本文選題：高強度聚焦超聲 + 增強MRI　； 參考：《重慶醫(yī)科大學》2014年碩士論文

【摘要】：研究背景 子宮肌瘤是育齡女性生殖系統(tǒng)中的最常見的良性腫瘤[1]，約占婦科良性腫瘤的52%[2]。其治療方法各具優(yōu)勢，包括藥物（類固醇），手術(shù)治療（子宮切除術(shù)，子宮肌瘤切除術(shù)，腹腔鏡手術(shù)），宮腔鏡及子宮動脈栓塞術(shù)，但均為有創(chuàng)治療，術(shù)后并發(fā)癥較多，從生理、心理和社會角度切除子宮對患者有著不同程度的影響。 高強度聚焦超聲（high intensity focused ultrasound，HIFU）是一種非侵入性的局部治療腫瘤的治療技術(shù)，已經(jīng)較多的運用于子宮肌瘤[3-5]治療。有研究[6-7]超聲造影能準確地評價子宮肌瘤的HIFU治療的療效報告，而研究報道[8]常規(guī)平掃MRI T1W1和T2W1相結(jié)合能準確地評價HIFU治療子宮肌瘤的療效。 目的 比較增強MRI和超聲造影評估高強度聚焦超聲（HIFU）治療子宮肌瘤的消融情況。 資料和方法 1.回顧性分析上海市徐匯區(qū)中心醫(yī)院臨床診斷為子宮肌瘤并行HIFU治療的子宮肌瘤患者，采用隨機抽樣，患者30例，單發(fā)肌瘤27例，多發(fā)肌瘤3例，共治療肌瘤36個。所選擇肌瘤總計30個，27個來自于單發(fā)肌瘤，另外3個來自于多發(fā)肌瘤患者的前壁肌瘤。 2.所有患者治療前、治療后一天內(nèi)采用西門子3.0T超導(dǎo)高場強磁共振掃描儀行常規(guī)MRI成像序列采集，掃描橫斷位、矢狀位、冠狀位T1WI和T2WI并加壓脂相，增強MR掃描采用T1WI-vibe3D掃描，造影劑使用釓噴替酸葡甲胺（Gd-DTPA）。 所有患者在治療前、治療后即刻行超聲造影檢查，監(jiān)控超聲（EsaoteMyLab70, Italy）。治療前、治療后即可均靜脈推注聲諾維造影劑，觀察肌瘤周邊及血流灌注情況。 3.聚焦超聲治療設(shè)備為JC-200型聚焦超聲腫瘤治療系統(tǒng)（重慶海扶醫(yī)療科技股份有限公司生產(chǎn)），監(jiān)控超聲（Esaote MyLab70, Italy）與該腫瘤治療系統(tǒng)結(jié)合。術(shù)前脹尿后于機載超聲定位，根據(jù)定位情況預(yù)設(shè)好治療參數(shù)，治療中為使患者處于鎮(zhèn)靜鎮(zhèn)痛狀態(tài)，在實時超聲引導(dǎo)下進行超聲消融治療。 4.分別在增強MRI和超聲造影圖像中測量術(shù)前肌瘤大小，，包括肌瘤長徑（D1）、前后徑（D2）、左右徑（D3）和術(shù)后無灌注區(qū)（NPV）。計算肌瘤體積大小、無灌注區(qū)體積大小和消融率，體積計算方法：V=0.5233×D1×D2×D3，無灌注體積消融率（消融率）=無灌注區(qū)體積/靶肌瘤體積×100%。 采用肌瘤瘤體顯示級別評估標準對增強MRI、超聲造影圖像按1-4分進行質(zhì)量評分，肌瘤瘤體顯示的圖像質(zhì)量按清晰可見（4分），可見（3分），模糊可見（2分），不可見（1分）評分。 結(jié)果 1.在圖像質(zhì)量評分中，CE-MRI總評分和平均分分別為113和3.8±0.4高于CEUS的63和2.1±0.8，差異有顯著性（P0.05）。增強MRI測量得出的肌瘤平均消融率為80.6±18.5%，高于超聲造影所測量得出72.9±20.0%的平均消融率，統(tǒng)計學處理有顯著性意義（P=0.00）。 2.治療前增強MRI肌瘤體積與超聲造影肌瘤體積比較，無顯著差異（P0.05）；HIFU治療后肌瘤NPV在增強MRI上測得為82.5±83.5cm3，明顯高于超聲造影測得的66.0±66.2cm3，統(tǒng)計學處理有顯著性意義（P0.01）。 3.30個肌瘤，增強MRI和超聲造影圖像質(zhì)量顯示存在明顯差異，增強MRI上可以明確顯示肌瘤大小、邊界，與周圍組織的毗鄰關(guān)系；超聲造影上對肌瘤的邊界顯示相對模糊，甚至有5例無法準確確定肌瘤的邊界，使其大小的準確測量受到影響，更無法判斷周圍組織結(jié)構(gòu)。 結(jié)論 1. CEUS可能低估肌瘤HIFU治療后的消融程度，同時由于邊界無法清晰顯示，無法確定HIFU消融后殘留肌瘤組織是否存在，尤其對肌瘤深面后層CEUS無法確定準確的邊界，從而其評估HIFU治療子宮肌瘤消融程度的客觀性受到影響。 2.增強MRI在顯示子宮肌瘤大小、邊緣和評估HIFU治療子宮肌瘤的無灌注區(qū)等方面優(yōu)于超聲造影，它可以更準確地、客觀地顯示肌瘤的消融情況，為HIFU治療子宮肌瘤療效以及臨床治療方案提供可靠的依據(jù)。
[Abstract]:Research background
Uterine leiomyoma is the most common benign tumor of reproductive age in women's reproductive system, which accounts for about 52%[2]. of benign gynecologic tumors, including drugs (steroids), surgical treatment (hysterectomy, hysteromyomectomy, laparoscopy), intrauterine mirror and uterine artery embolization, but all are invasive and postoperative complications. The removal of uterus from physiological, psychological and social perspectives has different effects on patients.
High intensity focused ultrasound (high intensity focused ultrasound, HIFU) is a noninvasive treatment for local tumor treatment. It has been used more in the treatment of uterine myoma [3-5]. There is a study of the efficacy of [6-7] sonography to accurately evaluate the curative effect of HIFU therapy for uterine myoma, and the study is reported in [8] routine plain scan MRI T1W1 and T2W1. The combination can accurately evaluate the efficacy of HIFU in the treatment of uterine fibroids.
objective
Contrast enhanced MRI and contrast-enhanced ultrasound were used to evaluate the ablation of uterine fibroids by high intensity focused ultrasound (HIFU).
Information and methods
1. retrospective analysis of the uterine myoma in Central Hospital of Shanghai Xuhui District, which was clinically diagnosed as uterine myoma and HIFU, using random sampling, 30 patients, 27 single myoma, 3 myoma and 36 myoma. The total selection of myoma was 30, 27 from single myoma, and 3 in the anterior wall of multiple myoma. Myoma.
2. before treatment, the routine MRI imaging sequence was collected by SIEMENS 3.0T superconducting high field magnetic resonance scanner, scanning transversal, sagittal, coronal T1WI and T2WI and pressure lipid phase, enhanced MR scan using T1WI-vibe3D scan, and contrast agent using gadolinium gadolinium acid methylamine (Gd-DTPA).
Before treatment, all patients were treated with sonography (EsaoteMyLab70, Italy) immediately after treatment. Before treatment, the sonoveno contrast agent was injected intravenously to observe the peripheral and blood flow of the myoma.
3. focused ultrasound therapy equipment is JC-200 focused ultrasound tumor treatment system (Chongqing Haifu medical Polytron Technologies Inc production), monitoring ultrasound (Esaote MyLab70, Italy) combined with the tumor treatment system. Pre operation onboard ultrasound positioning, according to the location of the presupposition of the treatment parameters, in the treatment of the patient in the town of sedative town. Pain state was treated by real-time ultrasound guided ultrasound ablation.
4. the size of the preoperative myoma was measured in the enhanced MRI and ultrasound contrast images, including the length of the myoma (D1), the anterior and posterior diameter (D2), the left and right diameter (D3) and the postoperative instillation area (NPV). The volume of myoma, the volume of the instillation area and the ablation rate, the volume calculation method: V=0.5233 * D1 x D2 x D3, the perfusion free volume (ablation rate) = no perfusion zone Volume / target myoma volume * 100%.
The quality of MRI was enhanced with the evaluation criteria of the leiomyoma, and the image quality was scored at 1-4 points. The image quality of the myoma body was clearly visible (4 points), visible (3), blurred visible (2), and invisible (1 points).
Result
1. in the image quality score, the total score and the average score of CE-MRI were 113 and 3.8 + 0.4 higher than that of CEUS 63 and 2.1 + 0.8. The difference was significant (P0.05). The average ablation rate of myoma measured by enhanced MRI was 80.6 + 18.5%, higher than that measured by contrast ultrasound, and the average ablation rate was 72.9 + 20%, statistically significant (P=0.00).
2. before treatment, there was no significant difference between the volume of enhanced MRI myoma and the volume of contrast-enhanced ultrasound (P0.05). The NPV of the myoma after HIFU was 82.5 + 83.5cm3 on the enhanced MRI, which was significantly higher than the 66 + 66.2cm3 measured by contrast ultrasound, and statistically significant (P0.01).
3.30 myoma, enhanced MRI and ultrasound contrast image quality showed significant difference, enhanced MRI can clearly show the size of the myoma, boundary, adjacent to the surrounding tissue; ultrasound contrast on the boundary of myoma is relatively blurred, and even 5 cases can not accurately determine the boundary of myoma, so that the accurate measurement of the size of its influence, It is more impossible to judge the surrounding structure.
conclusion
1. CEUS may underestimate the degree of ablation of myoma after HIFU treatment. At the same time, it is impossible to determine whether the residual myoma tissue exists after HIFU ablation, especially for the deep posterior layer of myoma, and CEUS cannot determine the exact boundary, so that the objectivity of the treatment of HIFU for the treatment of uterine fibroids is affected.
2. enhanced MRI is better than contrast-enhanced ultrasound in showing the size of uterine myoma, edge and evaluation of the non perfusion area of HIFU for the treatment of hysteromyoma. It can more accurately and objectively show the ablation of myoma, providing a reliable basis for the treatment of uterine myoma by HIFU and the clinical treatment scheme.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33;R445.2

【相似文獻】

相關(guān)期刊論文 前10條

1 陳亦樂;唐迪紅;劉珈;劉世平;劉艷瓊;;HIFU治療婦科晚期難治性復(fù)發(fā)性盆腔惡性腫瘤的評價[J];醫(yī)學臨床研究;2006年12期

2 熊正愛,杜永洪,龔曉波,王雁琴,羅天友,丁勇利,王智彪;MRI在HIFU治療后隨訪中的作用[J];重慶醫(yī)科大學學報;2005年03期

3 吳蓉,胡兵,姜立新;HIFU治療裸鼠皮下移植瘤超聲和磁共振變化的初步觀察[J];聲學技術(shù);2004年S2期

4 田國剛;黃運佰;朱才義;陳列;梁寧;王世端;;全麻復(fù)合硬膜外阻滯麻醉對肝癌患者HIFU治療圍術(shù)期β-EP的影響[J];海南醫(yī)學院學報;2009年09期

5 孫立群;鄒建中;鄧鳳蓮;;多普勒超聲預(yù)測HIFU治療子宮肌瘤早期療效[J];中國腫瘤臨床;2009年18期

6 吳彥玲;;HIFU治療子宮肌瘤臨床療效觀察[J];河南外科學雜志;2014年03期

7 張松;王磊;吳曉東;;伽瑪?shù)堵?lián)合HIFU治療小肝癌的臨床觀察[J];醫(yī)藥論壇雜志;2014年09期

8 鞠進;鄧健;;HIFU治療腫瘤對體溫影響因素的探討[J];重慶醫(yī)學;2007年11期

9 冉立峰;唐靜;謝勛鵬;伍烽;杜永洪;;HIFU治療荷瘤鼠后鼠外周血細胞免疫功能的變化[J];臨床超聲醫(yī)學雜志;2008年06期

10 繆雪陽;袁志會;何懿;梁志剛;;胎盤植入HIFU治療的臨床護理體會[J];貴州醫(yī)藥;2012年08期

相關(guān)會議論文 前10條

1 徐亞玲;李士紅;魏民;;HIFU治療晚期胰腺癌臨床與護理研究[A];創(chuàng)建患者安全文化——中華護理學會第15屆全國手術(shù)室護理學術(shù)交流會議論文匯編（中冊）[C];2011年

2 林啟平;黃耀;張衛(wèi)星;黎克全;陳小珍;;HIFU治療腹部腫瘤中診斷超聲的應(yīng)用[A];2005年全國超聲醫(yī)學工程學術(shù)會議論文集[C];2005年

3 丁鑫;韓珍珍;菅喜岐;;經(jīng)顱腦腫瘤HIFU治療中相位及幅值補償?shù)臄?shù)值仿真研究[A];天津市生物醫(yī)學工程學會第三十四屆學術(shù)年會論文集[C];2014年

4 鄒建中;王冬;閔加艷;郭宇;杜燕;卜銳;劉芳;趙欣;銀麗;范俊;;HIFU治療腫瘤的影像監(jiān)控技術(shù)[A];中國超聲醫(yī)學工程學會第十一屆全國超聲醫(yī)學學術(shù)大會論文匯編[C];2012年

5 吳蓉;胡兵;姜立新;;HIFU治療裸鼠卵巢癌模型影像學變化的初步研究[A];中華醫(yī)學會超聲醫(yī)學新進展學術(shù)會議論文匯編[C];2004年

6 謝方林;伍烽;趙R

本文編號：2002827