| Adenomyosis is a common benign gynecologic disease that is characterized by the presence of ectopic endometrial glands and stroma within the myometrium.Its symptoms include secondary dysmenorrhea,menorrhagia,and sometimes accompanied by subfertility.It mostly diagnosed between 30 and 50 years of age in multipara,however,in recent years,the age of adenomyosis women become more and more younger,which may be caused by the increasingly cesarean section,abortion and the use of intra-uterine device.Based on the distribution and the range of lesions,adenomyosis is divided into two types: the diffused-type and the focal-type.Traditional treatments include surgical procedures and medical therapies.High-intensity focused ultrasound(HIFU)is a kind of non-invasive ultrasound ablation technology for adenomyosis in recent years.Its remarkable characteristics lies that HIFU can destroy the target tissue without noticeable damage to adjacent tissues,so as to achieve the goal of noninvasive treatment.Nevertheless,at present,it is still worth paying attention to the application of HIFU in the treatment for two types of adenomyosis.In addition,the biological characteristics of the target tissue will also affect the deposition of ultrasonic energy.Therefore,this study aims to analyze the relationship between different types of adenomyosis and ultrasound ablation dose,the efficacy and safety of HIFU,which can provide reference for the clinical to screen cases and predict the efficacy,and exploring the effects of different perfusion characteristics on the ultrasonic energy,which has the great significance to optimize the clinical protocols of ultrasound ablation in the treatment of adenomyosis.Objective1.To analysis the intraprocedural and postprocedural adverse effects in HIFU ablation for patients with adenomyosis and the improvement of dysmenorrhea and menorrhagia after the procedure,then compare the feasibility,safety and efficacy of HIFU ablation between the patients with diffuse and focal adenomyosis.2.To evaluate the blood supply and perfusion characteristics of adenomyosis via color doppler flowing image and contrast-enhanced ultrasound,and explore the correlation between the perfusion characteristics and the ultrasonic dose.Methods1.A total of 297 patients with adenomyosis treated with high-intensity focused ultrasound in First Affiliated Hospital of Chongqing Medical University from January 2012 to December 2014 were retrospectively analyzed.Among them,there were 177 patients with diffuse adenomyosis(diffuse group)and 120 patients with focal adenomyosis(focal group).Magnetic resonance imaging(MRI)were performed in the first day after operation.Follow-up was conducted at 1,3,6,12,24 and 36 months after HIFU ablation.The ablation results,intraprocedural and postprocedural adverse effects,dysmenorrhea and menorrhagia were recorded and compared between the two groups.2.A total of 109 symptomatic adenomyosis Chinese women who underwent ultrasound-guided HIFU between July 2015 and September 2016 at 1st Affiliated Hospital of Chongqing Medical University,Chongqing,China.The blood flow condition was evaluated by color Doppler ultrasound.All patients should accept the contrast-enhanced ultrasound before the procedure and save the video.The perfusion pattern was determined,the videos were quantitative analyzed and the enhanced time and enhanced gray were recorded through the software of JC Focused Ultrasound Tumor Therapeutic System.MRI were performed in the first day after operation,the non-perfused volume ratio(NPVR)and energy effect factor(EEF)was calculated.The effects between different hemodynamic indexes on therapeutic dose were compared.The correlation between blood flow levels and enhanced time,enhanced gray,perfusion pattern were analyzedResults1.For 297 patients,the procedure were completed successfully.The incidence of ablation among 297 patients was 99.33%(295/297).The follow-up time was 3~50 months.There were 177 cases in diffuse group,while 120 cases in focal group.The NPVR of diffuse and focal group were 25.38±13.39% and 44.30±19.93%,respectively.There were significant difference of ablation ratio between the two groups(P<0.01).During the procedure,the odds ratio of skin-burning pain was 1.82,when comparing diffuse group with focal group,while the odds ratio of inguinal pain was equal to 2.00,when focal group was compared to diffuse group.There were 64 of 297 cases(64/297,21.15%)accepted nominal therapy because of complications([Society of Interventional Radiology,SIR]-B grade).Among them,there were 38 cases(38/177,21.47%)in diffuse group and 26 cases(26/120,21.67%)in focal group,respectively.No significant difference was found between the two groups(P>0.05).Neither of the complained complications of SIR-C~SIR-F grade occurred in the two groups.Both dysmenorrhea and menorrhagia scores were significantly lower than the baseline in two groups(P<0.05).The total remission rate of dysmenorrhea was 73.51%(197/268),60.71%(136/224)and 46.83%(59/126)at 12,24 and 36 months after HIFU ablation,respectively,and rate in focal group was preferred to diffuse group at 24 and 36 months(P<0.05).The total remission rate of menorrhagia were 68.63%(140/204),63.64%(105/165)and 45.92%(45/98)at 12,24 and 36 months after HIFU ablation,respectively,and there were no significant difference between two groups(P>0.05).2.For 109 patients,the procedure were completed successfully.The incidence of ablation among 297 patients was 100%(109/109).No complications of SIR-C~SIR-F grade occurred in this study.Among these patients,there were 5 cases in grade 0,60 cases in grade ?,39 cases in grade ? and 5 cases in grade ?.The volume of lesion and the average power were 85.05±81.17 cm3,150.39±107.24 cm3,218.08±147.91 cm3,246.82±164.46 cm3 and 360.80±59.78 W,383.77±25.24 W,391.95±20.17 W,400±0 W,respectively,there were significant differences in these four levels(P<0.05),but no differences in therapeutic dose,EEF,hemodynamic indexes(Vmean,PSV,PI,RI)of inside and peripheral(P>0.05).According to the correlation analysis,the blood flow level has no linear correlation with EEF(P=0.345).Among 109 patients,there were 67 cases in synchronous enhancement pattern,and 42 cases in slow endocentric pattern.The non-perfused volume(NPV),the initiation time of enhancement and enhanced gray scale were 63.96±53.61 cm3,41.89±39.57 cm3,15.36±6.83 s,18.23±6.26 s and 43.04±17.69,35.79±16.18,there were significant differences in two patterns(P<0.05),but no linear correlation between perfusion pattern,initiation time of enhancement,enhanced gray scale and EEF(P=0.102?0.686?0.418).Conclusions 1.HIFU is safe and feasible for both diffuse and focal adenomyosis with strict control of the ablation range.HIFU is significant effective for adenomyosis,the short-term efficacy of focal and diffuse adenomyosis are familiar,while the long-term efficacy of focal adenomyosis is better than that of diffuse adenomyosis.2.Color doppler ultrasound and contrast-enhanced ultrasound were safe to evaluate the blood perfusion characteristics of adenomyosis.The more abundant blood flow level was,the larger the average power of HIFU needed.The synchronous enhancement pattern is more rapid and intensity than the slow endocentric pattern,but there were no significant differences in ablation results and therapeutic dose between two patterns.The blood flow level,initiation time of enhancement,enhanced gray scale and perfusion pattern had no effect on the dosage of ultrasound ablation. |
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