved, hypogastrium pendant expansion relieved in all of patients. The clinical curative effect was obvious after MWA. Conclusion CEUS can determine the position of uterine leiomyomas, measure the size of leiomyoma nodules, and observe blood perfusion, so as to guide local MWA and to evaluate the postoperative curative effect of MWA for the treatment of uterine leiomyomas effectively.