PDF(Pubmed)
Abstract：
UNASSIGNED: The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI).
UNASSIGNED: A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury.
UNASSIGNED: Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury.
UNASSIGNED: Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.
UNASSIGNED: A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury.
UNASSIGNED: Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury.
UNASSIGNED: Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.
摘要：
■高强度聚焦超声（HIFU）在子宫肌瘤治疗中的应用日益广泛，术后对邻近组织的附带热损伤已成为一个突出的讨论主题。然而,与骨损伤相关的研究有限。因此,本研究的目的是通过磁共振成像(MRI)探讨HIFU消融子宫肌瘤后意外骨盆骨损伤的潜在影响因素.
■共纳入重庆医科大学附属第一医院HIFU治疗的635例肌瘤患者。所有患者在HIFU前后均接受对比增强MRI（CE-MRI）。根据治疗后的MRI,将患者分为两组:骨盆骨损伤组和非损伤组,同时记录每位患者骨盆骨损伤的具体部位。单因素和多因素分析用于评估肌瘤特征和治疗参数与骨盆骨损伤之间的相关性。并进一步分析损伤部位的影响因素。
■在CE-MRI上观察到51％（324/635）的HIFU患者的骨盆信号变化。其中,269例（42.4％）患者发生骶骨损伤，135例（21.3％）发生耻骨损伤。多变量分析表明，年龄较高的患者[P=0.003;比值比（OR），1.692；95%置信区间（CI）：1.191-2.404]，纤维瘤前侧到皮肤的距离大(P<0.001；OR，2.297；95%CI：1.567-3.365），后壁肌瘤（P=0.006；OR，1.897；95%CI：1.204-2.989），T2加权成像上的高强度(T2WI，P=0.003;或,2.125；95%CI：1.283-3.518），和大治疗剂量(TD，P<0.001;OR,3.007；95%CI：2.093-4.319）术后骨盆骨损伤的风险较高。进一步分析影响骨盆骨损伤部位的因素显示，部分肌瘤特征和治疗参数与之相关。此外，一些术后疼痛相关不良事件与骨盆骨损伤相关.
■HIFU后处理，患者可能会经历骨盆损伤的骶骨，耻骨,或者两者的结合，其中一些经历了不良事件。一些纤维瘤特征和治疗参数与损伤相关。术前充分考虑其影响因素,减缓治疗，延长术中降温阶段有助于优化HIFU的治疗决策。
■共纳入重庆医科大学附属第一医院HIFU治疗的635例肌瘤患者。所有患者在HIFU前后均接受对比增强MRI（CE-MRI）。根据治疗后的MRI,将患者分为两组:骨盆骨损伤组和非损伤组,同时记录每位患者骨盆骨损伤的具体部位。单因素和多因素分析用于评估肌瘤特征和治疗参数与骨盆骨损伤之间的相关性。并进一步分析损伤部位的影响因素。
■在CE-MRI上观察到51％（324/635）的HIFU患者的骨盆信号变化。其中,269例（42.4％）患者发生骶骨损伤，135例（21.3％）发生耻骨损伤。多变量分析表明，年龄较高的患者[P=0.003;比值比（OR），1.692；95%置信区间（CI）：1.191-2.404]，纤维瘤前侧到皮肤的距离大(P<0.001；OR，2.297；95%CI：1.567-3.365），后壁肌瘤（P=0.006；OR，1.897；95%CI：1.204-2.989），T2加权成像上的高强度(T2WI，P=0.003;或,2.125；95%CI：1.283-3.518），和大治疗剂量(TD，P<0.001;OR,3.007；95%CI：2.093-4.319）术后骨盆骨损伤的风险较高。进一步分析影响骨盆骨损伤部位的因素显示，部分肌瘤特征和治疗参数与之相关。此外，一些术后疼痛相关不良事件与骨盆骨损伤相关.
■HIFU后处理，患者可能会经历骨盆损伤的骶骨，耻骨,或者两者的结合，其中一些经历了不良事件。一些纤维瘤特征和治疗参数与损伤相关。术前充分考虑其影响因素,减缓治疗，延长术中降温阶段有助于优化HIFU的治疗决策。
