deSouza N M, McMillan D L, Puni R K, Coutts G A, Hall A S, Harris D N, Young I R
Robert Steiner Magnetic Resonance Unit, Royal Postgraduate Medical School Hammersmith Hospital, London, United Kingdom.
AJR Am J Roentgenol. 1996 Nov;167(5):1121-6. doi: 10.2214/ajr.167.5.8911162.
Our objective was to study the appearance of the uterus on MR images obtained during and 3 months after laser ablation of the endometrium and to determine if a correlation exists between the MR imaging findings and the subsequent clinical outcome. The appearance could then be used to guide the application of laser energy during the procedure to optimize the clinical result.
Eight women 34-55 years old (mean, 42 years old) with symptoms of heavy, painful menses underwent laser ablation under epidural anesthesia. Imaging was done on a 0.5-T Picker Asset system with a pelvic phased-array receiver coil using conventional T1-weighted spin-echo, T2-weighted spin-echo, and gradient-recalled-echo sequences. Images were obtained preoperatively, after ablation of the anterior surface, after completion of the procedure, and 3 months later. Images were visually assessed for signal intensity changes in the endometrium and myometrium by two observers in conference. Images were quantitatively analyzed by measuring uterine volume and the width of the endometrium, junctional zone (JZ), and outer myometrium (OM) on the T2-weighted images. Preoperative and 3-month postoperative symptom scores including duration, amount of bleeding, and associated pain were recorded.
MR images obtained immediately after treatment showed an increase in the volume of the uterus (mean, 21%). Endometrial thickness increased in five patients, and the JZ:OM ratio increased on the T2-weighted scans in six patients. The increase in the ratio probably represented myometrial edema. Two patients with persistent symptoms were treated with hysterectomy 6 weeks postoperatively. Of the remaining six patients, five showed an improvement in symptom scores after 3 months. The uterus returned to its preoperative size after 3 months in three patients, endometrial thinning was noted in two, and the JZ:OM ratio remained increased in two. The difference between the mean improvement in symptom scores at 3 months was significant in the patients with and without the endometrial swelling seen immediately after treatment. No statistically significant correlation existed between the amount of perioperative uterine swelling or the increase in JZ:OM ratio and the improvement in symptom scores at 3 months.
On laser ablation of the endometrium, MR imaging showed significant immediate uterine swelling as well as an increase in the endometrial thickness and JZ:OM ratio. The presence of immediate endometrial swelling and the reduction in the JZ:OM ratio after 3 months correlated with a subsequent improvement in symptom scores. Perioperative endometrial swelling rather than myometrial changes is therefore an indicator of clinical outcome.
我们的目的是研究子宫内膜激光消融术中及术后3个月所获得的磁共振（MR）图像上子宫的表现，并确定MR成像结果与随后的临床结局之间是否存在相关性。然后，这种表现可用于在手术过程中指导激光能量的应用，以优化临床结果。
8名年龄在34至55岁（平均42岁）、有月经过多和痛经症状的女性在硬膜外麻醉下接受了激光消融术。使用盆腔相控阵接收线圈，在0.5-T的Picker Asset系统上采用常规T1加权自旋回波、T2加权自旋回波和梯度回波序列进行成像。在术前、前壁消融后、手术完成后及3个月后获取图像。由两名观察者在会诊时对图像进行视觉评估，观察子宫内膜和肌层的信号强度变化。通过在T2加权图像上测量子宫体积、子宫内膜、交界区（JZ）和外层肌层（OM）的宽度进行定量分析。记录术前和术后3个月的症状评分，包括持续时间、出血量和相关疼痛。
治疗后立即获得的MR图像显示子宫体积增大（平均增大21%）。5例患者的子宫内膜厚度增加，6例患者的T2加权扫描上JZ:OM比值增加。该比值的增加可能代表肌层水肿。2例症状持续的患者在术后6周接受了子宫切除术。其余6例患者中，5例在3个月后症状评分有所改善。3个月后，3例患者的子宫恢复到术前大小，2例患者子宫内膜变薄，2例患者的JZ:OM比值仍升高。治疗后立即出现子宫内膜肿胀和未出现子宫内膜肿胀的患者在3个月时症状评分的平均改善差异显著。围手术期子宫肿胀程度或JZ:OM比值的增加与3个月时症状评分的改善之间不存在统计学上的显著相关性。
子宫内膜激光消融术后，MR成像显示子宫立即出现明显肿胀，同时子宫内膜厚度和JZ:OM比值增加。治疗后立即出现的子宫内膜肿胀以及3个月后JZ:OM比值的降低与随后症状评分的改善相关。因此，围手术期子宫内膜肿胀而非肌层变化是临床结局的一个指标。
