多参数MRI检查对子宫肌瘤患者超声引导下微波消融治疗效果的评估价值

Evaluation Value of Multi-Parameter MRI for Curative Effect of Ultrasound-GuidedMicrowave Ablation in Patients with Uterine Fibroid

目的探讨多参数MRI检查对子宫肌瘤患者超声引导下微波消融(MWA)治疗效果的评估价值。方法选取行超声引导下MWA治疗的71例子宫肌瘤患者的临床资料进行回顾性分析,所有患者于治疗前及治疗6个月后行MRI平扫和增强扫描,测量T_(2)WI序列的信号强度比值(SIR)、T_(2)WI信号值、表观扩散系数(ADC)及肿瘤体积。比较各MRI参数与消融效果以及临床效果的关系,绘制ROC曲线评估各MRI参数对治疗效果的评估价值。结果71例子宫肌瘤患者经超声引导下MWA治疗后,T_(2)WI SIR、T_(2)WI信号值、ADC值参数均较治疗前降低(P<0.05)。不同MRI参数的肌瘤体积消融率比较有显著差异,其中T_(2)WI SIR<1.5、T_(2)WI信号值<200、ADC值<1.4×10^(-3)mm^(2)/s的肌瘤体积消融率较高(P<0.05)。Pearson相关性分析结果显示,治疗后T_(2)WI SIR、T_(2)WI信号值、ADC值均与肌瘤体积消融率呈负相关(P<0.05)。不同临床疗效患者治疗后T_(2)WI SIR、T_(2)WI信号值、ADC值比较有显著差异,其中显效患者各参数值均较低(P<0.05)。ROC曲线分析显示,各项参数评估临床疗效的AUC分别为0.726、0.738、0.744(P<0.05),采用并联的方式进行联合检测,评估子宫肌瘤患者临床疗效的AUC为0.884,联合检测AUC高于各参数单独检测(P<0.05)。结论多参数MRI检查对子宫肌瘤患者超声引导下MWA治疗效果有较好的评估价值,T_(2)WI SIR、T_(2)WI信号值、ADC值较低的肌瘤体积消融效果较好。

Objective To explore the evaluation value of multi-parameter MRI for curative effect of ultrasound-guided microwave ablation(MWA)in patients with uterine fibroid.Methods A retrospective study was performed on 71 patients with uterine fibroid who underwent elective ultrasound-guided MWA in the hospital.Before and after 6 months of treatment,all patients underwent MRI plain scan and enhanced scan to measuresignal intensity ratio(SIR)in T_(2)WI sequence,T_(2)WI signal value,apparent diffusion coefficient(ADC)and tumor volume.The relationship between different MRI parameters and ablation effect,clinical effect was compared.The evaluation value of MRI parameters for curative effect was assessed by ROC curves.Results In the 71 patients with uterine fibroid after ultrasound-guided MWA,T_(2)WI SIR,T_(2)WI signal value and ADC were decreased(P<0.05).There were significant differences in ablation rate of fibroid volume by different MRI parameters.The ablation rate of fibroid volume was higher by T_(2)WI SIR<1.5,T_(2)WI signal value<200 and ADC<1.4×10^(-3)mm^(2)/s(P<0.05).The results of Pearson correlation analysis showed that T_(2)WI SIR,T_(2)WI signal value and ADC were negatively correlated with ablation rate of fibroid volume(P<0.05).After treatment,there were significant differences in T_(2)WI SIR,T_(2)WI signal value and ADCamong patients with different clinical curative effect,and which were lower in patients with obvious effect(P<0.05).ROC curves analysis showed that AUC values of T_(2)WI SIR,T_(2)WI signal value,ADC and combined detection(parallel mode)for evaluating clinical curative effect were 0.726,0.738,0.744 and 0.884,respectively(P<0.05).AUC of combined detection was greater than that of single index(P<0.05).Conclusion Multi-parameter MRI has good evaluation valuefor curative effect of ultrasound-guided MWA in patients with uterine fibroid.The ablation effect of fibroid volumeis better with lower SIR,T2WI signal value and ADC.