【摘要】：目的： 子宮肌瘤的MRI信號差異對其HIFU消融效果影響較大，本研究根據(jù)MRI T2WI信號及增強類型將肌瘤分為不同的組別，通過比較其消融率及單位體積所需輻照時間及能量的差異，探討導致消融療效及消融效率產(chǎn)生差異的可能性因素，同時為高強度聚焦超聲(HIFU)消融治療子宮肌瘤的消融率及消融效率進行預判，為臨床適應癥的選擇提供理論基礎(chǔ)。 方法： 選擇經(jīng)MRI確診的癥狀性子宮肌瘤病例72例（72個肌瘤），并將其依據(jù)不同標準進行分組研究。依據(jù)T2WI信號強度差別分為低信號及等高信號肌瘤，病例數(shù)分別為41例及31例；依據(jù)T2WI信號均一性差別分為均勻信號及非均勻信號肌瘤，病例數(shù)分別為38例及34例；依據(jù)增強MRI T1WI強化程度分為輕度強化及明顯強化肌瘤，病例數(shù)分別為38例及34例。然后對其分別進行HIFU消融治療，治療后次日行增強MRI評估肌瘤體積的消融范圍，比較不同組別間消融率、單位體積輻照劑量及輻照時間的差異。 結(jié)果： 72例患者共72個子宮肌瘤接受了HIFU消融，T2低信號者消融率(88.85±9.32)％，T2等高信號者消融率(79.67±10.38)％，兩者比較有統(tǒng)計學差異。T2均勻信號者消融率(83±10.98)％，T2非均勻信號者消融率(81±12.81)％，兩者比較無統(tǒng)計學差異。T1輕度強化者消融率(86.40±8.94)％，T1明顯強化者消融率(75.44±12.57)％，兩者比較有統(tǒng)計學差異。同時，T1輕度強化者單位體積輻照劑量為(3.42±2.29)J/mm3，T1明顯強化者單位體積輻照劑量為(6.85±5.14)J/mm3，兩者比較有統(tǒng)計學差異。T1輕度強化者單位體積輻照時間為(8.33±5.73)S/cm3，，T1明顯強化者單位體積輻照時間為(16.74±12.83)S/cm3，兩者比較有統(tǒng)計學差異。 結(jié)論： T2WI低信號及T1WI輕度強化者易達到較高的消融率，是易于消融的標志；同時T1WI輕度強化者較強化明顯者單位體積所需的能量、時間均更少，消融效率更高；再者MRI-T2WI聯(lián)合動態(tài)增強MRI可用于預測HIFU消融子宮肌瘤的消融率及消融效率，指導臨床方案的制定，值得進一步研究。
[Abstract]:Objective: the difference of MRI signal of uterine myoma has a great influence on the effect of HIFU ablation. According to the MRI T2WI signal and enhancement type, the myoma is divided into different groups. By comparing the ablation rate and the difference of irradiation time and energy per unit volume, the possible factors leading to the difference of ablation effect and ablation efficiency are discussed. At the same time, it can predict the ablation rate and ablation efficiency of high intensity focused ultrasound (HIFU) ablation in the treatment of uterine myoma, and provide a theoretical basis for the selection of clinical indications. Methods: 72 cases (72 myoma) of symptomatic uterine myoma diagnosed by MRI were selected and divided into two groups according to different criteria. According to the difference of T2WI signal intensity, the cases were divided into low signal myoma (41 cases) and iso-hyperintensity myoma (31 cases), uniform signal myoma (38 cases) and non-uniform signal myoma (34 cases) according to the uniformity of T2WI signal intensity. According to the enhancement degree of MRI T1WI, the cases were divided into mild enhancement and obvious enhancement, and the number of cases was 38 and 34, respectively. Then HIFU ablation was performed. The ablation range of myoma volume was evaluated by enhanced MRI the next day after treatment, and the ablation rate, irradiation dose per unit volume and irradiation time were compared among different groups. Results: 72 cases of uterine myoma underwent HIFU ablation. The ablation rate of T2 patients with low signal intensity was (88.85 鹵9.32)%, and that of T2 patients with high signal intensity was (79.67 鹵10.38)%. There was significant difference between the two groups. The ablation rate of T2 homogeneous signal group was (83 鹵10.98)%, and that of T2 non-uniform signal group was (81 鹵12.81)%. There was no significant difference between the two groups. The ablation rate of T2 patients with mild enhancement was (86.40 鹵8.94)%. The ablation rate of T1 patients with obvious enhancement was (75.44 鹵12.57)%, and there was significant difference between the two groups. At the same time, the unit volume irradiation dose per volume of T1 mild enhancement was (3.42 鹵2.29) J 鈮

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