| A large number of clinical studies have shown that SonoVue-based CEUS followed by HIFU ablation for uterine fibroids,ultrasonic microbubbles can enhance the efficiency of HIFU ablation by promoting cavitation and thermal effects.But the commonly used contrast medium,Sono Vue,has a short duration in the body,the time of the concentration of the microbubbles in the body is also very short.And the peak time of each patient was different.Therefore,looking for a contrast agent in the body that lasts for a long time in vivo,and according to the individual difference of the patient to determine when an injection of contrast agent when the time of ablation treatment is the difficulty of the clinical effect of HIFU ablation.ObjectiveAccording to the individual difference of patients,the best time to improve the efficiency of HIFU ablation is discussed;To assess the feasibility and safety of Sonazoid-based contrast-enhanced ultrasound(CEUS),followed by HIFU ablation for uterine fibroids.Methods1.A prospective study of 109 patients with single uterine myoma was treated with HIFU ablation under ultrasound guidance.109 cases were randomly divided into groups according to their admission numbers:the single number was included in the ultrasound contrast group,and the Sono Vue was performed before HIFU.When the microbubbles began to enter the target area under ultrasonic monitoring,the HIFU treatment began immediately;While in the control group,no preoperative angiography,only treated with HIFU.The data in the HIFU treatment and after the operation were analyzed and compared.2.A total of 64 Asian patients with single uterine fibroids were assigned to the control or CEUS group.Thirty patients from the control group were treated with HIFU alone,while 34 patients from the CEUS group were examined using Sonazoid-based CEUS followed by HIFU.Enhanced MRI was performed for all patients before HIFU in order to assess the uterine fibroids.One day after HIFU,enhanced MRI or Sonazoid-based CEUS was repeated to evaluate the ablation results.Results1.The HIFU treatments were completed successfully in all the 109patients.The ablation rate of the CEUS group and the control group reached more than 70%.No significant differences were observed in the age,diameter,volume and massive gray scale changes(MGSCs)(P>0.05).In the CEUS group,the average sonication power is 390±27W,the average treatment time is 64±14min,the average sonication time is 732±217s,the average total energy used is 286±88KJ,and the EEF is 3.33±0.93J/mm~3,It was significantly lower than the control group.In the control group,the average sonication power is 433±24W,the average treatment time is 148±53min,the average sonication time is 2851±1166s,the average total energy used is 1243±529KJ,and the EEF is 11.13±1.91J/mm~3.There were significant differences in the ablation treatment parameters between the two groups(P<0.05).The incidence of complications during and after the two groups of ablation treatment was as follows:In the CEUS group,the incidence of sacrococcygeal pain,skin burn,pain in treatment zon,groin pain,sensation of rectal tenesmus,leg pain,fever,lower abdominal pain,paresthesia of lower limb,vaginal discharge,skin injury and anal distention were respectively:12.30%(8/65),4.62%(3/65),20.00%(13/65),3.08%(2/65),1.54%(1/65),1.54%(1/65),4.62%(3/65),33.85%(22/65),4.62%(3/65),12.31%(8/65),20.00%(13/65);In the control group,there were respectively:22.73%(10/44),4.55%(2/44),22.73%(10/44),2.27%(1/44),4.55%(2/44),4.55%(2/44),4.55%(2/44),29.55%(13/44),4.55%(2/44),9.09%(4/44),22.73%(10/44).No statistically significant differences were noted in the adverse effects.A total of 5 cases were lost 3 months after the operation,of which 2were from the control group,and the remaining 3 were from the CEUS group.No postoperative recurrence was found in 104 patients who were followed up.No blood flow was found in the necrotic region.In the 3months after the operation,the myoma began to decrease,and there was no significant difference between the two groups(P>0.05).The patients complained that the clinical symptoms were improved,the amount of menstruation was reduced and the menstrual period was restored to normal.2.The HIFU treatments were completed successfully in all the 64Asian patients.No significant differences were observed in the age,diameter,volume and massive gray scale changes(MGSCs)(P>0.05).In the CEUS group,the average sonication power is 204.3±37.6W,the average treatment time is 44.2±15.4min,the average sonication time is358.4±271.3s,the average total energy used is 76.18±58.75KJ,and the energy efficiency factor(EEF)is 1.6±0.3J/mm~3,It was significantly lower than the control group.In the control group,the average sonication power is 399.4±1.9W,the average treatment time is 181.3±36.3min,the average sonication time is 2824.1±419.8s,the average total energy used is 1127.76±165.44KJ,and the EEF is 10.9±6.3 J/mm~3.There were significant differences in the ablation treatment parameters between the two groups(P<0.05).The incidence of complications during and after the two groups of ablation treatment was as follows:In the CEUS group,the incidence of sacrococcygeal pain,skin burn,pain in treatment zon,groin pain,sensation of rectal tenesmus,leg pain,fever,lower abdominal pain,paresthesia of lower limb,vaginal discharge,skin injury and anal distention were respectively:11.8%(4/34),0,23.5%(8/34),0,2.9%(1/34),0,8.8%(3/34),5.9%(2/34),0,5.9%(2/34),0,2.9%(1/34);In the control group,there were respectively 16.7%(5/30),0,20.0%(6/30),3.3%(1/30),6.7%(2/30),3.3%(1/30),10.0%(3/30),13.3%(4/30),3.3%(1/30),10.0%(3/30),0,3.3%(1/30).No statistically significant differences were noted in the adverse effects,except in the sacrococcygeal pain(P=0.045)that varied significantly between the two groups.Conclusion1.Immediately after the entry of the contrast medium into the target area,HIFU ablation can play the strongest synergistic effect in meeting the individual differences and achieve the purpose of precisely and efficiently ablation different patients.2.Sonazoid-based CEUS performed for 30 min pre-HIFU is feasible and safe with successful ablation with a potential to enhance the ablation of uterine fibroid with HIFU treatment. |
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