Two-Dimensional Ultrasound Monitor And Evaluate Efficacy Of Uterine Fibroids After HIFU

BackgroundUterine fibroids are common benign tumors of the reproductive system of women of childbearing, despite its low rate of malignant transformation, but the quality of life have been effected . The symptomatic uterine fibroids are treated by traditional surgery. However, due to uterine artery supply ovarian blood about 50% to 60% , it was reported that premenopausal women without uterine, even if ovarian are reservated often have menopause syndrome, coronary heart disease and osteoporosis. As a result, it is significant that a method is used to treat Uterine fibroids with uterine reserved to reduce or eliminate symptoms and improve the quality of life. So in recent years, it is well known that uterine fibroids were treated by minimally invasive or non-invasive methods .Treating uterine fibroids by HIFU (High Intensity Focused Ultrasound,HIFU) makes the use of ultrasonic sound which penetrats organizations and accumulates vitro ultrasonic energy in tumor tissue, makes tumor tissue momently risen to 60 ~100℃temperature, so as to achieve in-situ "removal" or thermal ablation of the tumor. Some scholars conducted the treatment of uterine fibroids by MRI (Magnetic resonance imaging, MRI) guiding HIFU . Researchs have shown it's feasibility and safety. Because it is very expensive, it has not conducted to the popularity of this technology, nor the formation of a standardized treatment plan and effective evaluation criteria. Although ultrasound-guided HIFU in the treatment of uterine fibroids has been reported, the system has not yet the criteria which it is about systematic monitoring and immediate efficacy and post-op efficacy.ObjectiveMonitoring HIFU treatment of uterine fibroids with Two-dimensional ultrasound images and comparing two-dimensional ultrasound images and MRI image aim at improving the accuracy of two-dimensional ultrasound monitoring. Through analyzing Ultrasound images on digital image, two-dimensional ultrasound half of the number of evaluation criteria is explored and created to guide clinical treatment.Materials and Methods1 Experimental equipment and clinical data1.1 experiment equipment:JC-focused ultrasound tumor therapeutic system, the treatment of frequency 0.8 MHz, 142 mm focal length, Sound Power 100 ~ 400 W(Chongqing Haifu (HIFU) Technology Co., Ltd.);PHILIPS HD3-color ultrasonic machine (transducer frequency 3.5 MHz); Magnetom Symphony Tim 1.5T (SIEMENS) equipment;Gray processing software Provided by Chongqing Haifu (HIFU) Technology Co., Ltd.1.2 clinical data:Selected criteria: patients with uterine fibroids diagnosed clinically and with ultrasound and MRI; pre-menopausal women, the uterus is asked to be retained; myoma can be shown with Airborne ultrasound; fibroids maximal diameter are not more than 10 cm; muscle intramural fibroids; non-pedunculated subserosal and the submucosal fibroids; women willing to accept such sedation analgesia methods and the treatmentExclusion criteria: Cervical fibroids; vascular smooth muscle tumor; abnormal cervical cytology tips cells; combined with gynecologic other diseases (such as vaginitis, pelvic inflammatory disease, tumors, etc.); pelvic tissues and organs adhesion suspected by gynaecological examinations and imaging examination; uterus after dumping fixed, prone position, uterine fibroids or uterine still oppression rectum; history of cesarean section two of the uterus or the history of cesarean section; menstrual period, pregnant women (pregnancy test was positive) and breast-feeding women; connective tissue disease or have undergone major abdominal dose radiotherapy; placed pacemaker patients with heart disease (unstable angina, heart-year infarction, arrhythmias require drug control, hypertension and serious effort Failure); NMR and other taboos anesthesia patients.Selected cases of 95 cases (a total of 108 fibroids), aged 27 to 51 years old, the average age of 37.65 years old. Leiomyoma volume averages 50.81 cm3 (1.09 ~ 566.41cm3). 86 out of 95 cases with varying degrees of menstrual abnormalities and / or anemia.2 Experimental methods2.1 Preoperative preparation①Preoperative routine examination;②Bowel preparation: three days before light therapy less residue diet, one day before treatment bowel preparation, clean enema at treatment the same day;③Skin preparations: treatment areas skin preparating, degreasing, degassing;④Bladder prepared: preoperative catheterization and bladder injection of 300 ~ 400 ml saline;⑤Position: exposure therapy areas, pronation;⑥Establish intravenous access. Preoperative 30 points, Infusion 5% GS500ml + granisetron 3mg and appropriate atropine based on patients'heart rate .2.2 Intraoperative monitoring①Positioning: Using ultrasound as an airborne operation and monitoring equipment. vertical scan pelvic to pinpoint the location of fibroids. The position unchanged, adjust bladder through the catheter, to make sure uterus and myoma can be clearly shown and ensure that the focus can reach all parts of the leiomyoma. Carefully observe the fibroids the size, number, location, at the same time observe whether intestinal in the sound channel . If necessary, place a cystic between patients'abdominal and probe to open them. Final determine the beginning and ending points;②Pre-scan: After determining the beginning and ending points, vertical scan from left to right to a 5 mm distance between the treatment of pre-scanning area;③Sedation analgesia: fentanyl 1 ug / Kg, midazolam 0.03 mg / Kg, the time interval of 40 minutes, 60 minutes. Closely observe vital signs and pain with their location and nature;④Treatment: treat fibroids region by intraoperative ultrasound. Sentinel point play, sound power 100 ~ 400 W. First used for smaller power irradiation, then in accordance with the response of patients with fibroids and changes in the gray increase sound power, in the scope of patients are able to tolerate such treatment. From points to lines from the line to face, layer by layer until the entire treatment of fibroids. Fibroids gray change significantly as the main indicator of effective treatment. Real-time monitoring in the course of treatment access and voice around the organ lesions, abnormal changes in the organizational structure, in that case the treatment must be terminated immediately; ⑤Evaluate again therapeutic effect before the end of treatment using ultrasound image, if the gray increases not obvious, added energy once again in the area .Finally , map for measurement and analyzing.2.3 After treatmentPatients conventional anti-infection, take note of the skin, lower abdominal, vaginal fluid and urine situation.2.4 Imaging examinationPatients are examed by ultrasound and MRI before, immediately after, after 1, 3, 6, respectively. Ensure that the conditions of the same before and after the inspection.2.4.1 Ultrasound image compared with MRI imageAccording to MRI images after HIFU 1 month, in accordance with the degree of fibroid necrosis fibroids are: complete necrosis, partial necrosis and un-necrosis.①comparing leiomyoma volumes measured by ultrasound and MRI respectively ;②compare gray-scale intraoperative ultrasound with the extent of necrosis;③compare intraoperative ultrasound image changes with the extent of necrosis;④Analyse intraoperative dose and the extent of necrosis;⑤Analyse treatment options and the extent of necrosis;⑥compare gray-scale ultrasound after HIFU1,3,6months with MRI enhanced images after HIFU 1month .2.4.2 Postoperative follow-up ultrasound 15 Analyzing different features and performance of ultrasound image, finding the target Evaluation①uterine volume changes:②leiomyoma volume changes;③fibroids gray change;④fibroids uniformity of change;⑤uterine fibroids and reduce rates.2.5 Clinical factors affectingComparing the effect of different size (divided into <4 cm3, 4 to 65 cm3,> 65 cm3), different types (intramural into muscle, serosa, submucosal), different gray (divided into high Echo type, echo type, echo-low type), different uniformity (evenly divided into echo, echo less homogeneous, heterogeneous echo) of the leiomyoma and analyzing the influence factors.2.6 Develop ultrasonic score Evaluation Table after uterine fibroids are treated by HIFUAccording to implications of different location, type, volume, echo Etc, and ultrasound changes during and after the treatment, ultrasonic score Evaluation Table is developed preliminary after HIFU . Score and assess the leiomyoma after the HIFU and sum up surplus Sound effective evaluation scores.3 statistical analysisResults are analysed by SPSS11.5 statistical software package, and Microsoft Excel. Results1. Fibroids with Necrosis obvious and without visible necrosis are different ultrasound image. Fibroids with Necrosis obvious were gray value increased significantly (> 25), Mission massive internal echo or higher increased overall gray. Leiomyomas without visible necrosis were not obvious gray value increase, fibroids no obvious echo within the district increased. Therefore, leiomyoma gray's change and change in the echo can be used in the monitoring of the indicators of judgement. 2. Treatment to the main power≥250 W (≥250 W irradiation time is about more than 50 per cent of the total irradiation time) of a total of 37 fibroids, two are not necrosis; treatment to power <250 W mainly (<250 W irradiation time is about more than 50 per cent of the total irradiation time), a total of 12 myoma, five are not necrosis,. This shows that treatment using high-power range of necrosis.3. After 6months an average rate of uterine narrow 24.20 percent, narrowing the leiomyoma was 56.31 percent. The gray increased to reach the highest after 1 mouth, then gradually decreased. The volume changes of Uterine and fibroid and changes of fibroids'can be used as HIFU treatment of uterine fibroids after the two-dimensional ultrasound evaluation of the effect of indicators. Changes of fibroids internal evenness is no difference between before and after. So it can not be used as indicators of Evaluation4. Different leiomyomas with different ultrasonographic characteristics have the different effecacy: Volume 4 ~ 65 cm3, muscle intramural and high-echo echo uneven fibroids are better efficacy than others.5. According to preoperative uterine fibroids and the location of the fibroids performance of audio, visual map, with changes in leiomyoma gray, gray and narrow after fibroid changes in the value of such factors, developed a standard efficacy score, score≥22 can be considered an effective treatment.Conclusion1. Ultrasound can monitor real-timely HIFU irradiation process change in the ultrasonic echo and Gray's changes can be used as standard.2. Ultrasound images Reaction of the volume of changes and within the gray values after treatment can accurately reflect the treatment as indicators Evaluation.3. Analysis of ultrasound before treatment can predict efficacy4. Preliminary designed score table can be more directly reflect the therapeutic effect. It can be regarded as an effective treatment if the score≥22...