MRI参数预测聚焦超声治疗子宫肌瘤的消融效果研究

目的 探讨子宫肌瘤的相关磁共振成像(MRI)参数在预测子宫肌瘤消融效果方面的价值.方法 回顾性分析上海市徐汇区中心医院超声消融治疗中心2012年4月至2013年12月共91例患者144个子宫肌瘤超声消融治疗的相关数据,分析术前靶肌瘤的血供类型、MRI-T2 WI信号强度比值(SIR)、信号均匀度、信号强度值(SI)和表观弥散系数(ADC)与超声消融疗效的关系,设定MRI参数阈值并分组比较各组间治疗后肌瘤的消融率.结果 少血供和多血供类型的肌瘤平均消融率为89.4％、80.9％(P＜0.05);T2WI SIR＜1.5、≥1.5的肌瘤平均消融率分别为89.1％、83.6％(P＜0.05);T2WI SI＜200、≥200的肌瘤平均消融率分别为89.5％、81.4％ (P＜0.05);ADC＜1.4×10-3 mm2/s、≥1.4×10-3 mm2/s的肌瘤平均消融率分别为88.3％、81.7％(P＜0.05);肌瘤为多血供伴T2 WI SIR≥1.5的消融率低于多血供或少血供伴T2WI SIR＜1.5、少血供伴T2 WI SIR≥1.5(P＜0.05);肌瘤为T2 WI均匀高信号的消融率低于均匀低信号、不均匀高信号、不均匀低信号(P＜0.05).结论 子宫肌瘤的MRI参数可预测超声消融子宫肌瘤的疗效,血供丰富和T2 WI均匀高信号的肌瘤超声消融率较低.

Study on MRI parameters for predicting ablation effect of focused ultrasound in treating uterine fibroid

Objective To investigate the value of the magnetic resonance imaging(RMI) parameters of uterine fibroid for predicting the ablation effect of uterine fibroid.Methods The relevant data of 91 patients with 144 uterine fibroids treated by ultrasound ablation in the center of Shanghai Xuhui District Central Hospital from April 2012 to December 2013 were retrospectively analyzed.The relationships between the blood supply patterns,MRI T2 WI signal intensity ratio(SIR),T2 WI signal uniformity,T2 WI signal intensity(SI) and apparent diffusion coefficient(ADC) value of preoperative uterine fibroids with the ultrasound ablation effect were analyzed.The threshold values of the MRI parameters were set and grouped for comparing the ablation rates non-perfused volume (NPV) ratios] ofuterine fibroid among various groups.Results The average NPV ratios of the fibroids with more blood supply and less blood supply were 89.4％ and 80.9％ respectively(P＜0.05),which of the fibroids with T2WI SIR＜1.5 and ≥1.5 were 89.1％ and 83.6％ respectively,which of the fibroids with T2WI SI＜200 and ≥200 were 89.5％ and 81.4％ respectively,which of the fibroids with ADC value＜ 1.4 × 10-3 mm2/s and≥ 1.4 × 10-3 mm2/s were 88.3 ％ and 81.7 ％ respectively (P＜0.05);which of the fibroids more blood supply complicating T2WI signal intensity ratio≥1.5 was lower than that of fibroids with more blood supply or less blood supply complicating T2 WI signal intensity ratio ＜1.5,less blood supply and T2 WI signal intensity ratio ≥1.5 respectively(P＜0.05);which of fibroids with T2WI homogeneous high signal intensity was lower than that of fibroids with homogeneous low signal,heterogeneous high signal and heterogeneous low signal respectively (P＜0.05).Conclusion The MRI parameters of uterine fibroids could predict the curative effect of ultrasound ablation for treating uterine fibroid,and the ablation efficacy is poor in the fibroids with rich blood supple and T2WI homogeneous high signal.