T_(2)WI联合DWI序列预测子宫腺肌症HIFU治疗非灌注体积比的价值

Value of T_(2)WI combined with DWI in predicting the non-perfused volume ratio of HIFU treatment of adenomyosis

目的:探讨非增强MRI序列预测子宫腺肌症高强度聚焦超声(High-intensity focused ultrasound,HIFU)治疗疗效的价值。方法:回顾性分析181例接受HIFU治疗的子宫腺肌症患者临床及影像资料。根据患者的非灌注体积比(Non-perfused volume ratio,NPVr)将其分为NPVr≥50%组和NPVr<50%组,并比较组间临床特征、传统影像特征及T_(2)WI、ADC直方图特征差异。并以有差异的特征为自变量、NPVr为因变量建立Logistic回归模型。结果:相较于NPVr<50%组的患者,NPVr≥50%组的患者腹壁厚度更薄、弥漫子宫腺肌症所占比例更小,而其T_(2)WI病灶/骨骼肌信号强度比更小,其T_(2)WI直方图特征中,10百分位数、90百分位数、中位值、均值、均方根、灰度、平均绝对离差、精细平均绝对离差、方差、熵、四分位距更大,而均匀性较NPVr<50%组患者更小。ADC值及ADC直方图的18个特征在组间均无统计学差异。Logistic回归显示,腹壁厚度、腺肌症类型及T_(2)WI直方图均匀性与患者的NPVr有显著相关性。ROC曲线显示,Logistic模型的曲线下面积为0.668(95%置信区间0.587~0.748),敏感性为0.631,特异性为0.643。结论:T_(2)WI序列直方图特征与子宫腺肌症HIFU消融NPVr有显著相关性,可用于疗效预测,而常规双b值ADC图不足以用来预测子宫腺肌症的HIFU疗效。

Objective:To investigate the value of non-contrast enhanced MRI sequence in predicting the therapeutic efficiency of high-intensity focused ultrasound(HIFU)for adenomyosis.Methods:The clinical and imaging data of 181 patients with adenomyosis who underwent HIFU treatment were retrospectively analyzed.According to their non-perfused volume ratio(NPVr),the patients were divided into two groups:NPVr≥50%group and NPVr<50%group.Clinical features,traditional imaging features and histogram features of T_(2)WI and ADC map were compared between the two groups.The features with statistical difference were set as independent variables,while NPVr was set as dependent variables to build a Logistic regression model.Results:Compared to patients with NPVr<50%group,patients with NPVr≥50%group had thinner abdominal wall thickness,smaller proportion of diffuse adenomyosis and lower signal intensity ratio of adenomyosis to skeletal muscle on T_(2)WI.Among T_(2)WI histogram features,the values of 10 percentile,90 percentile,median,mean,root mean square,gray scale,mean absolute deviation,robust mean absolute deviation,variance,entropy and interquartile in patients with NPVr≥50%group were larger but their uniformity were smaller than those in patients with NPVr<50%group.However,ADC value and histogram features of ADC map had no statistical difference between the two groups.The thickness of abdominal wall,classification of adenomyosis and uniformity of T_(2)WI histogram were significantly correlated with NPVr in Logistic regression model.ROC curve showed that the area under curve of Logistic model was 0.668(95%CI 0.587~0.748),the sensitivity was 0.631 and the specificity was 0.643.Conclusion:Histogram features of T_(2)WI are significantly correlated with NPVr of HIFU ablation in adenomyosis,which can be used to predict the the efficacy,while routine ADC map with only two b values is not enough to predict the efficacy of HIFU in adenomyosis.