Liu Yuhang, Lv Furong, Liu Yang, Zhong Yuqing, Qin Ying, Lv Fajin, Xiao Zhibo
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
Quant Imaging Med Surg. 2024 Jan 3;14(1):179-193. doi: 10.21037/qims-23-323. Epub 2024 Jan 2.
The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI).
A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury.
Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury.
Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.
高强度聚焦超声（HIFU）在子宫肌瘤治疗中的应用日益广泛，术后对邻近组织的附带热损伤已成为一个突出的讨论话题。然而，关于骨损伤的研究有限。因此，本研究的目的是利用磁共振成像（MRI）调查影响HIFU消融子宫肌瘤后无意盆腔骨损伤的潜在因素。
纳入重庆医科大学附属第一医院635例接受HIFU治疗的子宫肌瘤患者。所有患者在HIFU治疗前后均接受对比增强MRI（CE-MRI）检查。根据治疗后的MRI，将患者分为两组：盆腔骨损伤组和无损伤组，同时记录每位患者盆腔骨损伤的具体部位。采用单因素和多因素分析评估肌瘤特征和治疗参数与盆腔骨损伤之间的相关性，并进一步分析影响损伤部位的因素。
HIFU治疗后，51%（324/635）的患者在CE-MRI上观察到盆腔信号改变。其中，269例（42.4%）患者发生骶骨损伤，135例（21.3%）患者发生耻骨损伤。多因素分析显示，年龄较大的患者[P=0.003；比值比（OR），1.692；95%置信区间（CI）：1.191-2.404]、肌瘤前侧至皮肤距离较大（P<0.001；OR，2.297；95%CI：1.567-3.365）、后壁肌瘤（P=0.006；OR，1.897；95%CI：1.204-2.989）、T2加权成像（T2WI）上高信号（P=新问题0.003；OR，2.125；95%CI：1.283-3.518）以及治疗剂量较大（TD，P<0.001；OR，3.007；95%CI：2.093-4.319）的患者术后发生盆腔骨损伤的风险较高。对影响盆腔骨损伤部位的因素进一步分析表明，一些肌瘤特征和治疗参数与之相关。此外，一些术后疼痛相关不良事件与盆腔骨损伤有关。
HIFU治疗后，患者可能会出现骶骨、耻骨或两者联合的盆腔损伤，其中一些患者经历了不良事件。一些肌瘤特征和治疗参数与损伤有关。术前充分考虑其影响因素，减慢治疗速度，延长术中冷却期，有助于优化HIFU治疗决策。
