Contrast Enhanced MRI And Ultrasonography To Evaluate The Comparative Study Of HIFU Treatment Of Uterine Fibroids

BackgroundUterine fibroids is the most common benign tumor of femalereproductive system, accounting for about52%of gynecologic benigntumor. The treatment of uterine fibroids each has its advantages,includingmedication (hormone drugs), surgical treatment (surgery, uterine fibroidsrejecting), laparoscopy and hysteroscopy and uterine artery embolization，but all are invasive treatment, postoperative complications, From theperspective of physiological, psychological and social hysterectomy onpatients have different degree of influence.High intensity focused ultrasound (HIFU) is a kind of local treatmentof non-invasive treatment technology, has been successfully used in thetreatment of uterine fibroids. Reports contrast-enhanced ultrasound cancorrect evaluation of HIFU treatment of uterine fibroids, and research reports routine scan MRI T1W1and T2W1combination can be accurate toevaluate the effect of ultrasound ablation treatment of uterine fibroids.ObjectiveTo compare CE-MRI and CEUS evaluation of high intensity focusedultrasound (HIFU) for the treatment of uterine fibroids ablation.Methods1. Retrospectively analyzed Shanghai xuhui district central hospitalclinical diagnosis for patients with uterine fibroids HIFU therapy, randomsampling, a total of30cases, single fibroids27cases, multiple myoma in3patients, treatment of fibroids36. Selected fibroids a total of30,27fromsingle fibroids, and three from the multiple myoma patients with anteriorwall fibroids.2.All of the patients before and after treatment in a single day use theSiemens3.0T superconducting high field strength MRI scanner routineMRI sequence acquisition, Scanning transection, sagittal and coronal T1WIand T2WI and pressurized fat phase, enhanced MR scanning the T1WI-vibe3d, enhance contrast medium using Gadolinium injection acidmeglumine (Gd-DTPA).All of the patients before and after treatment immediate docontrast-enhanced ultrasound examination, monitoring ultrasound (EsaoteMyLab70, Italy). Before and after treatment respectively intravenous injection novy contrast agents, to observe the fibroids peripheral and bloodperfusion.3.Focused ultrasound treatment equipment for JC-200type focusedultrasound tumor treatment system (chongqing haifu technology co., LTD.,chongqing, China), monitor the ultrasound (Esaote MyLab70, Italy) withthe tumor therapy system. Preoperative bulge urine to onboard ultrasonicpositioning, according to the positioning of the preset treatment parameters,in a state of calm analgesic, in real time ultrasound ablation underultrasonic audio and video monitoring.4.In CE-MRI and CEUS measurement fibroids size, including fibroidslength to diameter (D1), diameter (D2) before and after, left and right sidesdiameter (D3) and no perfusion area (NPV). Calculating the fibroid volume,no perfusion area volume and ablation rate, the methods: V=0.5233*D2*D1*D3, no perfusion volume ablation rate (ablation rate)=no perfusionarea volume/fibroid volume by100%.By level of fibroid tumors show evaluation criteria for enhanced MRIand ultrasound angiography image quality score according to1to4points.According to the image quality score, fibroid tumors showed clear visible(4points), visible (3points), fuzzy visible (2points), not visible (1point).Results1. In image quality score, CE-MRI total score and average respectively in113and3.8±0.4higher than that of63and2.1±0.8CEUS, withsignificant difference (P <0.05). CE-MRI measured fibroids ablation ratewas80.6±18.5%on average, higher than CEUS measured72.9±20.0%ofthe average ablation rate, with significant difference (P=0.00).2. Before treatment CE-MRI fibroid volume compared with CEUSfibroid volume, there was no significant difference (P>0.05); After HIFUtreatment of fibroids NPV measure on CE-MRI was82.5±83.5cm3,significantly higher than CEUS measured66.0±66.2cm3, with significantdifference(P <0.01).3.30myoma, CE-MRI and CEUS image quality showed obviousdifference, on CE-MRI can clearly show fibroids size, boundary, and thesurrounding tissue adjacent to the relationship; On the boundary of themyoma CEUS showed relatively fuzzy, even have5cases unable toaccurately determine the boundary of the myoma, the size of accuratemeasurement is affected, more impossible to judge the surroundingstructure.Conclusions1. CEUS may underestimate the ablation of myoma after HIFUtreatment, at the same time because of a border can’t clear display, unableto determine the residual myoma after HIFU ablation organization exists,especially for fibroids deep surface layer CEUS is unable to determine the accurate boundary, which affect the accurate assessment of HIFU treatmentof fibroids melting degree.2. CE-MRI in display fibroids size, boundary and evaluating HIFU inthe treatment of uterine fibroids no perfusion area is better than that ofCEUS, it can more accurately show the fibroids melting condition, effect ofHIFU treatment of uterine fibroids, and reliable basis for clinical scheme.