CAJ | 학술논문

目的：通过研究消融前M RI T2 WI信号强度特点与高强度聚焦超声消融术（high intensity focused ultrasound ablation ，HIFU ）治疗子宫肌瘤消融疗效之间的关系，从信号方面探讨影响 HIFU 治疗子宫肌瘤疗效的因素。方法选择2011年10月～2013年7月经MRI诊断的子宫肌瘤患者50例，行超声引导下的 HIFU 治疗，共有子宫肌瘤56个，消融前根据M RI T2 WI信号强度将其分为四种类型：①高信号；②等信号；③低信号；④混杂信号，消融后次日及术后6个月行增强M RI扫描评估肌瘤体积的消融范围，计算消融率及术后6个月肌瘤体积的缩小率，分别作为早期和中期 HIFU疗效的指标，同时记录术中与消融有关的不良反应。结果所有患者顺利完成治疗，未出现显著并发症。消融前肌瘤的体积0.43～502．12cm3，平均（125．13±111．40）cm3，消融后次日增强M RI中无增强剂灌注区域体积0．38～316．63cm3，平均（87．09±78．05）cm3，消融率25．16％～97．92％，平均（70．61±15．62）％，且MRI T2WI不同信号强度之间疗效差异有统计学意义（P ＜0．05），低信号强度的肌瘤消融率最高，6个月后此类肌瘤体积进一步缩小，且此缩小率与术后次日消融率呈正相关（ r ＝0．67，P ＜0．05）。结论 M RI T2 WI低信号子宫肌瘤更易达到理想的消融疗效，且术后肌瘤体积缩小程度较大，可为选择患者提供依据。
목적：통과연구소융전M RI T2 WI신호강도특점여고강도취초초성소융술（high intensity focused ultrasound ablation ，HIFU ）치료자궁기류소융료효지간적관계，종신호방면탐토영향 HIFU 치료자궁기류료효적인소。방법선택2011년10월～2013년7월경MRI진단적자궁기류환자50례，행초성인도하적 HIFU 치료，공유자궁기류56개，소융전근거M RI T2 WI신호강도장기분위사충류형：①고신호；②등신호；③저신호；④혼잡신호，소융후차일급술후6개월행증강M RI소묘평고기류체적적소융범위，계산소융솔급술후6개월기류체적적축소솔，분별작위조기화중기 HIFU료효적지표，동시기록술중여소융유관적불량반응。결과소유환자순리완성치료，미출현현저병발증。소융전기류적체적0.43～502．12cm3，평균（125．13±111．40）cm3，소융후차일증강M RI중무증강제관주구역체적0．38～316．63cm3，평균（87．09±78．05）cm3，소융솔25．16％～97．92％，평균（70．61±15．62）％，차MRI T2WI불동신호강도지간료효차이유통계학의의（P ＜0．05），저신호강도적기류소융솔최고，6개월후차류기류체적진일보축소，차차축소솔여술후차일소융솔정정상관（ r ＝0．67，P ＜0．05）。결론 M RI T2 WI저신호자궁기류경역체도이상적소융료효，차술후기류체적축소정도교대，가위선택환자제공의거。
Objective To investigate the relationship between the signal intensity of T 2-weighted magnetic resonance im-ages and the therapeutic effect of US-guided high-intensity focused ultrasound (HIFU ) ablation in the treatment of uterine fibroids .Methods Fifty patients with 56 uterine fibrcids were enrolled in the study from October 2011 to July 2013 .They underwent US-guided HIFU ablation ,which were classified into 4 types based on the signal intensity of T2-weighted mag-netic resonance images type 1 ,high intensity ;type 2 ,intermediate intensity ;type 3 ,low intensity ;type 4 ,mixed intensi-ty .The next day and 6 months after ablation ,the volume of the nonperfused fibroids and the volume reduction ratio were observed on contrast-enhanced MR .They were used as the indices of therapeutic effect .We noted the relevant adverse e-vents .Results All the patients were completed the treatment successfully .No major complications occurred .The pre-treatment fibroid volume ranged from 0 .43 to 502 .12 cm3 ,the mean (125 .13 ± 111 .40) cm3 ,the non-enhancer region vol-ume was 0 .38~316 .63 cm3 ,the mean (87 .09 ± 78 .05) cm3 measured in the enhanced MRI after the treatment .Myoma volume ablation rate was 25 .16% ~97 .92% ,mean ablation ratio (70 .61 ± 15 .62)% .The treated area ratio of type 3 fi-broids was highest among the 4 types ( P < 0 .05) .During six-month follow-up ,the valume of this type fibroids were shrunk further .The volume reduction ratio was correlated with the treated area ratio ( r=0 .67 ,P<0 .05) .Conclusion The efficacy of US-guided HIFU correlates with the signal intensity of T 2-weighted magnetic resonance images .Low sig-nal fibroids are suitable candidates for MRgFUS ,which can provide evidenle for choosing pations .