The Study Of DWI And DTI In Assessing The Effect Of High Intensity Focused Ultrasound Ablation For Uterine Fibroids

As a non-invasive treatment technique with is no wound early recovery,onrgan-preserving, safe and feadible, high intensity focused ultrasound (HIFU) ablation is widely used for treatment of solid tumours and benign disease especially uterine fibroids.Because of its purpose is providing local control of uterine fibroids, the way of evaluation of tumor response to therapy is important for determining whether the tumor has been ablation. As it is a non-invasive techniques, there is a need for non-invasive methods to evaluate the therapeutic effect after HIFU ablation. There are many ways for it, such as color doppler flow image(CDFI), contrast-enhanced ultrasound (CEUS), contrast-enhanced MRI (CE-MRI). Ultrasound grey changes in ablated tissue after HIFU ablation verified that it correlated well with the volume of coagulation necrosis, these changes just suit to USgHIFU,but MRgHIFU. CEUS has been widely used as a method for the treatment of uterine fibroids with FUS.It also has limitation that if patients have multi-fibroids or have a huge fibroid, the deep fibroids or the deep area might not be sensitive. CE-MRI is a standard of reference for coagulation necrosis of tumors after HIFU ablation. Because of the safety profile of the contrast agent after heating that we don't know,the possible adverse reaction,the application of CE-MRI was limited. Functional magnetic resonance image(fMRI) has its advantages in its lower cost as well as no adverse drug reaction. The objective of this study is to investigate the efficiency of using fMRI in assessing the effect of high intensity focused ultrasound ablation for uterine fibroids.Purpose1.Using DWI to assess the effect of high intensity focused ultrasound ablation for uterine fibroids.2.Using DTI to assess the effect of high intensity focused ultrasound ablation for uterine fibroids.methodsLFrom March 2014 to February 2015,270 patients diagnosed with uterine fibroids and scheduled for HIFU in the 1st Affiliated Hospital of Chongqing Medical University.270 patients were enrolled in the study.Magnetic resonance image proved pre-and post treatment. Main Outcome Measures:ablation time, sonication power,sonication time,sonication energy, therapeutic intensity. All patients divided into two groups by the time of MRI scan.Patients in group A were performed in 6 hour while patients in group B were performed between 24 hour to 48 hour. Valuated the non-perfused volume (NPV),the volume of signal changed in DWI and ADC value.Statistical analysis was performed by using SPSS 19.0 software.2.From March 2014 to February 2015,128 patients diagnosed with uterine fibroids and scheduled for HIFU in the 1st Affiliated Hospital of Chongqing Medical University were enrolled in the study.Outcome Measures:ablation time, sonication power,sonication time,sonication energy, therapeutic intensity. The plain,enhanced MRI and DTI scanning were performed before and after the treatment of HIFU in all patients to evaluate the non-perfused volume (NPV),the volume of signal changed in DTI and FA value. Statistical analysis was performed by using SPSS19.0 software.Results1.Post-DWI shows that signal was higher than before treatment and it likes a target.2.ADC value of ablation area after HIFU ablation within 6 hours was (1.313�0.256) �10-3 which is lower than pre-treatment((1.382 � 0.211) � 10-3).And the ADC value of ablation area between 24 hours to 48 hours after HIFU ablation was (1.376�0.119)�10-3 which is higher than pre-treatment((1.521�0.130) � 10-3),P<0.05.3.The volume of the area,of which DWI signal intensity enhanced(50.780 (30.033-89.598)),was in accordance with NPV of EC-MRI(52.654 (30.033-89.598)),P>0.05.4.Post-DTI shows that signal was higher than before treatment and it likes a target.5.FA value of ablation area after HIFU ablation was (0.267+0.089) which is lower than pre-treatment(0.344 � 0.125),P<0.05.6.The volume of the area,of which DTT signal intensity enhanced(57.94 (32.91-101.08)),was in accordance with NPV of EC-MRI(57.97 (32.91-100.09)),P>0.05.Conclusions1.Using DWI can assess the effect of high intensity focused ultrasound ablation for uterine fibroids.2.Using DTI can assess the effect of high intensity focused ultrasound ablation for uterine fibroids.