| Background:Uterine leiomyoma is a benign tumor of the highest incidence in women of reproductive age, the incidence of the disease in the 20%-40%, the incidence rate of different racial differences. Hysterectomy myomectomy and hysterectomy is currently the preferred treatment, along with the transformation of medical model, the endocrine therapy, interventional therapy and physical therapy has been gradually known and accepted.In the past 10 years, high intensity focused ultrasound (HIFU) as a non-invasive physical therapy is a new treatment of uterine fibroids, its safety and effectiveness has been confirmed.HIFU as a non-invasive therapy, imaging monitoring is a necessary condition to guide the treatment. Ultrasound-Guided High Intensity Focused Ultrasound (USgHIFU) is widely used in clinical treatment of uterine fibroids. In the course of treatment of real-time image gray scale change is believed to be associated with myoma coagulation necrosis, the treatment area echo enhanced description of target tissue necrosis, but this change may be transient, and such changes are not observed in some cases and showed only slightly enhanced the overall echo myoma. Therefore, searching for a image methodology be used to evaluate the treatment response of uterine fibroids during HIFU is particularly important.Objective:1.With the pelvic magnetic resonance imaging (MRI) in the treatment of comparison, contrast enhanced ultrasound (CEUS) to evaluate the clinical value of HIFU in the treatment of uterine fibroids.2.By Color Doppler Flow Imaging (CDFI) in comparison with the MRI examination, evaluation of the follow-up cases of fibroids shrink rate, to explore the feasibility and value of CEUS in follow-up after treatment.Methods:1.110 cases from First Affiliated Hospital of Chongqing Medical University HIFU center between 2013 and 2014, were single myoma of uterus patients.92/110 patients underwent pre-treatment and post-treatment MR imaging with a standardized protocol.All patients underwent contrast-enhanced ultrasound (CEUS) examinations during pre-evaluation, and treatment. The number of myomas, position, size, volume, the volume of infusion and Non-Perfused Volume (NPV) were measured, then, according to the formula:the ablation rate=no perfused volume/target tumor volume x 100%, to calculate the ablation rate. Count data using chi square test and t test. Analysis of Spearman rank correlation.2. Follow up of 23/110 cases during the period from 2013 to 2014 in First Affiliated Hospital of Chongqing Medical University HIFU Center after HIFU treatment between 3 months-1 year, all these single myoma of uterus patients underwent CDFI and MRI examination. After the treatment of leiomyoma of the size, volume, perfusion were measured, and calculate the rate of shrink fibroids. Count data using t test, Based on P<0.05 the difference was statistically significant.Results:1.CEUS:92 cases, the tumor volume was 79.78±53.13 cm3,the average non-perfused volume was 64.22±42.67 cm3, the average fractional ablation was 81.03±12.68%. Among them,16 cases of the CEUS examination showed that the range of the myoma ablation did not reach the treatment requirements, Contrast enhanced ultrasound 8-10 minutes later, give the myoma residual perfusion area additional treatment, when the perfusion echo enhanced obviously, check the CEUS again. Calculate the non-perfused volume and the fractional ablation. The first time CEUS results:the average NPV was 36.41±18.75 cm3,the average fractional ablation was 49.90±9.86%. CEUS results after Additional treatment:the average NPV was 67.24±32.04 cm3,the average fractional ablation was 91.37±5.27%. Results are shown the twice CEUS have significant difference.2. pelvic enhanced MRI:92 cases, the average tumor volume was 82.75±56.17 cm3,the non-perfused volume was 67.13±48.29 cm3, the average fractional ablation was 80.75±14.28%.3. Comparison of CEUS and MRI results:the two groups have significant correlation, there was no significant difference in the largest diameter of Uterine fibroids, fibroid volume, the largest diameter of no perfusion area, non-perfused volume and fractional ablation.4. The comparison follow-up results of CDFI and MRI, CDFI:The average volume of the leiomyoma was 92.73±82.16cm3,The average tumor shrinkage rate was 53.18±19.42%. MRI results:The average volume of the leiomyoma was 103.71±96.02cm3,The average tumor shrinkage rate was 53.04±18.65%. Results:there were significant differences in tumor volume, but tumor shrinkage rate had no significant difference.Conclusions:1. CEUS can accurately show clearly the size of the myoma and non perfusion area (Part has been melting), the results of CEUS and MRI examination showed no statistically significant difference. CEUS can clearly show the myoma residual perfusion area, found that ablation is not complete, should give supplementary treatment timely.2. Follow up:CDFI and MRI examination showed that there were significant differences in tumor volume, MRI is better than CDFI. |
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