超声造影联合声辐射力脉冲成像在评价子宫肌瘤高强度聚焦超声消融中的应用研究

Research of ultrasound contrast combined ARFI imaging in the evaluation on ablation therapy of HIFU for uterine fibroid

目的:通过超声造影及声辐射力脉冲成像(ARFI)检查技术,评估子宫肌瘤患者行高强度聚焦超声(HIFU)的治疗效果,并分析影响患者疗效的多种因素及其相关性。方法:选取满足HIFU治疗指征并自愿接受HIFU治疗的96例子宫肌瘤患者进行回顾性分析。所有患者分别于治疗前1周及治疗后4~8周进行常规超声、超声造影及ARFI检查,根据治疗后4~8周时超声造影和ARFI结果将患者分为显效、有效及无效3个等级,并根据患者基础资料、一般病情等研究HIFU治疗效果的影响因素,分析各种因素与疗效之间的相关性。结果:在96例患者中显效42例,有效49例,无效5例,总有效率为94.79%。单因素分析结果发现,患者的不同靶皮距、肌瘤位置、肌瘤类型以及肌瘤体积HIFU治疗显效率与非显效比较存在显著差异(x^2=28.254,x^2=30.982,x^2=31.630,x^2=23.670;P<0.05);患者超声造影不同增强类型以及ARFI指数对治疗显效率与非显效比较存在显著差异(x^2=6.402,x^2=6.590;P<0.05),但不同年龄、二维超声回声强度对HIFU治疗显效率的影响则差异无统计学意义(x^2=0.163,x^2=6.297;P>0.05);多因素分析结果显示,靶皮距、肌瘤位置、肌瘤类型、超声造影强度、ARFI值与HIFU治疗显效率具有明显相关性(OR=0.128,OR=0.143,OR=0.177,OR=3.695,OR=3.557;P<0.05);而年龄、肌瘤体积则与HIFU治疗显效率无关(OR=0.071,OR=0.052;P>0.05)。结论:结合超声造影以及ARFI检查可准确评估子宫肌瘤患者HIFU治疗效果,并且发现患者肌瘤体积、靶皮距、肌瘤位置、肌瘤类型、超声造影强度以及ARFI值均对子宫肌瘤HIFU治疗显效率存在影响,且靶皮距、肌瘤位置、肌瘤类型、超声造影强度以及ARFI可作为疗效的独立影响因素。

Objective:To evaluate the curative efficacy of high intensity focused ultrasound(HIFU)for patients with uterine fibroids through ultrasound contrast and acoustic radiation force impulse(ARFI)imaging,and then analyze the multi-factors that affected the curative efficacy for patients and their correlation.Methods:96patients with uterine fibroids who met the treatment sign of HIFU and voluntarily accepted the treatment of HIFU were enrolled in the retrospectively analysis.And all of patients underwent examinations of routine ultrasound,ultrasound contrast and ARFI at pre-treatment1week and post-treatment4-8weeks,respectively.According to the results of ultrasound contrast and ARFI at post-treatment4-8weeks,all of patients were divided into three grades included of excellent group,efficacious group and invalid group.Besides,the basic documents and state of illness were applied to research the influence factors of the curative effect of HIFU.And the correlation between various factor and curative effect was further analyzed.Results:In the96cases,42cases were in excellent group,and49cases were in efficacious group,and5cases were in invalid group.The results of single factor analysis indicated that the differences of different target skin distance(TSD),fibroid position,fibroid type and fibroid volume of patients between excellent group and invalid group were significant(x2=28.254,x2=30.982,x2=31.630,x2=23.670,P<0.05),respectively.The differences of different kinds of ultrasound contrast and ARFI index between excellent group and invalid group were significant(x2=6.402,x2=6.590,P<0.05).While the differences between the excellent effective rate of HIFU and different age,two dimensional echo intensity of ultrasound were not significant(x2=0.163,x2=6.297,P>0.05),respectively.The results of multiple-factor analysis showed that there was significant correlation between the excellent curative effect of HIFU and TSD,fibroid position,fibroid type,ultrasound contrast intensity and ARFI value,respectively(OR=0.128,OR=0.143,OR=0.177,OR=3.695,OR=3.557,P<0.05).Besides,there were no significant differences between the excellent curative effect of HIFU and age,fibroid volume(OR=0.071,OR=0.052,P>0.05),respectively.Conclusion:Combination of ultrasound contrast and ARFI examination can accurately assess the curative effect of HIFU for patients with uterine fibroids,and the fibroid volume,TSD,fibroid position,fibroid type,intensity of ultrasound contrast and ARFI value can influence the excellent effective rate on the treatment of HIFU for patients with uterine fibroid.And TSD,fibroid position,fibroid type,intensity of ultrasound contrast and ARFI value can be used as an independent influence factors of curative effect.