本文選題：高強度聚焦超聲 + T2WI信號強度值��； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：子宮肌瘤是婦科常見的良性腫瘤，尤其在中年女性內(nèi)有較高的發(fā)病率。除藥物、傳統(tǒng)手術(shù)、子宮動脈介入栓塞術(shù)外，目前高強度聚焦超聲（High Intensity Focused Ultrasound，HIFU）消融技術(shù)也在臨床廣泛應(yīng)用。其利用超聲波在人體組織內(nèi)良好的穿透性，從體外投射高能量超聲波聚焦于體內(nèi)的肌瘤病灶，使靶區(qū)組織溫度升高并達(dá)到發(fā)生凝固性壞死的溫度（≥60℃），實現(xiàn)體表無創(chuàng)傷、非侵入式的治療。由于其生物學(xué)焦域面積小，在影像監(jiān)控系統(tǒng)下能夠依據(jù)病灶的范圍，精確完整的消融病灶，且不會對周圍正常組織細(xì)胞產(chǎn)生不可逆的損傷。除了應(yīng)用最廣泛的子宮肌瘤治療，超聲消融也被應(yīng)用于骨肉瘤、肝癌、胰腺癌、前列腺癌等惡性腫瘤的治療。目前研究發(fā)現(xiàn)，超聲消融子宮肌瘤的療效與肌瘤自身性質(zhì)及治療中參數(shù)有關(guān)。由于治療中參數(shù)亦會受到肌瘤自身性質(zhì)的影響，故肌瘤自身性質(zhì)，如體積、位置、T2WI信號強度值等，都與超聲消融子宮肌瘤療效有著密切的關(guān)系，通過治療前核磁共振成像（MRI）檢查可以了解這些自身性質(zhì)。而根據(jù)研究，MRI-T2WI信號強度值能夠反映了肌瘤的組織學(xué)特性，提示肌瘤內(nèi)成分如平滑肌細(xì)胞數(shù)量、結(jié)締組織含量及血供情況的差異，而由于各種成分對于超聲能量的穿透、吸收均不相同，因此，T2WI信號強度值與超聲能量肌瘤內(nèi)沉積關(guān)系密切。此外，目前臨床上有磁共振引導(dǎo)下HIFU消融治療（MRI guided HIFU，MRgHIFU）及超聲引導(dǎo)下HIFU消融治療（Ultrasound guided HIFU，USgHIFU）兩種模式，兩者區(qū)別主要在于影像學(xué)監(jiān)控方式不同。 目的 研究通過MRgHIFU與USgHIFU消融子宮肌瘤的兩組病例，采集治療前肌瘤的MRI-T2WI信號強度值與消融治療的超聲能量，了解肌瘤組織T2WI信號強度值與消融所需超聲能量的聯(lián)系，并簡要分析兩組方式消融具有相同T2WI信號強度值的子宮肌瘤出現(xiàn)超聲能量差異的原因。 方法 1研究對象：2009年7月至2013年12月期間在上海市徐匯區(qū)中心醫(yī)院完成HIFU治療的納入病例共56例,其中MRgHIFU治療26例共30個肌瘤，USgHIFU治療30例共37個肌瘤。 2治療設(shè)備：磁共振引導(dǎo)下高強度聚焦超聲系統(tǒng)：由1.5T磁共振（Avanto；西門子醫(yī)療）引導(dǎo)高強度聚焦超聲腫瘤治療系統(tǒng)（JM2.5；重慶海扶醫(yī)療科技股份有限公司）結(jié)合而成。超聲引導(dǎo)下高強度聚焦超聲系統(tǒng)：JC200型聚焦超聲腫瘤治療系（重慶海扶醫(yī)療科技股份有限公司）。 3治療方法： 3.1MRgHIFU治療中通過監(jiān)測靶區(qū)及周圍的溫度變化。治療方式為超聲點輻照，通過逐步增加超聲釋放能量使組織內(nèi)靶區(qū)溫度升高到60℃及以上即表示實現(xiàn)消融，在超聲輻照按計劃完全覆蓋離肌瘤的全部體積后停止治療。 3.2USgHIFU治療從肌瘤的最大層面開始，選擇靶點置于肌瘤的深面后層離肌瘤后緣10mm處，然后沿肌瘤的后緣間隔5-8mm左右布置焦點進行后層的點輻照，使輻照區(qū)覆蓋肌瘤的深面后層，以其形成相應(yīng)的超聲錐形聲場覆蓋整個肌瘤即可。 4治療結(jié)果分析比較指標(biāo) 4.1肌瘤體積消融率：通過公式： 體積消融率=無灌注區(qū)體積（Non-Perfused Volume，NPV）/靶肌瘤體積×100% 4.2治療時間和輻照時間：治療時間是指第一次超聲輻照開始至最末一次超聲輻照之間的時間；輻照時間指超聲治療頭投射能量的工作時間。 4.3超聲能量和單位體積超聲能量： 超聲能量（KJ）是指治療過程中投射的超聲總能量；單位體積超聲能量（J/mm3），即能效因子，，是指每單位體積內(nèi)投射的超聲總能量，根據(jù)公式： 單位體積超聲能量=超聲能量/無灌注區(qū)體積。 結(jié)果 1.肌瘤自身性質(zhì)：MRgHIFU組和USgHIFU組的平均體積分別為121.8±74.8cm3和114.7±53.9cm3（P0.05）；肌瘤的T2信號強度值為121.7±38.2和135.7±44.7（P0.05），均無差異性。 2.兩組病例治療參數(shù)：MRgHIFU組和USgHIFU組的平均肌瘤的消融體積分別為109.4±66.9cm3和101.5±50.0cm3，消融率分別為89.4±10.2%和93.9±8.7%，單位體積超聲能量分別為4.71±3.4J/mm3和5.49±2.4J/mm3，超聲輻照時間分別為1217±397s和1309±505s，治療時間分別為132.5±37.4min和116.0±36.6min，以上數(shù)據(jù)兩組間比較差異無統(tǒng)計學(xué)意義(P0.05)。MRgHIFU組和USgHIFU組平均超聲能量釋放功率分別為302.0±53.2W和377.8±32.2W，超聲能量分別為374.9±173.7kJ和484.6±190.6kJ，以上數(shù)據(jù)兩組間比較差異均有統(tǒng)計學(xué)意義。 3. MRgHIFU與USgHIFU兩組病例的T2WI信號強度值與單位體積超聲能量（能效因子）均有線性正相關(guān)關(guān)系(r＞0, P0.05)。 結(jié)論 1.在兩種不同引導(dǎo)方式下的HIFU治療中，隨肌瘤T2WI信號強度值增高，其消融單位體積超聲能量增加，即消融肌瘤所需的超聲能量增加。 2.由于影像監(jiān)控設(shè)備及靶點分布傳遞能量方式的差異，最終導(dǎo)致了在消融相同T2WI信號強度值的肌瘤時，USgHIFU組所需的超聲能量高于MRgHIFU組，但USgHIFU組對肌瘤組織的消融率更高，殘余病灶組織更少。
[Abstract]:Uterine myoma is a common benign tumor in gynecology, especially in middle-aged women. Besides drugs, traditional surgery, interventional embolization of uterine artery, high intensity focused ultrasound (High Intensity Focused Ultrasound, HIFU) ablation technique is also widely used in clinical practice. Sex, projecting high energy ultrasound from the body in the body to focus on the body tumor lesion in the body to increase the temperature of the target tissue and reach the temperature of the coagulation necrosis (> 60 degrees C), to achieve the non invasive and noninvasive treatment of the body surface. Because of its small area of biological focal area, the accurate and complete ablation disease can be obtained under the range of the focus of the lesion. In addition to the most extensive use of uterine fibroids, ultrasound ablation is also used in the treatment of osteosarcoma, liver cancer, pancreatic cancer, and prostate cancer. The current study shows that the efficacy of ultrasound ablation of uterine myoma is related to the properties of the myoma and the parameters of the treatment. As the parameters of the treatment are also affected by the properties of the myoma, the properties of the myoma, such as volume, position and T2WI signal intensity, are closely related to the efficacy of ultrasonic ablation of uterine myoma. These properties can be understood by MRI examination before treatment. According to the study, the intensity of MRI-T2WI signals can be obtained. It reflects the histological characteristics of the myoma, indicating the differences in the number of smooth muscle cells, the content of connective tissue and the condition of blood supply in the myoma, and the absorption of the T2WI signal intensity is closely related to the internal deposition of the ultrasonic energy myoma. The two modes of HIFU ablation therapy (MRI guided HIFU, MRgHIFU) and HIFU ablation therapy (Ultrasound guided HIFU, USgHIFU) are guided. The difference is mainly due to the different methods of imaging monitoring.
objective
Two cases of uterine myoma were ablated by MRgHIFU and USgHIFU. The MRI-T2WI signal intensity value of the preoperative myoma and the ultrasonic energy of the ablation treatment were collected. The relationship between the T2WI signal intensity of the myoma tissue and the ultrasonic energy needed for the ablation was investigated, and the two groups of uterine myoma with the same T2WI signal intensity were briefly analyzed. The reasons for the difference of ultrasonic energy.
Method
1 subjects: 56 cases of HIFU treatment were completed in Central Hospital of Shanghai Xuhui District from July 2009 to December 2013, of which 26 cases with 30 myoma were treated with MRgHIFU, and 30 cases with 37 myomas were treated by USgHIFU.
2 treatment equipment: high intensity focused ultrasound system guided by magnetic resonance (MRI): 1.5T magnetic resonance (Avanto; SIEMENS) guided high intensity focused ultrasound tumor therapy system (JM2.5; Chongqing Haifu medical Polytron Technologies Inc) combined. Ultrasound guided high intensity focused ultrasound system: JC200 focused ultrasound tumor treatment system ( Chongqing Haifu medical Polytron Technologies Inc).
3 treatment methods:
In the treatment of 3.1MRgHIFU, the temperature changes in the target area and around the target area are monitored. The treatment method is irradiated by the ultrasonic point. The target area temperature in the tissue is increased to 60 degrees and above by gradually increasing the ultrasound release energy. The treatment is stopped after the complete coverage of the total volume of the leiomyoma according to the plan.
3.2USgHIFU therapy starts from the maximum level of myoma, and chooses the target to place the deep posterior layer of the myoma from the posterior edge of the myoma at the back edge of the leiomyoma, and then arrange the focus for the posterior layer of the posterior layer along the posterior margin of the myoma at about 5-8mm, so that the irradiated area covers the deep posterior layer of the myoma and forms the corresponding ultrasonic conical field to cover the whole myoma.
4 Analysis and comparison index of the results of treatment
4.1 volume ablation rate of myoma: through the formula:
Volume ablation rate = non perfusion volume (Non-Perfused Volume, NPV) / target volume volume * 100%
4.2 treatment time and irradiation time: the time of treatment refers to the time between the first ultrasound irradiation and the last ultrasound irradiation; the time of irradiation refers to the working time of the projection of the energy of the head by ultrasonic treatment.
4.3 ultrasonic energy and unit volume ultrasonic energy:
The ultrasonic energy (KJ) refers to the total ultrasound energy projected during the treatment; the unit volume ultrasonic energy (J/mm3), that is, the energy efficiency factor, refers to the total ultrasonic energy projected within each unit volume, according to the formula:
Ultrasonic energy per unit volume = ultrasonic energy / no perfusion volume.
Result
1. the average volume of myoma in group MRgHIFU and USgHIFU group was 121.8 + 74.8cm3 and 114.7 + 53.9cm3 (P0.05), and the T2 signal intensity of myoma was 121.7 + 38.2 and 135.7 + 44.7 (P0.05), no difference was found.
2. two groups of treatment parameters: the ablation volume of average myoma in group MRgHIFU and group USgHIFU was 109.4 + 66.9cm3 and 101.5 + 50.0cm3 respectively. The ablation rate was 89.4 + 10.2% and 93.9 + 8.7% respectively. The ultrasonic energy per unit volume was 4.71 + 3.4J/mm3 and 5.49 + 2.4J/mm3 respectively. The ultrasonic irradiation time was 1217 + 397s and 1309 + 505s, respectively. The differences were 132.5 + 37.4min and 116 + 36.6min. There was no significant difference between the two groups (P0.05). The average ultrasonic energy release power of the.MRgHIFU group and the USgHIFU group was 302 + 53.2W and 377.8 + 32.2W respectively. The ultrasonic energy was 374.9 + 173.7kJ and 484.6 + 190.6kJ respectively. The difference of the upper data two groups was statistically significant.
3. there was a positive linear correlation between the T2WI signal intensity of the two groups of MRgHIFU and USgHIFU and the ultrasonic energy (energy efficiency factor) of the unit volume (r > 0, P0.05).
conclusion
1. in the HIFU treatment under two different guiding methods, the ultrasonic energy of the ablation unit volume increased with the increase of the T2WI signal intensity of the myoma, that is, the increased ultrasonic energy needed for the ablation of the myoma.
2. because of the difference between the image monitoring equipment and the distribution of energy in the target distribution, the ultrasonic energy needed in group USgHIFU was higher than that of group MRgHIFU when the muscle tumor of the same T2WI signal intensity was ablated, but the ablation rate of the myoma tissue was higher in the USgHIFU group and the remnants of the lesion were less.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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