Application of enhanced MRI and contrast-enhanced ultrasound in the evaluation of HIFU uterine fibroids before and after treatment
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摘要:
目的比较增强MRI与超声造影在高强度聚焦超声（HIFU）治疗子宫肌瘤疗效观察中的应用价值。 方法 选取2019年2月~2020年2月我院收治102例行HIFU治疗的子宫肌瘤患者，患者治疗前后均进行超声造影和增强MRI检查，比较两种检测方法在疗效评价中的作用。 结果两种检测方法治疗前后肌瘤均径、肌瘤体积比较差异无统计学意义（P>0.05），其中增强MRI可明显显示肌瘤的大小和边界，而超声造影对子宫肌瘤的边界图像显示相对不足，且增强MRI图像质量评分、消融率高于超声造影， 差异有统计学意义（P<0.05）；增强MRI和超声造影对消融区、残余灶均能有效显示，两者评价HIFU治疗子宫肌瘤总有效率比 较差异无统计学意义（P>0.05）。 结论增强MRI在子宫肌瘤定性诊断方面优于超声造影，而超声造影检查更具有可重复性、灵活性，两者均为HIFU治疗前后的必要检查。 Abstract:ObjectiveTo compare the application value of enhanced MRI and contrast-enhanced ultrasound in efficacy observation of high-intensity focused ultrasound (HIFU) for uterine fibroids. MethodsBetween February 2019 and February 2020, 102 patients with uterine fibroids underwent HIFU treatment in our hospital were selected for contrast- enhanced ultrasound and enhanced MRI pre- and postoperatively. The effects of the two detection methods in the evaluation of efficacy were compared. ResultsThere was no significant difference in the average diameter and volume of fibroids before and after treatment by the two detection methods (P>0.05). The enhanced MRI could clearly show the size and boundary of fibroids, while contrast- enhanced ultrasound showed relatively insufficient automatic fibroids. The image quality score and the ablation rate of Enhanced MRI were higher than those of contrast-enhanced ultrasound (P < 0.05). Enhanced MRI and contrastenhanced ultrasound were effective in presenting ablation areas and residual lesions. There was no significant difference in the total effective rate of HIFU for uterine fibroids between the two (P>0.05). ConclusionEnhanced MRI is superior to contrastenhanced ultrasound in the qualitative diagnosis of uterine fibroids, while contrast-enhanced ultrasound examination is more repeatable and flexible. Both are necessary examinations before and after HIFU treatment.c -
Key words:
- enhanced MRI /
- contrast-enhanced ultrasound /
- uterine fibroids /
- efficacy evaluation
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图 1 两种检测方法图像质量比较
A: 增强MRI术前图像; B: 增强MRI术后图像; C: 超声造影术前图像; D: 超声造影术后图像
Figure 1. Comparison of image quality in two detection methods.
表 1 两种检测方法图像质量和消融率比较
Table 1. Comparison of image quality and ablation rate by detection methods (n=153, Mean±SD)
检查 图像质量评分 消融率（%） 增强MRI 3.8±0.4 80.4±10.5 超声造影 2.7±0.5 72.6±11.8 t 21.249 6.108 P 0.000 0.000 
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表 2 两组残余灶检查情况比较
Table 2. Comparison of residual focus inspection between the two groups (n=153)
检查 消融区 残余灶 + - + - 增强MRI 153 0 151 2 超声造影 153 0 150 3
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表 3 治疗前后子宫肌瘤体积变化
Table 3. Volume changes of uterine fibroids before and after treatment (n=153, Mean±SD)
检查 肌瘤均径（cm） 肌瘤体积（cm3） 治疗前 治疗后 治疗前 治疗后 增强MRI 54.9±6.4 13.6±1.5 113.6±27.4 85.6±10.5 超声造影 53.7±6.8 13.9±1.2 110.5±29.2 83.9±11.3 t 1.590 1.932 0.958 1.363 P 0.113 0.054 0.339 0.174
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表 4 两种方法评价HIFU疗效比较
Table 4. Comparison of the efficacy of HIFU by two methods [n(%), n=153]
检查方式 显效 有效 无效 总有效 增强MRI 84（54.90） 41（26.80） 28（18.30） 125（81.70） 超声造影 82（53.59） 44（28.76） 27（17.65） 126（83.35） χ2 - 0.148 P - 0.929
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