Research Of Imaging Characteristics And Microwave Ablation Dose-effect Correlation For Uterine Fibroids And Adenomyosis

Purpose1. To investigate the feasibility of predicting energy needed for uterine fibroids andadenomyosis microwave ablation according to MR T2W1signal intensity.2. To investigate the dose-effect relationship parameters of quantitative microwaveablation for uterine fibroids of different T2W1signal intensity and different quantitativeablation combination. To investigate the dose-effect relationship parameters ofquantitative microwave ablation for adenomyosis of different quantitative ablationcombination.3. To analyse the factors that influencing dose-effect relationship of microwave ablationfor uterine fibroids and adenomyosis and its influencing way.4. To investigate the dose-effect relationship of ultrasound elastography imaging and3Dpower doppler ultrasound microwave ablation for uterine fibroids and adenomysis.Materials and methodsPart11. Analysed the98patients of uterine fibroid (116lesion in total) and87patients ofadenomyosis who underwent utlrasound-guided percutaneous microwave abaltion fromApril2011to August2012in PLA general hospital, aging from33to46(average42.7±4.2) years old.72patients meeting the inclusion standards were included, of which there were53patients with uterine fibroids (58lesions) and19patients withadenomyosis. Before and after microwave ablation, pelvic plain and enhanced MRIwere undertaken. Before therapy, divided uterine fibroids to3groups of hyper-, iso-andhypo-intensity, taking the uterine myometrium and musculue skeleti signal intensity ofMR T2W1as stantard. After ablation, measured the nonperfusion zone of enhancedMRI as the ablation volume, statistically analysed the dose-effect factor (EPV) ofmicrowave ablation for uterine fibroids and adenomyosis, evaluated the feasiblity topredict the microwave ablation energy needed for uterine fibroids and adenomyosisaccording to MR T2W1.2. Analysed the78patients of uterine fibroid (81lesion in total) and123patients ofadenomyosis who underwent utlrasound-guided percutaneous microwave abaltion fromOctober2012to December2013in PLA general hospital. Before therapy, divided theuterine fibroids into3groups of hyper-, iso-and hypo-intensity taking the uterinemyometrium and musculue skeleti signal intensity of MR T2W1as stantard. Applymicrowave output50w/60w for300s for uterine fiboids and microwave output50w/60wof signal or two antenna for300s for adenomyosis quantitative therapy. After ablation,measured the quantitative ablation volume on contrast-enhanced sonography,investigated the quantative microwave ablation range parameters for uterine fibroidsand adenomyosis of different T2W1intensity, and then probed the dose-effectrelationship of different signal intensity and different ablation combination.Part2Taking Jiang Hanbao et al. tritus phantom prescription as standard (moisturecapacity70%), respectively allocated microwave phantom of moisture capacity of60%、65%、70%、75%and80%, undertook quantitative microwave ablation at outputof50w for900s for phantom of different moisture capacity after MRI scanning.Collectted the teperature rise data10mm away from the slit of microwave ablationantenna, analysed the relationship between moisture capacity of microwave phantom,signal intensity of MR T2W1and the teperature rise of microwave ablation. Part31. For35patients of uterine fibroid (35lesion in total) and30patients ofadenomyosis who underwent utlrasound-guided percutaneous microwave abaltion fromApril2013to December2013in PLA general hospital, quantitative50w300smicrowave ablation was undertaken. Measured the quantitative ablation volume oncontrast-enhanced sonography. Before therapy, undertook ultrasound elastography foreach patient, tracing analysed lesions on Q-analysis system to obtain the elasticity value,analysed the characteristics of elasticity imagings for uterine fibroids and adenomyosisand compared the difference, investigated the associativity between elasticity value andthe quantitative ablation volume of lesion for uterine fibroids and adenomyois.2. For35patients of uterine fibroid (35lesion in total) and30patients ofadenomyosis who underwent utlrasound-guided percutaneous microwave abaltion fromApril2013to December2013in PLA general hospital, quantitative50w300smicrowave ablation was undertaken. Measured the quantitative ablation volume oncontrast-enhanced sonography. Before therapy, unertook3D power doppler ultrasoundfor each patient, tracing analysed lesions on VOCAL analysis system to obtainvascularised blood flow index number (VFI), analysed the characteristics of3D powerdoppler ultrasound for uterine fibroids and adenomyosis and compared the difference,investiagted the associativity between elasticity value and the quantitative ablationvolume of lesion for uterine fibroids and adenomyois.ResultPart11. There was statistical difference of the EPV between uterine fibroids andadenomyosis (Z=-2.616, P=0.009). More energy was needed for adenomyosis thanutereine fibroids to ablate unit volume lesion. The difference of interblock EPV ofuterine fibroids were statistically significant (F=3.296,P=0.046). Afterpaired-comparision, there was statistical difference of the EPV between hyper-intensityand hypo-intensity groups(P=0.015). To ablate unit volume lesion of hyper-intensityuterine fibroids, more energy was needed. MRI can be used to predict the microwaveablation energy that needed for uterine fibroids and adenomyosis. 2. The ablation volume for hyper-, iso-and hypo-intensity uterine fibroids undersingle antenna quantitative50w300s were respectively46.48±25.63cm3,44.46±16.72cm3,23.58±11.85cm3; the EPV were respectively381.91±120.74J/cm3，393.00±171.86J/cm3，843.80±592.09J/cm3. The ablation volume for hyper-, iso-and hypo-intensity uterine fibroids under single antenna quantitative60w300s wererespectively54.29±22.46cm3，51.36±8.63cm3，22.54±2.98cm3; the EPV wererespectively373.79±119.26J/cm3，368.54±49.26J/cm3，807.81±102.87J/cm3.Under the same output and time, the microwave ablation range of T2W1hypo-intensityand iso-intensity uterine fibroids were larger than that of hyper-intensity. There wasstatistical difference(p＜0.05). For the hypo-intensity and iso-intensity groups, theablation volume of60w300s were larger than that of the50w300s, of which thedifference was statistically significant (p＜0.05).The ablation volume for diffuse adenomyosis under single antenna quantitative50w300s was15.94±8.16cm3, the EPV was1202.98±610.08J/cm3; the ablationvolume under single antenna quantitative60w300s was21.32±12.14cm3, the EPVwas1022.17±558.63J/cm3. The ablation volume for diffuse adenomyosis underdouble antenna quantitative50w300s was54.16±17.50cm3, the EPV was590.91±260.02J/cm3; the ablation volume under double antenna quantitative60w300s was76.22±4.64cm3, the EPV was473.72±28.56J/cm3. The ablation volume for uterineadenomyoma under single antenna quantitative50w300s was10.60±4.76cm3, theEPV was1712.96±764.67J/cm3; the ablation volume for uterine adenomyoma undersingle antenna quantitative60w300s was17.80±11.15cm3, the EPV was1354.92±796.27J/cm3. The ablation volume of60w300s was larger than that of50w300s, ofwhich the difference was statistically significant (p＜0.05). The EPV of double antennawas smaller than that of the single antenna, of which the difference was statisticallysignificant (p＜0.05).Part2The T2W1signal intensity of phantom of different moisture capacity was different.That of60%moisture capacity phantom was the lowest, of80%moisture capacity phantom was the highest, that of the70%moisture capacity phantom was between thetwo. There was linear correlativity between the phantom moisture and the temperatureof temperature sensing point during microwave ablation. It’s negative correlation, of the300s, r=-0.642，p＜0.01, of the600s,，r=-0.409，p=0.01. Higher moisture capacity,lower temperature of sensing point. Of the interblock comparing result, the difference ofmoisture capacity interblock phantom with statistical significance was larger than10%.The temperature change of sensing points of each phantom T0s–T300s、T300s-T600s、T600s-T900s was gradually decreased, of which the temperatue changed the mostfrom0s to300s.Part31.85.71%lesion of uterine fiboids were mostly blue under ultrasound elastography,small part of it were green or green and red. Of76.67%adenomyosis patients, theultrasound elastography was mainly red and green, small parti of it was blue. Theanalytic result displayed that the tissue of uterine fibroids was harder than that ofadenomyosis, of which the difference was statistically significant (p＜0.05). Accordingto the data so far, it cannot be considered that there was linear correlation betweenelasoticity value of uterine fibroids and adenomyosis and microwave ablation range(p＞0.05).2.3D power doppler ultrasound displayed that the blood supply of uterine fibroidswas more abundant than its surrounded tissue, which gbolularly encircle the tumor; theblood vessel were confused and disorderly, without irregularity. The VFI of3D powerdoppler ultrasound between uterine fibroids and adenomyosis was without statisticallysignificant difference(p＜0.05). The associativity research between the VIF of uterinefibroids3D power doppler ultrasound and microwave ablation volume is negativecorrelation, r=-0.511，p=0.013. The regression equation: Y=3.873-0.044X(P <0.05);The associativity research between the VIF of adenomyosis3D power dopplerultrasound and microwave ablation volume is negative correlation, r=-0.511，p=0.013.The regression equation::Y=3.038-0.085X(P <0.05). Conclusion1. MR T2W1can be used to predict the microwave ablation needed for uterinefibroids and adenomyosis. Under the same condition, the quantitative microwaveablation range of adenomyosis was smaller than that of uterine fibroids, the quantitativemicrowave ablation range of hyper-intensity uterine fibroids was smaller than that of thehypo-and iso-intensity, double antenna can save energy. Under the obtained differentoutput and ablation time combination, microwave ablation range for and dose-effectfactor for uterine fibroids and adenomyosis can be used in clinical for reasonable designbefore surgery, avoid energy waste and raise the ablation safety.2. The T2W1signal intensity of phantom of different moisture capacity wasdifferent, higher moisture capacity, higher T2W1signal intensity.There was negativelinear correlation between phantom moisture capacity and temperature of sensing pointsdudring microwave ablation, higher moisture capacity, lower temperature. When thedifference of moisture capacity was larger than10%, the temperature difference waswith statistical significance.3. The elastography characteristics of uterine fibroids and adenomyosis wasdifferent, which can be used to distinguish uterine fibroids and adenomyosis. Butaccording to the data so far, ultrasound elastography cannot be used to predict energyneeded for microwave baltion, which needed further large sample delamination research.The VFI value of3D power doppler ultrasound for uterine fibroids and adenomyosiscan reflect the blood supply of lesion, and can predict energy needed for microwaveablation.