DWI对高强度聚焦超声治疗子宫腺肌病早期消融效果的评价

Evaluation of DWI on the early therapeutic efficacy of HIFU in adenomyosis

目的探讨磁共振扩散加权成像(diffusion weighted imaging,DWI)对高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗子宫腺肌病早期消融效果的价值。材料与方法回顾性分析82例接受HIFU治疗的子宫腺肌病患者资料,均于术前及术后48 h内行增强MRI(contrast-enhanced MRI,CE-MRI)及DWI检查。观察HIFU治疗后病灶DWI信号特征,分析病灶表观扩散系数(apparent diffusion coefficient,ADC)值变化。对DWI信号变化区形态进行评估分型:Ⅰ型,斑点状或无明显信号改变;Ⅱ型,斑片状信号改变;Ⅲ型,环状信号改变。并测量DWI信号变化区体积及CE-MRI非灌注区体积(nonperfused volume,NPV),分析两者的差异性及相关性。结果DWI显示消融灶信号变化区Ⅰ型3例、Ⅱ型4例、Ⅲ型75例,观察者间一致性Kappa值为0.848(P<0.001);DWI信号变化区体积41.24(25.63,85.21)cm3,观察者间可靠性好,差异无统计学意义(P=0.581);CE-MRI上NPV为41.71(20.72,87.03)cm3,与DWI信号变化区体积差异无统计学意义(P=0.932),且二者存在显著正相关关系(r=0.975,P<0.001)。无论DWI上消融灶表现为完整或非完整信号环,DWI上测量体积与NPV差异均无统计学意义(P>0.05)。消融灶ADC值较术前增高,差异有统计学意义(P<0.001)。结论DWI能有效评估子宫腺肌病HIFU术后早期消融效果,能对消融灶的发生及范围做出可靠的定性及定量评价。

Objective:To explore the value of diffusion weighted imaging(DWI)for evaluating the early therapeutic efficacy of high intensity focused ultrasound(HIFU)in treating adenomyosis.Materials and Methods:The clinical and imaging data of 82 patients underwent HIFU treatment for adenomyosis were retrospectively analyzed.Contrast enhanced MRI(CE-MRI)with DWI were performed before treatment and within 48 hours post-treatment.DWI signal performance and change of ADC values of post-operative lesions were observed.The morphology of DWI signal change areas was evaluated and classified into three types:type I,spot-like or no obvious signal change;typeⅡ,patchy signal change;typeⅢ,ring-like signal change.The volume of DWI signal change areas and the nonperfused volume(NPV)on CE-MRI were evaluated and the difference and correlation between them were analyzed.Results:DWI showed that there were 3 cases of type I,4 cases of typeⅡ,and 75 cases of typeⅢin the signal change areas of the necrotic lesions,and the kappa value of inter-observer reliability reached 0.848(P<0.001).The volume of DWI signal variation zones was 41.24(25.63,85.21)cm³,and the statistical analysis revealed no significant difference in the inter-observer reliability(P=0.581).The NPV on CE-MRI was 41.71(20.72,87.03)cm³,which was not statistically significant difference in the concordance with the volume of signal change areas on DWI(P=0.932),and there was a significant positive correlation between them(r=0.975,P<0.001).Whether the ablated necrotic area on DWI showed complete or incomplete signal ring,the volume measured on DWI was not significantly different from the NPV(P>0.05).The post-operative ADC values were significantly higher compared with the pre-operative values(P<0.001).Conclusions:DWI can effectively evaluate the early ablation effect of adenomyosis after HIFU,and it can make a reliable qualitative and quantitative evaluation of the occurrence and scope of ablation lesions.