探讨三维血管能量成像联合实时超声弹性成像在子宫肌瘤射频消融治疗指导及疗效评估中的应用价值

The application value of three-dimensional vascular power angiography combined with real-time ultrasound elastography in guidance and evaluation of curative effecton radiofrequency ablation treatment for uterine fibroids

目的:探讨三维彩色血管能量造影(3D-CPA)联合实时超声弹性成像(RTE)在子宫肌瘤射频消融(RFA)治疗指导及疗效评估中的应用价值。方法:选取45例子宫肌瘤患者(69处病灶),术前根据3D-CPA检测的血流情况,将子宫肌瘤分为富血供组(38处)和乏血供组(31处),再根据回声情况分为低回声组(35处)、高回声组(19处)及混合回声组(15处),于手术前后均进行3D-CPA和RTE检查,并采用Q-analysis实时组织弹性定量分析技术对治疗前后子宫肌瘤硬度进行分析。结果:富血供和乏血供组不同回声组消融时间、消融针数比较差异有统计学意义(t=-5.762,t=-6.782;P<0.05);RFA治疗前低回声组病灶应变率(SR)值明显低于高回声组与混合回声组,并且以高回声组SR值最高,混合回声组介于高回声组与低回声组之间,3组SR值比较差异具有统计学意义(F=7.784,P<0.05);3组病灶经RFA治疗后1 h和3个月,较治疗前SR值差异均有统计学意义(F=8.075,F=6.872;P<0.05)。结论:术前超声联合应用RTE检查能够准确评估子宫肌瘤患者RFA前后病灶硬度的变化情况,进而实现对患者治疗效果及预后结局的定量与定性的双重评估。

Objective:To investigate the value of three-dimensional vascular color power angio(3D-CPA)combined with real-time ultrasound elastography(RTE)in guidance and evaluation of curative effect on radiofrequency ablation(RFA)treatment of uterine fibroids.Methods:45patients with uterine fibroid(included69lesions)were divided into abundant vascularity group and scarce vascularity group according to blood flow detected by3D-CPA in pre-operation.And patients of every group were further divided into low hypoechoic group,hyperechoic group and mixed echo group according to the echo situation of lesions.All of patients received examination of3D-CPA and RTE in pre and post operation.And the real-time tissue elastic quantitative analysis technique of Q-analysis was used to analyze the hardness of uterine fibroids in pre and post treatment.Results:The differences of ablation time and ablation needle count between abundant vascularity group and scarce vascularity group were not statistically significant(t=-5.762,t=-6.782;P<0.05),respectively.Before patients received treatment of RFA,the strain rate(SR)of lesions in hypoechoic group was obviously lower than that in hyperechoic group which SR value was highest and mixed echo group which SR value was between in other two group.And the differences of SR value among three groups were statistically significant(F=7.784,P<0.05).For three kinds of lesions in three groups,the differences of SR value both of between pre and post RFA treatment1h and between pre and post RFA treatment3months were statistically significant(F=8.075,F=6.872;P<0.05),respectively.Conclusion:Preoperative ultrasound combined with RTE can accurately assess the changes of uterine fibroids before and after RFA treatment so as to further achieve the dual evaluation for quantitative data and qualitative data of curative effect and prognosis outcome of patients.