不同大小子宫肌瘤单次超声引导下高强度聚焦超声消融的剂量与有效性比较
Comparison of Dose and Effectiveness of a Single-Session Ultrasound-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids With Different Sizes.
作者信息
Yang Mei-Jie, Yu Ren-Qiang, Chen Jin-Yun, Wang Zhi-Biao
机构信息
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Medical Informatics, Chongqing Medical University, Chongqing, China.
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Oncol. 2021 Dec 21;11:725193. doi: 10.3389/fonc.2021.725193. eCollection 2021.
PURPOSE
This study aimed to compare the dose and effectiveness of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids with different sizes and explore the effect of uterine fibroid size on dose, which provided dose evaluation for clinicians in accordance with the size of uterine fibroids.
MATERIALS AND METHODS
A total of 1,000 patients with symptomatic uterine fibroids who received a single-session USgHIFU treatment were enrolled in this study. The size of fibroids was divided into seven groups: 3-4 cm, 4-5 cm, 5-6 cm, 6-7 cm, 7-8 cm, 8-9 cm, and 9-11 cm. The dose was expressed on the basis of the energy efficiency factor (EEF) as the energy required for ablation per unit volume of tissue, and the non-perfused volume ratio (NPVR) was used to assess the effect of HIFU ablation.
RESULTS
The median NPVR of 88.3% (IQR: 80.3%-94.8%) was obtained, and no significant difference was observed among the seven groups. The classification of T2-weighted image signal intensity fibroids in the 4-5 cm group was compared with that in the 6-7 cm and 8-9 cm groups, and the difference was significant ( < 0.05). However, the proportion of T2WI hyperintense signal fibroids had no significant difference among the seven groups ( > 0.05). The median EEF was 3.88 J/mm, and a significant difference was observed among the seven groups of EEF ( < 0.05). The EEF of groups with a fibroid size less than 6 cm was more than double the EEF of groups with a fibroid size above 6 cm. In addition, the EEF of groups with a fibroid size of 4-5 cm and 3-4 cm was 3-4 times higher than those with a fibroid size above 7 cm ( < 0.05).
CONCLUSIONS
A single-session HIFU ablation for uterine fibroids of 3-11 cm can obtain an NPVR of more than 80%. The EEF decreased with the increase of the size of uterine fibroids. A fibroid size of 6.5 cm was considered as a clinical meaningful point affecting EEF.
目的
本研究旨在比较不同大小子宫肌瘤的超声引导下高强度聚焦超声（USgHIFU）消融剂量及有效性，探讨子宫肌瘤大小对剂量的影响，为临床医生根据子宫肌瘤大小进行剂量评估提供依据。
材料与方法
本研究共纳入1000例接受单次USgHIFU治疗的有症状子宫肌瘤患者。肌瘤大小分为七组：3 - 4 cm、4 - 5 cm、5 - 6 cm、6 - 7 cm、7 - 8 cm、8 - 9 cm和9 - 11 cm。剂量以能量效率因子（EEF）表示，即每单位体积组织消融所需能量，采用无灌注体积比（NPVR）评估HIFU消融效果。
结果
获得的NPVR中位数为88.3%（四分位间距：80.3% - 94.8%），七组间未观察到显著差异。比较4 - 5 cm组与6 - 7 cm组及8 - 9 cm组子宫肌瘤T2加权像信号强度分类，差异有统计学意义（<0.05）。然而，七组间T2WI高信号肌瘤比例差异无统计学意义（>0.05）。EEF中位数为3.88 J/mm，七组EEF间差异有统计学意义（<0.05）。肌瘤大小小于6 cm组的EEF是肌瘤大小大于6 cm组的两倍多。此外，肌瘤大小为4 - 5 cm组和3 - 4 cm组的EEF比肌瘤大小大于7 cm组高3 - 4倍（<0.05）。
结论
对3 - 11 cm子宫肌瘤进行单次HIFU消融可获得超过80%的NPVR。EEF随子宫肌瘤大小增加而降低。肌瘤大小6.5 cm被认为是影响EEF的临床意义关键点。
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