MRI诊断高强度聚焦超声治疗子宫体外平滑肌瘤疗效价值

Value of MRI Diagnosis for The Efficacy of High-intensity Focused Ultrasound in the Treatment of Extrauterine Leiomyoma

目的分析磁共振成像(Magnetic Resonance Imaging,MRI)诊断高强度聚焦超声(High-Intensity Focused Ultrasound,HIFU)治疗子宫体外平滑肌瘤疗效的价值。方法选取40例子宫体外平滑肌瘤患者,均行HIFU治疗,分别在治疗前与治疗后1d给予MRI诊断,观察不同MRI参数[表观弥散系数(ADC)、MRI-T2WI信号强度比(SIR)、信号强度(SI)、信号均匀度以及血供类型]肌瘤消融率,术后6个月复查MRI,按照消融疗效分为未完全消融组与完全消融组,比较2组MRI参数,分析其与疗效相关性。结果 ADC<1.4×10-3mm^2/s、MRI-T2WI SIR<1.5、MRI-T2WI SI<200、T2WI信号均匀度<20、血供类型少的消融率明显高于ADC≥1.4×10^-3mm^2/s、MRI-T2WI SIR≥1.5、MRI-T2WI SI≥200、T2WI信号均匀度≥20肌瘤、血供丰富肌瘤(P<0.05);完全消融组ADC、MRI-T2WI SIR、MRI-T2WI SI、T2WI信号均匀度明显小于未完全消融组(P<0.05),血供少所占比例明显高于未完全消融组(P<0.05);ADC、MRI-T2WI SIR、MRI-T2WI SI、T2WI信号均匀度、血供类型与消融疗效呈负相关性(P<0.05)。结论 MRI参数能够预测HIFU对子宫体外平滑肌瘤疗效,MRI-T2WI均匀高信号以及血供丰富患者消融率更低。

Objective To analyze the value of magnetic resonance imaging(MRI) diagnosis for the efficacy of high-intensity focused ultrasound(HIFU) in the treatment of extrauterine leiomyoma. Methods 40 patients with extrauterine leiomyoma admitted were chosen, they were treated with HIFU. MRI diagnosis was performed before and 1 day after treatment. Different MRI parameters [apparent diffusion coefficient(ADC), MRI-T2WI signal intensity ratio(SIR), signal intensity(SI), signal uniformity and blood supply type], fibroid ablation rate were observed, MRI was reviewed 6 months after surgery. According the ablation efficacy, they were divided into incomplete ablation group and complete ablation group, MRI parameters of the two groups were compared, their correlation with efficacy was analyzed. Results The ablation rate with ADC less than 1.4 ×10^-3 mm^2/s, MRI-T2WI SIR less than 1.5, MRI-T2WI SI less than 200, T2WI signal uniformity less than 20 and little blood supply type was significantly higher than that with ADC not less than 1.4×10^-3 mm^2/s, MRI-T2WI SIR not less than 1.5, MRI-T2WI SI not less than 200, T2WI signal uniformity not less than 20, fibroids and rich blood supply fibroids(P<0.05). The signal uniformity of ADC, MRI-T2WI SIR, MRI-T2WI SI and T2WI in complete ablation group was significantly smaller than that in the incomplete ablation group(P<0.05). The proportion of little blood supply was significantly higher than that in the incomplete ablation group(P<0.05). The signal uniformity and blood supply type of ADC, MRI-T2WI SIR, MRI-T2WI SI, T2WI were negatively correlated with ablation efficacy(P<0.05). Conclusion MRI parameters can predict the efficacy of HIFU on extrauterine leiomyoma, patients with uniform high signal of MRI-T2WI and rich blood supply have lower ablation rate.