磁共振引导高强度聚焦超声治疗子宫肌瘤后弥散加权成像、T2 加权成像和增强 T1 加权成像的比较：初步结果。
Comparison between diffusion-weighted imaging, T2-weighted, and postcontrast T1-weighted imaging after MR-guided, high intensity, focused ultrasound treatment of uterine leiomyomata: preliminary results.
机构信息
The Russell H. Morgan Department of Radiology and Radiological Science, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, USA.
出版信息
Med Phys. 2010 Sep;37(9):4768-76. doi: 10.1118/1.3475940.
PURPOSE
To investigate the comparison between diffusion-weighted imaging (DWI), T2-weighted imaging, (T2WI) and contrast T1-weighted imaging (cT1WI) in uterine leiomyoma following treatment by magnetic resonance imaging-guided, high intensity focused ultrasound surgery (MRg-HIFUS).
METHODS
Twenty one patients (45 +/- 5 yrs) with clinical symptoms of uterine leiomyoma (fibroids) were treated by MRg-HIFUS using an integrated 1.5T MRI-HIFUS system. MRI parameters consisted of DWI, T2WI, and T1-weighted fast spoiled gradient echo before and after contrast. The post-MRg-HIFUS treatment volume in the fibroid was assessed by cT1WI and DWI. Trace apparent diffusion coefficient maps were constructed for quantitative analysis. The regions of the treated uterine tissue were defined by a semisupervised segmentation method called the "eigenimage filter," using both cT1WI and DWI. Signal-to-noise ratios were determined for the T2WI pretreatment images. Segmented regions were tested by a similarity index for congruence. Descriptive, regression, and Bland-Altman statistics were calculated.
RESULTS
All the patients exhibited heterogeneously increased DWI signal intensity localized in the treated fibroid regions and were colocalized with the cT1WI defined area. The mean pretreatment T2WI signal intensity ratios were T2WI/muscle = 1.8 +/- 0.7 and T2WI/myometrium = 0.7 +/- 0.4. The congruence between the regions was significant, with a similarity of 84% and a difference of 8% between the regions. Regression analyses of the cT1WI and DWI segmented treatment volume were found to be significantly correlated (r2 = 0.94, p < 0.05) with the linear equation, (cT1WI) = 1.1 (DWI)-0.66. There is good agreement between the regions defined by cT1WI and DWI in most of the cases as shown from the Bland-Altman plots.
CONCLUSIONS
Diffusion-weighted imaging exhibited excellent agreement, congruence, and correlation with the cT1WI-defined region of treatment in uterine fibroid. Therefore, DWI could be useful as an adjunct for assessing treatment of uterine fibroids by MRg-HIFUS.
目的
探讨磁共振引导高强度聚焦超声治疗（MRg-HIFU）后子宫肌瘤弥散加权成像（DWI）、T2 加权成像（T2WI）和对比增强 T1 加权成像（cT1WI）的比较。
方法
21 例有子宫肌瘤（肌瘤）临床症状的患者（45±5 岁）采用 1.5T MRI-HIFUS 系统进行 MRg-HIFU 治疗。MRI 参数包括 DWI、T2WI 和 cT1WI 对比前后的 T1 加权快速扰相梯度回波。通过 cT1WI 和 DWI 评估肌瘤治疗后的体积。构建表观弥散系数图谱进行定量分析。采用“特征图像滤波器”的半监督分割方法，利用 cT1WI 和 DWI 定义治疗后的子宫组织区域。确定 T2WI 预处理图像的信噪比。通过相似性指数测试分割区域的一致性。计算描述性、回归和 Bland-Altman 统计。
结果
所有患者均表现为治疗性肌瘤区域的弥散加权信号强度不均匀增加，并与 cT1WI 定义的区域相一致。预处理 T2WI 信号强度比的平均值为 T2WI/肌肉=1.8±0.7 和 T2WI/子宫肌层=0.7±0.4。区域之间的一致性显著，相似性为 84%，差异为 8%。cT1WI 和 DWI 分割治疗体积的回归分析发现具有显著相关性（r2=0.94，p<0.05），线性方程为（cT1WI）=1.1（DWI）-0.66。从 Bland-Altman 图可以看出，cT1WI 和 DWI 定义的区域在大多数情况下具有良好的一致性。
结论
弥散加权成像与子宫肌瘤 cT1WI 定义的治疗区域具有极好的一致性、一致性和相关性。因此，DWI 可作为评估磁共振引导高强度聚焦超声治疗子宫肌瘤的辅助手段。
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