A Discussion On The Relativity Between The Perfusion Features Of Contrast Enhanced Ultrasonography And The Dose-Effect Relationship Of High Intensity Focused Ultrasound Ablation Adenomyosis

Background:Adenomyosis is one of the most common gynaecological diseases. There is no capsular or clear boundary between the adenomyosis lesion and normal myometrium, which leads to that the treatments of uterine preservation are facing difficulties. Therefore adenomyosis has became a troublesome problem of gynecotokology.High intensity focused ultrasound(HIFU) is a new noninvasive method for adenomyosis recently, and can relieve dysmenorrhea and hypermenorrhea effectively. The perfusion of adenomyosis lesion is a disincentive to energy deposition in target tissue, therefore it is significant for HIFU ablation adenomyosis that to know the perfusion features of adenomyosis lesion before treatment. The movement features of micro-bubble ultrasound contrast agent are similar to erythrocyte's one in blood vessel, and the micro-bubble's amount and speed in target organ can reflect the perfusion of tissue microcirculation. In view of the above, it is feasible to assess the perfusion features of adenomyosis microcirculation quantitatively. The intention of this paper is that to assess the contrast enhanced ultrasonography(CEUS) perfusion features of adenomyosis lesion by using time-intensity curve(TIC) quantitatively, and to discuss the relativity between the CEUS perfusion features of adenomyosis lesion and the dose-effect relationship of HIFU ablation adenomyosis.Objective:To assess the CEUS perfusion features of adenomyosis lesion quantitatively and to discuss the relativity between with the quantized indicators of perfusion features and the dose-effect relationship of HIFU ablation adenomyosis.Methods:24 patients with adenomyosis who were treated by HIFU at Chongqing Haifu hospital from October 2014 to March 2015. Pretherapy CEUS should be stored. The TIC of pretherapy lesion CEUS should be analyzed quantitatively, and also the enhanced time and enhanced intensity should be recorded accurately. The ablation volume should be evaluated by post-treatment enhanced MRI as well. The relativity between with the enhanced time and energy effect factor(EEF) would be analyzed, and the one between with the enhanced intensity and EEF should be analyzed also. All patients were divided into two groups(group A and group B) by taking EEF=10J/mm3 as standard. The treatment time, sonication time, energy, average acoustic power, treatment intensity, NPV, EEF, enhanced time, enhanced intensity and complications ratio were compared in two groups.Results:All patients were safe without any serious adverse effects after CEUS and HIFU. The EEF was negatively correlated to the enhanced time (Pearson correlation coefficient=-0.788,P<0.01). The EEF was positively correlated to the enhanced intensity (Pearson correlation coefficient=0.744, P<0.01). There were 13 patients in group A(EEF<10J/mm3), and 11 patients in group B(EEF?10J/mm3). The average acoustic power, the treatment intensity and the complications ratio had no significant difference in two groups(P>0.05). The enhanced time, enhanced intensity, treatment time, sonication time, energy, NPV, and EEF had significant difference in two groups(P<0.05).Conclusions:1.TIC can be uesd to reflect the perfusion features of adenomyosis lesion safely and efficiently, both the enhanced time and the enhanced intensity are able to be used for assessing the perfusion features of adenomyosis lesion quantitatively.2.The faster and stronger adenomyosis lesion perfused, the more ultrasonic energy would be required for HIFU ablating the unit volume of adenomyosis lesion.