Clinical Study On Short-term Interventional Treatment Evaluation Of Uterine Leiomyoma By Contrast-enhanced Ultrasound

Objective To explore the clinical application value of short-term interventional treatment of uterine leiomyoma by contrast-enhanced ultrasound, whose performance of uterine leiomyoma treated by uterine artery embolisati on (UAE) were compared before and after. Metheds Collected 26 cases to confirm the diagnosis in patients with uterine fibroids, fibroids number totaled 30, including single uterine fibroids in 23 cases, multiple uterine fibroids in 3 cases (7),22 intramural fibroids, subserosal 8 fibroids. In patients with menstrual clean after 3 to 7 days, the Seldinger technique femoral artery catheterization, the use of the the Roadmap technology super choose to insert the horizontal part of uterine artery embolization of uterine fibroids blood vessels that supply the fibroids embolization. Use with real-time harmonic contrast-enhanced ultrasound technology, Color Doppler ultrasonography in patients with UAE preoperative and postoperative 7 days in January, March, June, respectively, by the ventral line two-dimensional ultrasound and Color Doppler ultrasound, observe the fibroids shape, location, echo, inside and around the Color Doppler flow signal, and then select the best section of the fibroids, Color Doppler ultrasonography transition to advanced nonlinear pulse sequencing (ANPS) contrast conditions, the preparation of a good contrast agent SonoVue suspension antecubital intravenous fluid bolus injected into a patient, trailing 5 ml of normal saline wash pipe, focus observation uterine fibroids contrast mode, the contrast agent perfusion and muscle tumor size, internal echo, the internal contrast medium-intensity curve (time-intensity curve, TIC) and other indicators. Before and after the UAE preoperative and postoperative different time data collection, statistics, and comparative analysis to evaluate the efficacy of uterine fibroids intervention. Results①UAE preoperatively, 30 pieces of uterine fibroids contrast-enhanced ultrasound perfusion pattern has two kinds, namely surrounding the centripetal and synchronization; 30 tumors after contrast-enhanced ultrasound contrast agent for peak performance is different, homogeneously enhancement and uneven enhancement of two types; Uterine fibroids ultrasound contrast agent filling method and ultrasonic imaging time intensity curve and normal myometrium group had significant difference. ②UAE after 7 days,27 (90%) fibroids no ultrasound contrast agents, according to the internal and surrounding two (6.7%) fibroids within 1/2 tumors had visible contrast enhancement, edge enhanced half ring,1 pieces of myoma internal contrast agents (3.3%) in diffuse enhancement. The above three fibroids line again immediately UAE supplementation, DSA angiography found uterine artery embolism completely, but there are still other three fibroids blood supply artery variation, supplement treatment after contrast-enhanced ultrasound showed that the tumors had three internal no contrast filling and edge. After 1 month,3 months and 6 months contrast-enhanced ultrasound continuously perfusion within 30 pieces of fibroids, fibroids internal accumulation time intensity curve compared with preoperative have obvious changes, the peak intensity (PI) and the area under the curve (AUC) reduced to almost zero. Preoperative fibroids in the amplitude of time intensity curve was obviously higher than that of normal muscle layer, and a period of 6 months after operation fibroids significantly reduce internal time intensity curve of amplitude close to zero, prompt fibroids in a constant state of ischemia. ③UAE as postoperative observation time is different, fibroids echogenicity, rendering a variety of changes, short postoperative 1 week according to linear, strong echo in postoperative 1～3 months in a patchy, uneven echo, 6 months after surgery is a more homogeneous medium or high echo, part of the peripheral calcification.④Postoperative 1～6 months there are 26 pieces of fibroid volume reduced obviously (86.7%), there are 4 pieces of myoma postoperative shrink has been no significant (13.3%). The smaller degree preoperative was no significant difference (p> 0.05) after 1～3 months; the fibroid volume was statistically significantly reduced compared with the UAE preoperative (p<0.05) after 3～6 months. The 4 pieces of myoma PI and AUC were significantly reduced compared with preoperative, postoperative and time intensity curve amplitude to reduce close to zero.⑤The volume reduction of the degree were related of preoperative ultrasound contrast performance and location of the fibroids after UAE 6 months. Smaller groups of the 26 pieces of fibroids, preoperative imaging agents for peak performance for homogeneous enhancement after uterine flesh tumour shrinkage rate is significantly greater than nonuniforrnity increase uterine fibroids, the difference was statistically significant (p< 0.05); Muscle intramural myoma shrinkage rate is greater than the subserosal fibroids (p< 0.01). Conclusions① Contrast-enhanced ultrasound can display the uterine fibroids perfusion mode; ②Compared with CDFI, contrast-enhanced ultrasound can accurately reflect the internal blood flow occlusion of uterine fibroids after UAE more sensitive and accurate. ③ The time-intensity curve of uterine fibroids can be quantitative, objective evaluation of uterine fibroids; ④Contrast-enhanced ultrasound can measure the changes in the uterine fibroid volume more accuratly, to provide a more reliable basis for the assessment of uterine fibroids short-term intervention efficacy. ⑤ Contrast-enhanced ultrasound treatment of uterine fibroids UAE supplement again with some guidance.