影响 USgHIFU 消融治疗 NPVR≥50 的子宫腺肌病的因素。
Factors influencing USgHIFU ablation for adenomyosis with NPVR ≥ 50.
机构信息
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
College of Medical Informatics, Chongqing Medical University, Chongqing, China.
出版信息
Int J Hyperthermia. 2023;40(1):2211753. doi: 10.1080/02656736.2023.2211753.
OBJECTIVE
To investigate the influencing factors of ultrasound-guided HIFU (USgHIFU) ablation for adenomyosis with a non-perfused volume ratio (NPVR)≥50%.
METHODS
A total of 299 patients with adenomyosis who underwent USgHIFU ablation were enrolled. Quantitative signal intensity (SI) analysis was performed on T2WI and dynamic enhancement type. The energy efficiency factor (EEF) was defined as the ultrasound energy delivered for ablating 1 mm of tissue. NPVR ≥ 50% was used as the criterion for technical success. Adverse effects and complications were recorded. Logistic regression analyses of variables were conducted to identify the factors affecting NPVR ≥ 50%.
RESULTS
The median NPVR was 53.5% (34.7%). There were 159 cases in the NPVR ≥ 50% group and 140 cases in the NPVR < 50% group. The EEF in NPVR < 50.0% group was significantly higher than that in NPVR ≥ 50% group ( < 0.05). The incidence of intraoperative adverse effects and postoperative adverse events in the NPVR < 50% group were higher than those in the NPVR ≥ 50% group ( < 0.05 for both). Logistic regression analysis showed that abdominal wall thickness, SI difference on T2WI between adenomyosis and rectus abdominis, and enhancement type on T1WI were protective factors for NPVR ≥ 50% ( < 0.05), while the history of childbirth was an independent risk factor ( < 0.001).
CONCLUSIONS
Compared with NPVR < 50%, NPVR ≥ 50% did not increase the intraprocedural and postprocedural adverse reactions. The possibility of NPVR ≥ 50% was higher in patients with thinner abdominal walls, showed slight enhancement of adenomyosis on T1WI, with a history of childbirth, or in whom the SI difference on T2WI between adenomyosis and rectus abdominis was more minor.
目的
探讨非灌注体积比（NPVR）≥50%的超声引导高强度聚焦超声（USgHIFU）消融治疗子宫腺肌病的影响因素。
方法
共纳入 299 例接受 USgHIFU 消融治疗的子宫腺肌病患者。对 T2WI 和动态增强型进行定量信号强度（SI）分析。能量效率因子（EEF）定义为消融 1mm 组织所需的超声能量。以 NPVR≥50%为技术成功标准。记录不良反应和并发症。对变量进行逻辑回归分析，以确定影响 NPVR≥50%的因素。
结果
NPVR 的中位数为 53.5%（34.7%）。NPVR≥50%组 159 例，NPVR<50%组 140 例。NPVR<50.0%组的 EEF 明显高于 NPVR≥50%组（<0.05）。NPVR<50.0%组术中不良反应和术后不良事件的发生率高于 NPVR≥50%组（均<0.05）。逻辑回归分析显示，腹壁厚度、子宫腺肌病与腹直肌 T2WI 上的 SI 差值以及 T1WI 上的增强类型是 NPVR≥50%的保护因素（均<0.05），而分娩史是独立危险因素（<0.001）。
结论
与 NPVR<50%相比，NPVR≥50%并未增加术中及术后不良反应。腹壁较薄、T1WI 上子宫腺肌病呈轻度强化、有分娩史、或子宫腺肌病与腹直肌 T2WI 上 SI 差值较小的患者，NPVR≥50%的可能性更高。
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