子宫腺肌症四种亚型的MRI特征及其HIFU治疗相关参数的差异性研究

Difference of MRI characteristics and HIFU related parameters of four subtypes of adenomyosis

目的探讨基于MRI的子宫腺肌症四分型的MRI特征及其经高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗相关参数的差异。材料和方法回顾性分析203例经HIFU治疗的子宫腺肌症患者病例,根据MRI T2加权成像(T2-weighted imaging,T2WI)示子宫腺肌症病灶与子宫结合带、子宫内膜的位置关系,将子宫腺肌症变分为Ⅰ内源型(intrinsic)43例、Ⅱ外源型(extrinsic)48例、Ⅲ壁内型(intramural)29例,和Ⅳ不确定型(indeterminate)83例。比较四种亚型的临床资料、MRI特征以及与HIFU治疗相关的参数。结果四种亚型的能效因子(energy efficiency factor,EEF)分别为2.02、3.18、1.88、3.50 J/mm3,四种亚型的消融率(nonperfused volume ration,NPVR)分别为47.78%、39.98%、88.57%、32.47%,四种亚型经HIFU治疗的EEF、NPVR的差异均具有统计学意义(P<0.05),四种亚型的流产史、生育史、MRI特征以及经HIFU消融的治疗时间、辐照时间、辐照剂量、病灶体积、消融体积的差异均具有统计学意义(P<0.05)。结论四种亚型经HIFU消融的消融率、能效因子等的差异均具有统计学意义(P<0.05),因此这种基于病理和MRI的分型方法有助于子宫腺肌症的临床术前决策。

Objective:To explore the differences of MRI characteristics and relevant parameters of high intensity focused ultrasound therapy of the four subtypes of adenomyosis based on magnetic.Materials and Methods:A tatal of 203 cases with adenomyosis treated by high intensity focused ultrasound(HIFU)were retrospectively analyzed.According to the location relationship between the adenomyosis focus,the uterine junction zone and the endometrium shown by T2 weighted imaging(T2WI),the adenomyosis was divided into 43 cases of typeⅠ(intrinsic),48 cases of typeⅡ(extrinsic),29 cases of typeⅢ(intrinsic)and 83 cases of typeⅣ(intrinsic).The clinical data,preoperative MRI characteristics and postoperative treatment parameters of different subtypes were compared.Results:The energy efficiency factor(EEF)of the four subtypes were 2.02,3.18,1.88,and 3.50 J/mm3 respectively.The nonperfused volume ration(NPVR)of the four subtypes were 47.78%,39.98%,88.57%,and 32.47%respectively.The differences of EEF and NPVR of the four subtypes were statistically significant(P<0.05).The differences of abortion history,fertility history and MRI characteristics of the four subtypes were statistically significant(P<0.05),and the differences of treatment time,irradiation time,irradiation dose,lesion volume and ablation volume of the four subtypes after HIFU ablation were statistically significant(P<0.05).Conclusions:The difference of NPVR and EEF among the four subtypes after HIFU ablation was statistically significant(P<0.05).Therefore,this classification based on pathology and MRI is helpful for clinical preoperative decision-making.