DCE-MRI、DWI对HIFU治疗子宫腺肌病早期疗效的评价

Evaluation of DCE-MRI and DWI on the Early Efficacy of HIFU in Adenomyosis

目的探讨动态对比增强MRI(DCE-MRI)及扩散加权成像(DWI)相关参数对于评价高强度聚焦超声(HIFU)治疗子宫腺肌病早期疗效的价值。方法 32例子宫腺肌病患者,其中弥漫型10例,局限型22例,于术前、术后48 h内分别行盆腔DWI及DCE-MRI检查,测量消融前后病灶体积及消融灶体积,分析术前及术后消融灶、残留灶表观扩散系数(ADC)及最大增强斜率(MSI)值之间的差异。结果 32例腺肌病灶DWI、DCE-MRI均能明确其残留灶及消融灶范围,术前病灶平均ADC值为(1.19±0.15)×10^(-3)mm^(2)/s,术后48 h消融灶平均ADC值为(1.12±0.09)×10^(-3)mm^(2)/s,较术前降低,差异有统计学意义(t=2.50,P=0.017);残留灶平均ADC值为(1.28±0.16)×10^(-3)mm^(2)/s,较术前升高,差异具有统计学意义(t=2.62,P=0.013);残留灶平均ADC值高于消融灶,差异具有统计学意义(P<0.05)。术后消融灶MSI均值[(51.30±30.91)%/s]较术前[(322.49±106.67)%/s]明显降低(t=14.54,P=0.000),残留灶平均MSI值[(394.81±136.18)%/s]较术前升高(t=3.30,P=0.002),差异均具有显著性统计学意义;32例病灶均为不完全消融,消融率为(30.72±18.89)%。结论 DWI及DCE-MRI在早期评价HIFU治疗子宫腺肌病术后疗效方面均具有较高的临床价值。

Objective To explore the value of parameters related to Dynamic enhanced MRI(DCE-MRI) and Diffusion-weighted imaging(DWI) for evaluating the early efficacy of High intensity focused ultrasound(HIFU) in treating adenomyosis. Methods There were 32 patients with adenomyosis, including 10 patients with diffuse type and 22 patients with localized type.Pelvic DWI and DCE-MRI were performed before and 48 hours after surgery, respectively, to measure lesion volume and ablation focal volume before and after ablation, and to analyze the differences between preoperative and postoperative ablation focal points, residual focal points ADC and MSI values. Results DWI and DCE-MRI of the 32 adenomyosis foci could identify the range of residual foci and ablation foci.The mean ADC value of the lesions before surgery was(1.19±0.15)×10^(-3)mm^(2)/s, and the mean ADC value of the ablation foci 48 h after surgery was(1.12±0.09)×10^(-3)mm^(2)/s, which was lower than that before surgery, and the difference was statistically significant(t=2.50,P=0.017).The mean ADC value of residual lesions was(1.28±0.16)×10^(-3)mm^(2)/s, which was higher than that before operation, and the difference was statistically significant(t=2.62,P=0.013).The average ADC value of the residual area was higher than that of the ablation area, and the difference was statistically significant(P<0.05).The mean MSI of the ablation foci after surgery(51.30±30.91%/s) was significantly lower than that before surgery(322.49±106.67%/s)(t=14.54,P=0.000),and the mean MSI of the residual foci(394.81±136.18%/s) was significantly higher than that before surgery(t=3.30,P=0.002),the differences were statistically significant.Incomplete ablation was performed in 32 cases, and the ablation rate was(30.72±18.89)%. Conclusion DWI and DCE-MRI have high clinical value in early evaluation of HIFU for adenomyosis.