| Purpose:To investigate the value of three-dimensional power Doppler ultrasound(3D-PDU)in the evaluation of cervical cancer radiotherapeutic effect.Through the early evaluation of the curative effect in patients with cervical cancer,individualized treatment scheme was provided.Method:Forty-eight cases of cervical cancer were selected for the study,28 cases of them were preoperative neoadjuvant radiotherapy,which were treated by radiotherapy in the People's Hospital of Pingyi County from October 2017 to May 2018.The patients enrolled in this study included 45 cases of squamous cell carcinoma and 3 cases of adenocarcinoma.Clinical stage of them includes 18 cases of ?B stage,3 cases of ?A stage,17 cases of ?B stage,7 cases of ? stage,3 cases of ? stage.The patients was 28~68years old with an average age of(47.2±4.8).The changes of various parameters in 48 patients before,during and after radiotherapy were observed.All 48 patients were used three-dimensional optimal lion orintensity-modulated.The routine radiotherapy dose was 40 Gy,2Gy at a time,5 times every week.The examination was performed 3 times which before,during and after radiotherapy,and the examinational time point of during radiotherapy was selected when patients accepted 20 Gy radiotherapy,and the examinational time point of after radiotherapy was completed within 5 days.GE E8 three-dimensional ultrasonic diagnostic instrument was used,with the transvaginal ultrasonic probe and the frequency of 4.0 ~ 8.0 MHz.This instrument has 3D-PDU function.All patients were examined by transvaginal scanning,and told to empty their bladder before examination.Sterile condoms were put on the probe after being besmeared the coupling agent.Routine scan of the uterus and its appendages,for those with obvious inside cervical mass,the inside cervical mass was the region of interest;for those with exophytic mass of cervical,the probe will move outwards,exophytic mass of cervical was the region of interest.The lesions of 48 patients with cervical cancer were scanned by 3d-pdu before,during and after radiotherapy to get the blood flow grading,resistance index(RI)and vascularization index(VI),and evaluate the efficacy of cervical cancer radiotherapy through the changes.RI was directly measured by 3d ultrasonic diagnostic instrument.According to the cervical vascular power patterns of blood vessel distribution,walking and branching,the vessels of tumor were divided into 4 levels.0 level: no vessels andno blood flow signal was observed within and around the cervix;? level: peripheral vessels – some dotted or short strip blood vessels were visible around the cervix;? level:peripheral and central vessels – in addition to peripheral vessels,sparse blood vessels were found inside the cervix,with simple branches and relatively straight lines;? level:central vessels – rich vascular tree or network could be seen inside the cervix,with twisted and irregular branching vessels.VI was calculated by the number of tumor blood vessels and lesion volume.Using the following criteria count the total number of vessels in the lesions.If one blood vessel had no branch,it would be counted as one vessel;if one blood vessel had multiple branches,the total number of vessels in the lesion would be calculated by counting the number of peripheral branches.The volume of lesion was measured by using the GI3 DQ tool of Qlab software.The ratio was the number of vessels per unit volume of cervical cancer,as the vascular index reflecting the richness of tumor blood supply.Each time,the most abundant three blood flow images were counted by three experienced ultrasound physicians – that is,the number of vessels in each lesion had nine values,and the average value was taken as the number of vessels.Results:During and after radiotherapy,the blood vessel distribution of cervical cancer decreased to different degrees compared with that before radiotherapy.3D-PDU showed the blood vessels in the cervical lesions before radiotherapy were rich and disordered,such as a rich vascular tree or network,and branch blood vessels were disordered and irregular,? grade was the main one,and the rate of display was 83.33%(40/48).Blood flow is relatively sparse before radiotherapy,radiotherapy in cervical lesions displayed in? level is given priority to,blood flow rate was 77.08%(37/48).The blood vessels in the cervical lesions after radiotherapy were not rich,without branch or with a dot,which ?grade was the main one and the rate of display was 85.42%(41/48),the rate of display in? grade was 4.16%.The difference of blood flow grading between before radiotherapyand during radiotherapy was highly statistically significant(P<0.001),that between after radiotherapy and before radiotherapy was highly statistically significant(P<0.001),and that between after radiotherapy and during radiotherapy was also highly statistically significant(P<0.001).After radiotherapy,the lesion of cervical cancer in all 48 patients decreased and RI increased.The RI in the cervix was higher after radiotherapy than before and during radiotherapy,with statistical significance(P < 0.05);however there was no statistically significant difference between during radiotherapy and before radiotherapy(P > 0.05).After radiotherapy,cervical lesion VI was significantly lower than that before and during radiotherapy.There was a statistically significant difference in VI between post-radiotherapy and pre-radiotherapy(P<0.05).There was also a statistically significant difference in VI between radiotherapy and pre-radiotherapy(P<0.05).Conclusion:3D-PDU not only can objectively evaluate the size of the cervix and the blood supply between before radiotherapy and after radiotherapy for cervical cancer,but also can objectively reflect the blood flow in the lesions of cervical cancer.Blood flow grade,resistance index and vascularization index can be used as reliable indexes to evaluate the curative effect of radiotherapy for cervical cancer,which were important for the diagnosis and treatment of cervical cancer. |
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