Value Of Contrast-enhanced Ultrasonography In Treatment And Follow-up Of Uterine Fibroids With High Intensity Focused Ultrasound

Objective:1. To explore the value of contrast-enhanced ultrasonography in treatment of uterine fibroids with high-intensity focused ultrasound.2. To study the value of contrast-enhanced ultrasonography in follow-up of uterine fibroids with high-intensity focused ultrasound. Materials and methods:1. Selected from patients with single uterine fibroid in June 2015 to January 2016 in Affiliated Hospital of North Sichuan Medical College. A total of 64 cases and 64 uterine fibroids with high-intensity focused ultrasound(HIFU) treatment voluntarily. All patients underwent contrast-enhanced ultrasonography(CEUS) examination immediately before treatment and after treatment, and underwent MR imaging in 24 hours before treatment and after treatment. Observed CEUS imaging changes of uterine fibroids before treatment and after treatment, analyzed the correlation among enhancement degree, enhancement form and perfusion defect of CEUS before treatment with immediate HIFU non-perfused volume rates(NPVR). At the same time, analyzed the difference of the Time-intensity curve parameters(Time to Peak, TP and Peak Intensity, PI) before treatment and after treatment, compared the results of CEUS with MRI after HIFU treatment.2. Selected from patients with single uterine fibroid in July 2015 to January 2016 in Affiliated Hospital of North Sichuan Medical College. A total of 25 cases and 25 uterine fibroids with high-intensity focused ultrasound(HIFU) treatment voluntarily, all patients were followed up at 1month and 3months continuously after treatment. Observed CEUS imaging changes of uterine fibroids at immediate, 1month and 3months after treatment, comparatively studied TIC parameters, uterine fibroids volume, no perfusion area volume, residual tumor volume at immediate, 1month and 3months after treatment. Then analyzed the relationship between the uterine fibroids changes with the volume of no perfusion area and residual tumor tissue. Results:1. 64 patients with 64 uterine fibroids finished HIFU treatment successfully. Various CEUS features were seen in all uterine fibroids before treatment, no ultrasound contrast agents perfused into necrotic area of uterine fibroids, as no perfusion area after treatment. While the residual tumor tissue was CEUS hyperenhancement or isoenhancement.(1)HIFU immediate NPVR of CEUS hyperenhancement uterine firoids was the lowest, compared wtih hypoenhancement and isoenhancement,the difference was statistically significant(P<0.05).(2)HIFU immediate NPVR of CEUS homogeneous enhancement was higher than heterogeneous enhancement, HIFU immediate NPVR of CEUS perfusion defect was higher than no perfusion defect, no significant difference of immediate NPVR in CEUS enhanfcement form and perfusion defect(P>0.05).(3)After HIFU treatment, Time Intensity Curve of TP was longer, and IP was descended, the difference of TP and IP before and after HIFU was statistically significant(P<0.05).(4)No significant difference in fibroid size and volume, no perfusion area size and volume, residual tumor volume(P>0.05) by CEUS and MRI, these results between CEUS and MRI were correlated well(P<0.05).2. 25 patients with 25 uterine fibroids were performed CEUS examination successfully. The no perfusion area was seen in all fibroids at immediate, 1 month and 3 months after treatment, the residual tumor tissue was hypoenhancement or isoenhancement.(1)Compared to immediate after HIFU treatment, no amplitude of time intensity curve, it was a low line. TP was extended and IP was descended sequentially, the difference of TIC at immediate, 1 month and 3 months was statistically significant(P<0.05).(2)Compared to immediate after HIFU treatment, the fibroid and no perfusion area volume at 1 month and 3 months respectively decreased significantly(P<0.05). The reduction degree and rates of fibroid volume was positively correlated with the no perfusion area volume and absorption rates(P<0.05). The residual tumor tissue volume didn,t reduced at 1 month, no difference between immediate and 1 month(P>0.05), but it reduced at 3 month, the difference between immediate and 3 months after was statistically significant(P<0.05). But there was no correlation between reduction degree and rates of fibroid volume with reduction degree and rates of residual tumor(P>0.05).(3)The difference of complete and partial efficient about fibroid between 1 month and 3 months was statistically significant(P<0.05). The difference of UFS-OQL before and 3 months after HIFU treatment was statistically significant(P<0.05). Conclusions:1.(1)The CEUS features of uterine fibroid can predict HIFU immediate efficacy, and CEUS hyperenhancement uterine fibroid with HIFU efficacy is the lowest. CEUS enhancement degree can provide some basis for HIFU treatment strategic formulation and adjustment. Maybe HIFU immediate efficacy do not correlate with CEUS enhancement form and perfusion defect.(2)As providing real-time dynamic evaluation for necrotic area and blood perfusion of uterine fibroids, CEUS can be an evaluation method for HIFU immediate efficacy.2.(1)CEUS valuated the blood perfusion and volume of uterine fibroids timely, accurately in follow-up after HIFU treatment. CEUS can be a followup means for HIFU efficacy.(2)After HIFU treatment, the fibroid volume shrinkage mostly depend on no perfusion area volume and its absorption, no relationship with the residual tumor volume and reduction.