子宫肌瘤超声造影增强类型与高强度聚焦超声治疗疗效的关系

目的探讨子宫肌瘤超声造影的增强类型与高强度聚焦超声（HIFU）治疗子宫肌瘤疗效的关系。方法对47例子宫肌瘤患者（65个病灶）,在HIFU治疗前及治疗后采用对比脉冲序列（CPS）成像技术进行超声造影检查,并于HI-FU治疗后2、4、6、9、12个月采用常规超声随访,观察病灶体积的变化。结果 HIFU治疗前超声造影示65个子宫肌瘤中,15个病灶（23.08%）为高增强,41个病灶（63.08%）为等增强,9个病灶（13.85%）为低增强。HIFU治疗后超声造影显示45个病灶＂完全灭活＂;高增强病灶的完全灭活率低于等增强及低增强病灶（P〈0.05）,常规超声随访发现HIFU治疗后病灶体积较治疗前明显缩小（P〈0.05）。20个病灶HIFU治疗后超声造影显示有肌瘤残存,常规超声随访发现病灶体积在HIFU治疗前后差异无统计学意义（P〉0.05）。结论超声造影可提供子宫肌瘤的血流灌注信息,不同增强类型的子宫肌瘤其HIFU治疗效果不同。

Relationship between the enhancement type on contrast-enhanced ultrasonography and the effect of high intensity focused ultrasound in the treatment of hysteromyoma

Objective To observe the relationship between the enhancement type on contrast-enhanced ultrasonography（CEUS）and the effect of high intensity focused ultrasound（HIFU）in the treatment of hysteromyoma.Methods A total of 47 patients of uterine leiomyoma with 65 lesions underwent CEUS with the contrast pulse sequence（CPS）technique before and after HIFU treatment.In order to observe the lesion volume change after HIFU treatment,the follow-up was done with conventional ultrasonography after 2,4,6,9,12 months,respectively.Results Fifteen（23.08%）of the 65 lesions were hyper-enhanced,41（63.08%）lesions were iso-enhanced and 9（13.85%）lesions were hypo-enhanced in arterial phase of CEUS before HIFU treatment.After HIFU treatment,no enhancement was found in 45 of the 65 lesions on CEUS,which indicated tumor necrosis.The tumor necrosis rate of hyper-enhanced lesions was lower than that of iso-enhanced and hypo-enhanced lesions（P0.05）.Following-up showed that the volume of the 45 lesions of tumor necrosis decreased obviously after HIFU treatment（P0.05）,while the other 20 lesions remained enhancement on CEUS after HIFU treatment,and no significant difference of lesion volume was found before and after HIFU treatment（P0.05）.Conclusion CEUS can provide information about the feeding vessels of hysteromyoma,and the effect of HIFU treatment among hysteromyomas of varied types of enhancement on CEUS is different.