The Value Of Quantitative Parameters Of Uterine Fibroids Perfusion In Predicting The Ultrasound Ablation Effect

Uterine fibroids is a common gynecological disease,caused by benign hyperplasia of smooth muscle cells,can lead to an increase in the amount of menstruation,pelvic compression,infertility,anemia and other symptoms,seriously affecting women's physical and mental health.Hysterectomy is recognized as a way to cure uterine fibroids,however,the operation has a greater impact on women's physical and psychological health,and is not suitable for patients with fertility desire.Myomectomy has the risk of postoperative recurrence,uterine scar and uterine rupture during pregnancy.High intensity focused ultrasound(HIFU)as a completely non-invasive technique for tumor thermal ablation,due to its less complications,quick recovery after treatment and retains the advantages of organic integrity,has been more and more used in the treatment of uterine fibroids.A large number of clinical studies have shown that HIFU can significantly reduce the volume of fibroids,relieve the symptoms of anemia and other symptoms.The thermal effect is the main mechanism of HIFU treatment,blood perfusion of uterine fibroids is important factor influencing the deposition of ultrasonic energy.Therefore,it is of great significance for us to understand the characteristics of blood perfusion of uterine fibroids before HIFU treatment.Contrast enhanced ultrasound(CEUS)is a commonly used method for the evaluation of blood perfusion in clinic,and the ultrasound contrast agent(UCA)used in this study is a microbubble formed by lipid-coated carbon fluoride,which is similar to the red blood cells in vivo,and is a good blood vessel imaging agent.The purpose of this study was to quantitatively evaluate the characteristics of uterine fibroids perfusion by CEUS before operation and to explore the relationship with HIFU and its predictive value on the ablation effect.ObjectiveThrough the analysis of the relationship between the quantitative parameters and the ablation effect to explore the value of quantitative parameters to predict the effect of ultrasound ablation,and to provide help for the clinical treatment of uterine fibroids.MethodsSixty-three patients with uterine fibroids underwent contrast-enhanced ultrasound before operation.The software of gray level measurement in JC HIFU system was used to obtain quantitative parameters of uterine fibroids perfusion.According to postoperative enhanced MRI examination,the results were divided into satisfactory group(NPV ratio ?70%)and partial ablation group(NPV ratio < 70%).CEUS parameters of two groups were compared,and the correlation between parameters and ablation rate was analyzed.The predictive value was evaluated by ROC curve.ResultsThe arrival time(AT),peak time(PT),enhancement time(ET)of partial ablation group after the injection of contrast agent were(13.20 ± 4.09)s,(20.86 ± 5.38)s,(7.66 ± 2.19)s,significantly faster than those in satisfactory group(16.77 ± 3.50)s,(26.95 ± 4.98)s,(10.18 ± 2.58)s;The enhancement intensity(EI),enhancement rate(ER)of partial ablation group were(62.44 ± 27.86),(8.54 ± 4.56),significantly higher than those in satisfactory group(29.77 ± 16.72),(3.02 ± 1.67).Correlation analysis showed that the AT?PT and ET were positively correlated with the NPV ratio(P < 0.01),and the EI and ER were negatively correlated with the NPV ratio(P < 0.01),and the correlation between ER and NPV ratio was the largest(r=-0.724).Using AT,PT,ET,EI,ER for predictors,the area under ROC was 0.806?0.820?0.767?0.841?0.935,respectively.The corresponding optimal cut-off of predicting ablation were AT>13.50 s,PT>20.50 s,ET>9.50 s,EI<34.55,ER<5.23,respectively.Conclusion1.In different HIFU ablation effect,there are significant differences in the parameters of CEUS: In partial ablation group,The arrival time,peak time and enhancement time were significantly faster than that of the satisfactory ablation group,and the enhancement intensity,enhancement rate were significantly higher than those of the ablation group.2.There was a correlation between the quantitative parameters of CEUS and the ablation rate.The arrival time,peak time and enhancement time were positively correlated with the ablation rate,and the enhancement intensity and the enhancement rate were negatively correlated with the ablation rate.The correlation between enhancement rate and ablation rate was the highest.3.The quantitative parameters of contrast-enhanced ultrasound in uterine fibroids can be used to predict the effect of HIFU ablation,and the predictive value of enhancement rate is high.The slower the enhancement rate,the better the ablation effect,and the enhancement rate can be used as a good indicator to predict the effect of HIFU.