Comparison of IVIM-DWI and DCE-MRI in the treatment of uterine fibroids with high intensity focused ultrasound knife
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摘要:
目的分析体素内不相干运动扩散加权成像（IVIM-DWI）和动态对比增强MRI（DCE-MRI）定量参数对高强度聚焦超声刀治疗子宫肌瘤疗效的比较。 方法对60例子宫肌瘤患者进行高强度聚焦超声消融术，所有患者在术前1周、术后48 h及术后3月分别行IVIM-DWI及DCE-MRI检查，通过相关参数（ADC、eADC、StandardADC、f值、D值、D*值、MSI、SER）对同一肌瘤比较IVIM-DWI与DCE-MRI在消融和未消融区域的差异，分析两种扫描参数之间是否具有相关性。 结果术后48 h、术后3月的DCE-MRI相关参数MSI、SER与IVIM-DWI相关参数D*与f值与术前差异具有统计学意义（P < 0.05），IVIM-DWI相关参数f与D*值与DCE-MRI相关参数MSI、SER有显著正相关性。 结论IVIM-DWI所产生的伪彩图相较DCE-MRI对子宫肌瘤消融界限较难以区分，但IVIM-DWI相关参数仍能对子宫肌瘤HIFU术后早期病灶的血供及灌注情况提供一定的参考价值。 Abstract:ObjectiveTo compare the efficacy of IVIM-DWI and DCE-MRI in the treatment of uterine fibroids with highintensity focused ultrasound scalpel. Methods60 patients with hysteromyoma underwent high intensity focused ultrasound ablation. IVIM-DWI and DCE-MRI were performed in all patients 1 week before operation, 48 hours after operation and 3 months after operation respectively. The differences between IVIM-DWI and DCE-MRI in ablated and UN ablated areas were compared between IVIM-DWI and DCE-MRI through relevant parameters (ADC, eADC, standardABC, f value, D value, D*value, MSI, SER). The correlation between the two scanning parameters was analyzed. ResultsThe values of D* and F related with IVIM-DWI and the MSI, SER value of DCE-MRI at 48 h and 3 months after operation were significantly different from those before operation (P < 0.05). And there was a significant positive correlation between the values of F and D* of IVIMDWI and MSI and SER of DCE-MRI. ConclusionCompared with DCE-MRI, IVIM-DWI can not distinguish the ablation boundary of hysterical, but the parameters of IVIM-DWI can still provide some reference value for the blood supply and perfusion of uterine leiomyoma in the early stage after HIFU. -
Key words:
- uterine fibroids /
- high-intensity focused ultra-sound /
- IVIM-DWI /
- DCE-MRI
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图 1 多b值DWI拟合IVIM参数f值伪彩图
A: HIFU术前; B:术后48 h; C:术后3月; 子宫肌瘤消融界限模糊, 术前肌瘤以黄绿色为主, 术后以蓝黑色为主, 提示f值减低, 表明肌瘤血液灌注减低.
Figure 1. Pseudo-color diagram of IVIM parameter F value fitted by DWI with multi-B value
图 2 多b值DWI拟合IVIM参数D*值伪彩图
A: HIFU术前; B:术后48 h; C:术后3月; 子宫肌瘤消融界限模糊, 术前肌瘤以绿色为主, 术后以蓝色为主, 提示D*值减低, 表明肌瘤灌注的弥散信号减低, 提示肌瘤血供减少.
Figure 2. Pseudo-color diagram of multi-B value DWI fitting IVIM parameter D* value
图 3 DCE-MRI拟合MSI值伪彩图
A: HIFU术前; B:术后48 h; C:术后3月; 子宫肌瘤消融界限清晰, 术前肌瘤以蓝绿色为主, 术后以黑色为主, 提示MSI值减低, 表明肌瘤血流量减低.
Figure 3. DCE-MRI pseudo-color image of MSI value fitting
图 4 常规T2压脂序列基本图像
A: HIFU术前; B:术后48 h; C:术后3月; 从形态学上可以看出子宫肌瘤在逐步减小.
Figure 4. Basic image of conventional T2 lipid sequence
表 1 HIFU术前、术后48 h肌瘤以及术后3月IVIM各参数值及DCE-MRI各参数值差异比较
Table 1. Comparison of IVIM parameter values and DCE-MRI parameters before HIFU, 48 h after HIFU, and 3 months after HIFU
指标 Mean±SD t P eADC 术前（n=60） 0.26±0.06 - - 术后48 h（n=60） 0.25±0.06 0.77 0.44 术后3月（n=35） 0.24±0.04 -1.42 0.16 ADC（10-3 mm2/s） 术前（n=60） 1.44±0.15 - - 术后48 h（n=60） 1.41±0.15 0.89 0.38 术后3月（n=35） 1.43±0.1 -0.25 0.8 StADC（10-3 mm2/s） 术前（n=60） 1.27±0.32 - - 术后48 h（n=60） 1.35±0.35 -1.20 0.20 术后3月（n=35） 1.38±0.29 1.64 0.11 D（10-3 mm2/s） 术前（n=60） 1.31±0.15 - - 术后48 h（n=60） 1.33±0.27 0.42 0.67 术后3月（n=35） 1.35±0.16 1.13 0.26 f（%） 术前（n=60） 0.29±0.1 - - 术后48 h（n=60） 0.18±0.09 6.29 ＜0.05 术后3月（n=35） 0.17±0.1 -5.64 ＜0.05 D* 术前（n=60） 0.1±0.02 - - 术后48 h（n=60） 0.07±0.03 6.52 ＜0.05 术后3月（n=35） 0.07±0.01 -8.91 ＜0.05 MSI 术前（n=60） 306.75±122.32 - - 术后48 h（n=60） 71.43±31.62 14.54 ＜0.05 术后3月（n=35） 160.86±49.74 -6.73 ＜0.05 SER 术前（n=60） 43.21±13.49 - - 术后48 h（n=60） 12.07±2.92 17.39 ＜0.05 术后3月（n=35） 22.81±4.71 -8.63 ＜0.05 D: True diffusion value; D*: Pseudo diffusion value; f: Perfusion fraction; ADC: Apparent diffusion coefficient; St ADC: Standard apparent diffusion coefficient; EADC: Exponential apparent diffusion coefficient; MSI: Maximum slop of increase; SER: Signal enhancement rate. 
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表 2 IVIM-DWI与DCE-DWI术后各相关参数相关性比较（n=155）
Table 2. Correlation comparison between iVIm-DWI and CE-DWI after operation
指标 eADC ADC StADC D f D* MSI SER eADC r 1 0.007 -0.031 -0.032 0.031 0.061 0.143 -0.068 P - 0.932 0.702 0.693 0.704 0.448 0.075 0.398 ADC r 0.007 1 0.013 0.085 0.062 -0.014 -0.005 -0.082 P 0.932 - 0.869 0.293 0.447 0.865 0.951 0.313 StADC r -0.031 0.013 1 -0.060 -0.151 0.027 -0.079 0.066 P 0.702 0.869 - 0.459 0.061 0.737 0.327 0.412 D r -0.032 0.085 -0.060 1 -0.011 -0.071 -0.022 0.035 P 0.693 0.293 0.293 - 0.897 0.379 0.786 0.662 f r 0.031 0.062 -0.151 -0.011 1 0.236 0.452 0.509 P 0.704 0.447 0.061 0.897 - 0.003 0.000 0.000 D* r 0.061 -0.014 0.027 -0.071 0.236 1 0.377 0.422 P 0.448 0.865 0.737 0.379 0.003 - 0.000 0.000 MSI r 0.143 -0.005 -0.079 -0.022 0.452 0.377 1 0.650 P 0.075 0.951 0.327 0.786 0.000 0.000 - 0.000 SER r -0.068 -0.082 0.066 0.035 0.509 0.422 0.650 1 P 0.398 0.313 0.412 0.662 0.000 0.000 0.000 -
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