Sethi Rajni, Kuo Yueh Chun, Edraki Babak, Lerner Dimitry, Paik Daniel, Bice William
Department of Radiation, John Muir Health, Walnut Creek, CA.
Department of Radiation, John Muir Health, Walnut Creek, CA.
Brachytherapy. 2018 Sep-Oct;17(5):742-746. doi: 10.1016/j.brachy.2018.04.006. Epub 2018 May 31.
Doppler ultrasound (US) gives real-time information regarding anatomy and blood vessel location to guide needle placement for gynecologic interstitial (IS) brachytherapy (BT). We retrospectively assessed Doppler US images for vessel quantity, size, and distribution in cervical cancer patients undergoing high-dose-rate BT at our institution.
Eleven consecutive patients undergoing IS high-dose-rate BT implants for cervical cancer between 2015 and 2017 were included. Transrectal Doppler US was used for real-time image guidance. US images were retrospectively evaluated. Vessel quantity, size, and distribution at superior and inferior levels of the cervix were recorded. Correlation of vessel quantity with tumor size and International Federation of Gynecology and Obstetrics stage was evaluated.
Average vessel quantity was 4.2 in the inferior cervix and 3.8 in the superior cervix (range 1-11). Median vessel diameter was 2 mm in the inferior cervix and 2 mm in the superior cervix (range 1-6 mm). The most common location was posterolateral (3:00-5:00 and 7:00-9:00), outer third (78% of vessels inferiorly, 64% of vessels superiorly). Vessel quantity was correlated to initial tumor size superiorly (p = 0.04, paired t-test) but not inferiorly (p = 0.31, paired t-test). There was no correlation between vessel quantity and International Federation of Gynecology and Obstetrics stage (p > 0.05, analysis of variance). Doppler US was successfully used to guide needle placement away from visualized blood vessels with no incidents of hemorrhage in these patients.
Doppler US is a useful tool to guide needle placement for IS BT for cervical cancer. Vessel quantity varied with increased vessel quantity seen higher in the cervix for larger tumors. Vessels were most commonly distributed in the outer third of the posterolateral cervix.
多普勒超声（US）可提供有关解剖结构和血管位置的实时信息，以指导妇科间质内近距离放射治疗（BT）的针置入。我们回顾性评估了在本机构接受高剂量率BT的宫颈癌患者的多普勒超声图像，以了解血管数量、大小和分布情况。
纳入2015年至2017年间连续11例接受宫颈癌间质内高剂量率BT植入的患者。经直肠多普勒超声用于实时图像引导。对超声图像进行回顾性评估。记录宫颈上下层面的血管数量、大小和分布。评估血管数量与肿瘤大小及国际妇产科联盟（FIGO）分期的相关性。
宫颈下部平均血管数量为4.2条，宫颈上部为3.8条（范围1 - 11条）。宫颈下部血管直径中位数为2mm，宫颈上部为2mm（范围1 - 6mm）。最常见的位置是后外侧（3:00 - 5:00和7:00 - 9:00），外1/3处（宫颈下部血管的78%，宫颈上部血管的64%）。血管数量与宫颈上部的初始肿瘤大小相关（p = 0.04，配对t检验），但与宫颈下部无关（p = 0.31，配对t检验）。血管数量与国际妇产科联盟分期之间无相关性（p > 0.05，方差分析）。在这些患者中，多普勒超声成功用于引导针远离可见血管放置，未发生出血事件。
多普勒超声是指导宫颈癌间质内近距离放射治疗针置入的有用工具。血管数量因肿瘤较大时在宫颈较高位置可见血管数量增加而有所不同。血管最常见分布于宫颈后外侧的外1/3处。
