Evaluation Of The Efficacy Of High Intensity Focused Ultrasound (HIFU) In The Treatment Of Uterine Leiomyoma And Adenomyosis By MRI

The research content of this topic is divided into three parts.The first part is to evaluate the effectiveness of HIFU in the treatment of uterine leiomyoma and adenomyosis with volume ablation rate as a starting point,and to establish a model for predicting volume ablation rate by using the best scale regression equation.in the second part,according to the prediction model established in the first part,the correlation between the predicted volume ablation rate and the actual volume ablation rate is prospectively analyzed,and the effectiveness of the model is tested in order to predict the possible ablation rate at the end of surgery and evaluate the ablation effectiveness earlier.In the third part,by comparing the enhanced MRI scans before and after treatment,we analyze the various related factors that cause complications,so as to better guide clinicians to reduce or eliminate the occurrence of complications.Part One Efficacy evaluation and model establishment of high intensity focused ultrasound in the treatment of uterine fibroids and adenomyosisObjective:The effectiveness of HIFU in the treatment of uterine leiomyoma and adenomyosis was evaluated by enhanced MRI before and after treatment,and a model for predicting volume ablation rate was established.Method:The patients with uterine leiomyoma and adenomyosis from September 2017 to August 2018 were retrospectively collected.They were treated with HIFU and pelvic MRI was performed before and 7 days after operation.By measuring and calculating the volume of lesions before treatment and the volume of non-perfusion area after treatment,the volume ablation rate was calculated to evaluate the effectiveness of treatment.Volume ablation rate was used as dependent variable.Age,uterine location,lesion location,lesion signal intensity,lesion type of T1 WI enhancement,lesion volume,abdominal wall thickness,lesion anterior wall distance from abdominal wall,lesion posterior wall distance from abdominal wall,lesion center distance from abdominal wall,lesion anterior wall distance from sacrum,lesion posterior wall distance from sacrum,lesion center distance from sacrum,treatment time,the energy and energy efficiency ratio were taken as dependent variables.Meaningful variables were selected by single factor correlation analysis.Meaningful variables are included in the optimal scale regression model,and the optimal scale regression equation is obtained.Result:96 cases were enrolled in this study.The average volume ablation rate was 62.48%�15.98%.75 cases were in the effective group with the ablation rate of more than 50%.21 cases were in the ineffective group with the ablation rate of less than 50%.The effective rate was 78.13%.The therapeutic effect was acceptable.Variables closely related to volume ablation rate were screened out?all P < 0.05?,that is,signal intensity of lesion T2 WI,type of lesion T1 WI enhancement,thickness of abdominal wall,distance between lesion center and abdominal wall,treatment time and energy efficiency ratio.Quantitative tables and maps of volume ablation rate and above-mentioned independent variables were obtained based on the optimal scale regression equation,and the best scale regression was established to predict the quantitative value of volume ablation rate.The regression equation y=0.294X₄+0.173X₅-0.181X₇-0.197X₁₀+0.339X₁₄+0.176X₁₆.Conclusion:Variables closely related to volume ablation rate:T2WI signal intensity,T1 WI enhancement type,abdominal wall thickness,distance between lesion center and abdominal wall,treatment time,energy efficiency ratio.Quantitative tables and maps of the above variables are obtained,and the optimal scale regression equation is established,which can predict the volume ablation rate of patients at the end of surgery,guide clinical further optimization of diagnosis and treatment programs,and improve the effectiveness of HIFU treatment.Part Two To test the effectiveness of volume ablation rate prediction model for high intensity focused ultrasound in the treatment of uterine leiomyoma and adenomyosisObjective:The correlation between predicted volume ablation rate quantification and actual volume ablation rate quantification was prospectively analyzed,and the effectiveness of the best scale regression equation obtained in the first part was tested.Method:Prospective follow-up of patients with uterine leiomyoma and adenomyosis from September 2018 to December 2018,who were treated with HIFU and underwent pelvic MRI enhancement within 7 days before operation.At the end of operation,the volume ablation rate was predicted by the best scale regression equation,and the actual volume ablation rate was calculated by pelvic contrast-enhanced MRI scan within 7 days after operation.The quantitative value of the actual volume ablation rate was obtained according to the quantification table.The correlation between the predicted volume ablation rate and the actual volume ablation rate was tested by bivariate correlation test.Result:The correlation coefficient between predicted volume ablation rate and actual volume ablation rate was 0.672 and P < 0.05 in 29 patients.It shows that the best scale regression equation y=0.294X₄+0.173X₅-0.181X₇-0.197X₁₀+0.339X₁₄+0.176X₁₆ obtained in the first part can predict volume ablation rate and has a good prediction effect.Conclusion:The best scale regression equation for predicting volume ablation rate of uterine leiomyoma and adenomyosis by ultrasound ablation established in the first part of the project has good predictive effect.It can be popularized and applied in clinic.It can better optimize the diagnosis and treatment of HIFU,improve the curative effect of patients after HIFU treatment and improve the prognosis of patients.Part Three Evaluation of complications of high intensity focused ultrasound in the treatment of uterine leiomyoma and adenomyosis by MRIObjective:Various related factors causing complications were analyzed by enhanced MRI before and after treatment,and corresponding measures were put forward to better guide clinicians to reduce or eliminate the occurrence of complications.Method:To analyze the early complications of patients with uterine leiomyoma and adenomyosis treated with HIFU from August 2017 to December 2018.The patients were divided into complications group and non-complications group according to the presence or absence of complications.The related nature of the lesions was judged by MRI,the related data were measured and recorded,and the influencing factors of complications were analyzed by statistical methods.Result:125 cases were enrolled.1.The incidence of pelvic effusion was 82.4% in 103 cases.2.74 cases of abdominal wall injury were analyzed.There were statistical differences with lesion volume,abdominal wall thickness,treatment timeand energy efficiency factors.There were significant differences with lesion location,signal intensity of T2WI?compared with high and mixed signals?and type of T1 WI enhancement.3.There were 49 cases of sacrum and its surrounding injuries.There were significant differences in lesion volume,the distance between the sacrum and the lesion center,treatment time and energy efficiency factors,and the location of lesions,signal intensity of T2WI?compared with high and mixed signals?,and type of T1 WI enhancement.Conclusion:We can detect the complications of HIFU in the treatment of uterine leiomyoma and adenomyosis by MRI,and obtain the corresponding influencing factors according to the statistical method,which is conducive to guiding clinical further intervention and treatment.