经皮微波消融子宫肌层良性病变围消融期灰阶声像图表现及其临床意义

目的探讨二维灰阶超声在经皮微波消融(PMA)子宫肌层良性病变围消融期声像图特点及其临床意义。方法选择19例接受PMA治疗的患者,共21个病灶(13个子宫肌瘤,8个子宫腺肌病)。消融前常规观察病变位置、回声及血供特点,消融中以灰阶超声监测消融区高回声范围,消融后即刻测量、计算高回声体积,并与CEUS测量无增强区体积进行比较。结果灰阶超声显示消融前病变均为偏低回声。微波辐射开始约3s,辐射点周围组织回声即增高,并随时间延长而呈球形或类球形增大,子宫肌瘤以高回声达到肌瘤被膜时停止微波辐射,子宫腺肌病以高回声达到病灶内缘0.3cm时停止消融,高回声范围不再增大。消融后即刻灰阶超声高回声范围(97.94±72.88)cm3]与CEUS无增强区范围(88.82±70.06)cm3]差异无统计学意义,且二者呈正相关(r=0.859,P<0.01)。结论PMA子宫肌层良性病变围手术期灰阶声像图变化特点鲜明;高回声范围可粗略代表凝固坏死区范围。

Appearances and significance of gray-scale ultrasound in percutaneous microwave ablation of uterine myometrium benign lesions

Objective To investigate the image appearances and clinical significance of two-dimensional gray-scale ultrasound in percutaneous microwave ablation (PMA) for the treatment of uterine myometrium benign lesions. Methods Nineteen patients with 21 benign uterine lesions (13 uterine fibroids and 8 adenomyosis) who received PMA were selected. Before ablation, the location, echo and blood supply characteristics of uterine lesions were observed with conventional ultrasound. During ablation, the hyperechoic range of the ablation area was monitored with gray-scale ultrasound. Immediately after ablation, the hyperechoic volume was calculated and compared to the volume of non-enhancement area by CEUS. Results Two-dimensional gray-scale ultrasound revealed that uterine myoma and adenomyosis were both leaning low-echo before ablation. About 3 s after the beginning of microwave emit, gray-scale ultrasound showed hyperecho starting from the seam of microwave electrode, and enhanced as the time of microwave emission prolonged. When the hyperecho region reached the envelope of uterine myoma or 0.3 cm apart from the margin of the anticipated ablation area of adenomyosis, the microwave radialization was stopped, then the hyperecho region stopped increasing. Two-dimensional gray-scale hyperecho region immediately after the ablation (97.94±72.88]cm³) was a little larger than that of non-enhancement area by CEUS (88.82±70.06]cm³), but the difference was not statistical significant, and positive correlation was found between them (r=0.859, P<0.01). Conclusion Changes of two-dimensional gray-scale ultrasound in microwave ablation for myometrium benign lesions are distinct during ablation. The hyperechoic range can approximately represent the extent of the coagulation necrosis area.