■根据T2加权MR图像(T2WI)的信号强度,研究高强度聚焦超声(HIFU)消融对不同类型子宫肌瘤的治疗剂量和长期疗效。
■用HIFU治疗的四百零一名单发子宫肌瘤患者被分为四组,低信号,等强度和高强度纤维瘤。每组进一步分为两个亚型:同质和异质,基于肌瘤的信号均匀性。比较两组治疗剂量和长期随访结果。
■治疗时间有显著差异,超声处理时间,处理强度,总治疗剂量,治疗效率,四组之间的能量效率因子(EEF)和非灌注体积(NPV)比(p<0.05)。在极低信号的患者中达到的平均NPV比率,低信号,等强度和高强度肌瘤为75.2±14.6%,71.1±15.6%,68.2±17.3%和67.8±16.6%,HIFU后36个月的再干预率为8.4%,10.3%,12.5%和6.1%,分别。声波处理时间,治疗强度和总能量的异质性肌瘤大于同质肌瘤的患者有极低的纤维瘤(p<.05)。异型肌瘤患者的治疗时间明显长于同型肌瘤患者(p<0.05)。多因素有序logistic回归分析显示,肌瘤消融体积和治疗时间与NPV比值相关(p<0.05)。
■每组患者均获得了满意的长期疗效。高强度纤维瘤难以通过HIFU治疗。异质纤维瘤比同质纤维瘤更难以用HIFU治疗。
To investigate the therapeutic dose and long-term efficacy of high-intensity focused ultrasound (HIFU) ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images (T2WI).
Four hundred and one patients with a solitary uterine fibroid treated with HIFU were classified into four groups consisting of extremely hypointense, hypointense, isointense and hyperintense fibroids. Each group was further classified into two subtypes: homogeneous and heterogeneous, based on signal homogeneity of fibroids. The therapeutic dose and long-term follow-up results were compared.
There were significant differences in treatment time, sonication time, treatment intensity, total treatment dosage, treatment efficiency, energy-efficiency factor (EEF) and non-perfused volume (NPV) ratio among the four groups (p<.05). The average NPV ratio achieved in patients with extremely hypointense, hypointense, isointense and hyperintense fibroids was 75.2 ± 14.6%, 71.1 ± 15.6%, 68.2 ± 17.3% and 67.8 ± 16.6%, respectively; the re-intervention rates at 36 months after HIFU were 8.4%, 10.3%, 12.5% and 6.1%, respectively. Sonication time, treatment intensity and total energy for heterogeneous fibroids were greater than that for homogeneous fibroids in patients with extremely hypointense fibroids (p<.05). The treatment time for heterogeneous fibroids was significantly longer than that for homogeneous fibroids in patients with isointense fibroids (p<.05). Multivariate ordered logistic regression analysis showed that the ablation volume of fibroids and treatment time were related to NPV ratio (p<.05).
Every group of patients obtained satisfactory long-term results. Hyperintense fibroids are difficult to treat by HIFU. Heterogeneous fibroids are more difficult to treat with HIFU than homogeneity fibroids.