Effects of a microbubble ultrasound contrast agent on high-intensity focused ultrasound for uterine fibroids: a randomised controlled trial

Objective: To investigate the effects of a microbubble ultrasound contrast agent on high-intensity focused ultrasound (HIFU) treatment of uterine fibroids.

Methods: A total of 120 patients with solitary uterine fibroid were randomly assigned into Groups A, B, C and D. Patients in Groups A and B received 1.5?ml of SonoVue, Groups C and D received 1.5?ml of saline before HIFU ablation. HIFU sonication started at 6?min after administration of SonoVue or saline in Groups A and C, whereas it started at 10?min in Groups B and D. On day 1 after HIFU, magnetic resonance imaging was performed. Patients were followed up via phone or clinic visit during the first week after HIFU.

Results: No significant difference was observed in terms of age, fibroid location, diameter of fibroids, signal intensity on T2-weighted imaging, or tumour volume among the four groups (p?>?0.05). The use of SonoVue significantly shortened the treatment time and sonication time. The sonication start time of 6?min, relative to 10?min, had significant effects on the treatment time and sonication time. The use of intravenous SonoVue followed by HIFU ablation 6?min later significantly increased the rate of significant grey-scale changes (55.9%) and the non-perfused volume ratio (94.2%?±?10.6%). No significant differences were observed in the incidence of intra-procedure and post-HIFU adverse effects among the four groups (p?>?0.05).

Conclusions: SonoVue could be safely used to enhance the ablation effects of HIFU treatment of uterine fibroids.     

A comparison of ultrasound-guided high intensity focused ultrasound for the treatment of uterine fibroids in patients with an anteverted uterus and a retroverted uterus

Objective: The aim of this study was to compare the treatment outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids in patients with an anteverted uterus versus a retroverted uterus.

Materials and methods: Based on the principles of statistics we enrolled 221patients with an anteverted uterus and 221 with a retroverted uterus. All patients had a solitary uterine fibroid and every fibroid was identified as hypointense on the T2 weighted images (T2WI) on magnetic resonance. The baseline characteristics of the patients, treatment results and adverse events were compared between the two groups.

Results: There were no significant differences in baseline characteristics between the two groups. The average non-perfused volume ratio of fibroids was 85.2?±?18.7% in the group of patients with a retroverted uterus, while it was 87.7?±?11.8% in patients with an anteverted uterus (P?Conclusion: The results of this study indicated that uterine fibroids with hypointensity on T2WI in a retroverted uterus can be safely and effectively treated with USgHIFU. However, the fibroids in an anteverted uterus are easier to treat with USgHIFU.     

Factors influencing the ablative efficiency of high intensity focused ultrasound (HIFU) treatment for adenomyosis: A retrospective study

Objectives The aim of this study was to investigate factors affecting ablative efficiency of high intensity focused ultrasound (HIFU) for adenomyosis. Materials and methods In all, 245 patients with adenomyosis who underwent ultrasound guided HIFU (USgHIFU) were retrospectively reviewed. All patients underwent dynamic contrast-enhanced magnetic resonance imaging (MRI) before and after HIFU treatment. The non-perfused volume (NPV) ratio, energy efficiency factor (EEF) and greyscale change were set as dependent variables, while the factors possibly affecting ablation efficiency were set as independent variables. These variables were used to build multiple regression models. Results A total of 245 patients with adenomyosis successfully completed HIFU treatment. Enhancement type on T1 weighted image (WI), abdominal wall thickness, volume of adenomyotic lesion, the number of hyperintense points, location of the uterus, and location of adenomyosis all had a linear relationship with the NPV ratio. Distance from skin to the adenomyotic lesion’s ventral side, enhancement type on T1WI, volume of adenomyotic lesion, abdominal wall thickness, and signal intensity on T2WI all had a linear relationship with EEF. Location of the uterus and abdominal wall thickness also both had a linear relationship with greyscale change. Conclusion The enhancement type on T1WI, signal intensity on T2WI, volume of adenomyosis, location of the uterus and adenomyosis, number of hyperintense points, abdominal wall thickness, and distance from the skin to the adenomyotic lesion’s ventral side can all be used as predictors of HIFU for adenomyosis.     

High intensity focused ultrasound ablation for submucosal fibroids: A comparison between type I and type II

Abstract

Objective: The aim of this study was to compare high-intensity focused ultrasound (HIFU) treatment for type I and type II submucosal fibroids. Materials and methods: From October 2011 to October 2013, 55 patients with submucosal fibroids were enrolled in this study. Based on submucosal fibroid classification, 27 patients were grouped as type I submucosal fibroids, and 28 patients were classified as type II submucosal fibroids. All patients received HIFU treatment and completed 1-, 6-, and 12-month follow-ups. Adverse effects were recorded. Results: There were no significant differences in the baseline characteristics between the two groups (p?>?0.05). Using similar sonication power, sonication time, and acoustic energy, the non-perfused volume (NPV) ratio was 83.0?±?17.3% in the type I group, and 92.0?±?9.5% in the type II group. All the patients tolerated the procedure well, and no serious adverse events occurred. During the follow-up intervals, the treated fibroids shrank and fibroid-related symptoms were relieved. No other reinterventional procedures were performed during the follow-up period. Conclusion: Based on our results with a small number of subjects, HIFU is suitable for both type I and type II submucosal fibroids. It seems that type II submucosal fibroids are more sensitive to HIFU ablation. Future studies with larger sample sizes and longer follow-up times to investigate the long-term results, including long-term symptom relief, pregnancy outcomes, and the recurrence rate as well as the reintervention rate are needed.     

Factors influencing thermal injury to skin and abdominal wall structures in HIFU ablation of uterine fibroids

Objective: To investigate the factors which may cause thermal injury of abdominal wall structures in ultrasound-guided high-intensity focussed ultrasound (USgHIFU) ablation of uterine fibroids.

Method: A total of 892 patients with uterine fibroids diagnosed on contrast-enhanced magnetic resonance imaging (MRI) scans received HIFU ablation and follow-up MRI scanning. After therapy, thermal injury to the skin was assessed via measurement of skin redness, blisters, subcutaneous nodules and to the abdominal wall structures via measurement of signal intensity on T2-weighted MRI images. A total of 151 patients were assigned to the injury group, 741 patients were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were analysed using univariate and multiple logistic regression analyses.

Results: Univariate logistic regression revealed that sonication time, sonication time per hour, total energy deposited, distance from uterine fibroid ventral side to skin, volume of uterine fibroids, abdominal wall scar, abdominal wall thickness and body mass index (BMI) all affected whether thermal injury occurred (p?p?=?0.000, OR?=?2.228, 95% CI 1.831–2.712), abdominal wall scar (p?=?0.019, OR?=?1.639, 95% CI 1.085–2.477) and abdominal wall thickness (p?=?0.000, OR?=?1.562, 95% CI 1.313–1.857) were significantly correlated with thermal injury.

Conclusion: Multiple logistic regression analysis revealed that abdominal wall thickness, total energy and abdominal wall scar were the most significant influencing factors that influenced minimal thermal injury of abdominal wall structures in USgHIFU ablation of uterine fibroids.     

Factors influencing MR changes associated with sacral injury after high-intensity focused ultrasound ablation of uterine fibroids

Purpose: We investigated the risk factors influencing MR changes associated with sacral injury from ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids.

Methods: We retrospectively analyzed a total of 346 patients with symptomatic uterine fibroids who received USgHIFU ablation. All of the patients underwent contrast-enhanced magnetic resonance imaging (CE-MRI) before and after treatment. Injury to the sacrum was set as the dependent variable, while fibroid features and the treatment parameters were set as independent variables. These variables were used to assess respectively their correlation with sacral injury by using univariate and multivariate analyses.

Results: The results of univariate analysis revealed that the volume, distance from the fibroid to the skin, maximal diameter, distance from the fibroid to the sacrum, fibroid types, degree of enhancement, therapeutic dosimetry (TD), energy efficiency factor (EEF) and non-perfused volume (NPV) ratio manifested significant correlations with the sacral injury (p?<?.05). Multivariate analysis showed that the degree of enhancement, TD and EEF were independent risk factors for sacral injury (p?<?.05), while the distance from fibroid to sacrum and intramural or subserosal types were protective factors (p?<?.05). The incidence of sacral tail pain and leg pain showed a significant positive correlation with sacral injury (p?<?.05).

Conclusion: As important affecting factors, the degree of enhancement, distance from fibroid to sacrum and fibroid types all possess significant correlations with MR changes associated with sacral injury.     

A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa

Objective: To evaluate the shrinkage rate, symptom relief and improvement of the quality of life following ultrasound-guided high intensity focussed ultrasound (USgHIFU) for multiple uterine fibroids.

Methods: From October 2015 to November 2016, 81 black women with multiple symptomatic fibroids underwent USgHIFU. The number of the fibroids ranged from 3 to 9. The shrinkage rate of fibroids, symptom severity score and quality of life were evaluated following USgHIFU. Magnetic resonance imaging (MRI), the uterine fibroid symptom and quality of life (UFS-QOL) questionnaire were used for evaluation.

Results: The mean age of patients was 35.3?±?5.9 years. The average weight of these patients was 68.4?±?11.4?kg, with the median abdominal subcutaneous fat thickness of 38.0?±?11.4?mm. The median fibroid volume was 36.0 (range: 1.8–1220.1) cm³. During HIFU, 60.5% of the patients reported lower abdominal pain, 43.2% sciatic/buttock pain, 60.5% skin “burning” sensation, 6.2% abnormal vaginal discharge and 13.6% transient leg pain. No severe complications were observed. The average volume reduction rate of fibroids in 21 patients who completed the follow-up was 32.5?±?24.0, 42.3?±?32.2 and 52.5?±?36.3% 1, 3 and 6 months after HIFU, respectively. The UFS score decreased and the QOL values significantly increased during the follow-up period. Re-intervention treatment occurred in two of the 21 patients 6 months after HIFU. One patient conceived 3 months after HIFU, and she had a term vaginal delivery without any obstetrical complications.

Conclusions: Based on our results, USgHIFU is safe and effective in treating patients with multiple uterine fibroids.     

Mechanical fractionation of tissues using microsecond-long HIFU pulses on a clinical MR-HIFU system

Purpose: High intensity focussed ultrasound (HIFU) can non-invasively treat tumours with minimal or no damage to intervening tissues. While continuous-wave HIFU thermally ablates target tissue, the effect of hundreds of microsecond-long pulsed sonications is examined in this work. The objective of this study was to characterise sonication parameter-dependent thermomechanical bioeffects to provide the foundation for future preclinical studies and facilitate clinical translation.

Methods and materials: Acoustic power, number of cycles/pulse, sonication time and pulse repetition frequency (PRF) were varied on a clinical magnetic resonance imaging (MRI)-guided HIFU (MR-HIFU) system. Ex vivo porcine liver, kidney and cardiac muscle tissue samples were sonicated (3?×?3 grid pattern, 1?mm spacing). Temperature, thermal dose and T2 relaxation times were quantified using MRI. Lesions were histologically analysed using H&;E and vimentin stains for lesion structure and viability.

Results: Thermomechanical HIFU bioeffects produced distinct types of fractionated tissue lesions: solid/thermal, paste-like and vacuolated. Sonications at 20 or 60?Hz PRF generated substantial tissue damage beyond the focal region, with reduced viability on vimentin staining, whereas H&;E staining indicated intact tissue. Same sonication parameters produced dissimilar lesions in different tissue types, while significant differences in temperature, thermal dose and T2 were observed between the parameter sets.

Conclusion: Clinical MR-HIFU system was utilised to generate distinct types of lesions and to produce targeted thermomechanical bioeffects in ex vivo tissues. The results guide HIFU research on thermomechanical tissue bioeffects, inform future studies and advice sonication parameter selection for direct tumour ablation or immunomodulation using a clinical MR-HIFU system.     

Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study

Objectives: To evaluate the efficacy and safety of GnRH-α pre-treatment with HIFU ablation for diffuse adenomyosis.

Methods: From January 2014 to December 2016, 61 patients were divided into two groups. Twenty-three patients with larger uteri received pre-treatment with GnRH-α and were then subjected to HIFU, and 38 patients underwent HIFU alone. The technical parameters included treatment time, sonication time, average sonication power, treatment intensity, total energy, non-perfusion volume (NPV) and NPV ratio. Intra-, post-procedural complaints, the relief rate of dysmenorrhoea and clinical effectiveness were followed up.

Results: Although the lesion volume in the HIFU?+?GnRH group was larger than in the HIFU-only group, higher NPV, NPVR%, treatment intensity and total energy with shorter treatment and sonication times in the HIFU?+?GnRH group were obtained than that in the HIFU-only group. Significant differences were evident for NPV, NPVR%, average power, and total intensity energy (p?<?0.05), but not for other parameters between the two groups (p?>?0.05).

Although no differences in the intra-, post-procedural VAS scores, in the adverse effects and in the relief rate or clinical effectiveness were apparent between the two groups (p?>?0.05), the relief rate was better in the HIFU?+?GnRH group than that in the HIFU group from 6 to 12 months after treatment. Self-comparison of differences occurred in the two groups before and after treatment (p?<?0.05) and were between the two groups after only 6 months (p?<?0.05).

Conclusion: The combination of HIFU with GnRH-α is more effective than HIFU alone for ablation of diffuse adenomyosis. Moreover, the GnRH-α pre-treatment with HIFU is safe.     

Magnetic resonance texture parameters are associated with ablation efficiency in MR-guided high-intensity focussed ultrasound treatment of uterine fibroids

Objectives: The objective of this study is to assess the association between texture parameter analysis derived from T2-weighted images and efficiency of magnetic resonance-guided focussed ultrasound (MRgFUS) ablation for the treatment of uterine fibroids.

Materials and methods: Fifty-five women treated by MRgFUS were included in this retrospective analysis. Texture parameters were calculated using three 2D regions of interest placed on three consecutive slices on the same sagittal 3D T2-weighted images obtained at the beginning of MRgFUS ablation. Using uni- and multi-variate linear regression, texture parameters, fibroids/muscular T2W ratio (T2Wr), Funaki type, and fibroid depth were correlated with ablation efficiency, defined as the ratio of non-perfused volume (NPV) on post-treatment contrast-enhanced MRI by total volume of treatment-cell sizes used. Inter-rater reproducibility for texture analysis was assessed using variation coefficients.

Results: The mean total treatment cell volume was 49.5 (±30) ml, corresponding to a mean NPV of 57.2 (±57) ml (28%). The mean ablation efficiency was 1.14 (±0.7), with a range of 0.03–3.6. In addition to fibroid/muscular T2Wr, seven of the 14 texture parameters were significantly correlated with ablation efficiency: mean signal intensity (p?=?.047); Skewness (p?=?.03); Kurtosis (p?=?.015); mean uniformity (p?=?.052); mean sum of square (p?=?.045); mean sum entropy (p?=?.021) and mean entropy (p?=?.051). In multivariate linear regression, fibroid/muscular T2Wr and sum of entropy were associated with ablation efficiency. The inter-rater coefficient of variation for sum entropy was 2.6%.

Conclusions: Uterine fibroid texture parameters provide complementary information to T2Wr, and are associated with MRgFUS efficiency.

• Key points

• Mean sum entropy is negatively correlated with MRgFUS efficiency (ρ?=??0.307, p?=?.021).

• Fibroids/muscular T2-weighted ratio and entropy are associated with MRgFUS efficiency.

• Texture parameters are better predictors of MRgFUS efficiency than Funaki type.

• Fibroid MR texture analysis can improve patient selection for MRgFUS.

     

Reasons for different therapeutic effects of high-intensity focused ultrasound ablation on excised uterine fibroids with different signal intensities on T2-weighted MRI: a study of histopathological characteristics

Objective: The objective of this study was to explore the correlations between the therapeutic effect of high intensity focused ultrasound (HIFU) and histopathological characteristics of excised uterine fibroids with different signal intensities as visualized on T2-weighted magnetic resonance imaging (MRI).

Methods: We collected 47 specimens of uterine fibroids after surgical resection and classified them into four groups according to preoperative T2-weighted MRI hypo-intense, isointense, heterogeneous intense and homogeneous hyper-intense. Then, specimens in each group were irradiated by HIFU with the same parameters and the necrotic tissue volume was calculated. The smooth muscle cell (SMC) count and collagen fiber content were quantitatively measured and compared between different groups. We analyzed the correlation between the necrotic tissue volume and SMC count and the collagen fiber content.

Results: Necrotic tissue volume gradually decreased from the hypo-intense group to the homogeneous hyper-intense group (p?=?.008). The SMC count from the hypo-intense group to the homogeneous hyper-intense group was 215.6?±?59.3, 237.0(89.5), 232.3?±?72.5 and 330.5?±?30.9, respectively; collagen fiber content was 0.65?±?0.07, 0.64?±?0.10, 0.53?±?0.11 and 0.41?±?0.06, respectively. Comparison among the four groups showed that SMC count progressively increased (p?=?.001) but collagen fiber content progressively decreased (p?=?.000) from the hypo-intense group to the homogeneous hyper-intense group. Correlation analysis showed that necrotic tissue volume was negatively correlated with SMC count (R?=??0.488, p=.013) but positively correlated with collagen fiber content (R?=?0.534, p?=?.005).

Conclusions: Differences in histopathological characteristics may be one of the reasons for different therapeutic effects of HIFU ablation on uterine fibroids with different signal intensities on T2-weighted MRI.     

Uterine artery embolization for symptomatic fibroids with imaging follow up

The aim of this study was to determine the effectiveness of uterine artery embolization (UAE) as a primary treatment method in treatment of symptomatic fibroids, whether there are any preembolization MRI characteristics of fibroid predictive of reduction in volume and assess reduction in uterine and dominant fibroid volumes using ultrasound (US) and MRI. Study was carried out in total of 32 patients aged 25–49 years (mean 40.9 years). Uterine and dominant fibroid volume were determined using US and MRI before UAE, MRI and US at 3 months and US alone at 6 and 12 months post‐UAE, supplemented by clinical evaluation at interval of 3, 6 and 12 months. Procedure was carried out through unilateral femoral puncture using poly vinyl alcohol (PVA) particles 355–500 μm in size. All 32 patients had successful procedures. Overall, 25 patients responded, giving a clinical success rate of 78.12%. Mean reduction in volume of uterus and fibroid was 33 and 59.7% and 48.9 and 75.5% on US at 3 and 12 months respectively, and 33.3 and 58.6% on MRI at 3 months. Volume reduction on US and MRI at 3 months was highly correlative. There was no statistical difference in size reduction in volume of fibroids, which were hypointense or hyperintense on T2‐weighted image (T2WI) on pre‐UAE MRI. Uterine artery embolization leads to good technical success and fibroid volume reduction. Ultrasound alone may be used for follow up of patients post‐UAE. Preprocedure signal characteristics on T2WI are not predictors of volume reduction after UAE.     

Ultra-structure changes and survivin expression in uterine fibroids after radiofrequency ablation

Abstract

Purpose: To explore the reliability and validity of radiofrequency (RF) ablation in treating uterine fibroids. Materials and methods: We evaluated 63 patients who underwent hysterectomy to treat multiple fibroids. Thirty patients immediately underwent abdominal hysterectomy after the fibroids were ablated under direct vision. Thirty-three patients first experienced trans-vaginal ablation with the guidance of a baseline ultrasound. We performed abdominal or trans-vaginal hysterectomy 72?h later. The tissues in the centre of the ablated lesion (group A), at the edge of the ablated lesion (group B), 1?cm away from the ablated edge (group C) and the control group were sampled. We observed ultra-structure changes by transmission electron microscopy and detected survivin expression with Western blot analysis. Results: According to transmission electron microscopy, the ultra-structure of fibroid cells in groups A and B was damaged. However, in group C, the ultra-structure was normal. Compared with the control group, survivin expression was significantly decreased. Meanwhile survivin expression was significantly increased with the distance to the ablated centre (p?<?0.05). Conclusions: Radiofrequency ablation caused permanent and irreversible damage to fibroid cells and decreased survivin expression, which provided reliable clinical evidence for the success of radiofrequency ablation treating uterine fibroids.     

Specific antitumour immunity of HIFU-activated cytotoxic T lymphocytes after adoptive transfusion in tumour-bearing mice

Purpose: The aim of this study was to investigate the specific anti-tumour immunity of cytotoxic T lymphocytes (CTL) activated by high-intensity focused ultrasound (HIFU) after adoptive transfer in a murine tumour model. Materials and methods: H22 tumour-bearing mice were treated by either HIFU or sham-HIFU, while naïve syngeneic mice were used as controls. They were sacrificed and the spleens were harvested 14 days after HIFU. T lymphocytes were obtained from the spleens, and then adoptively transferred into 40 mice each bearing a 3-day implanted H22 tumour. On day 14 after adoptive transfer, 10 mice were sacrificed in each group for assessment of the number of tumour-infiltrating T lymphocytes and interferon-gamma (IFN-γ) secreting cells. The remaining 30 mice were continuously observed for 60 days, and tumour growth, progression and survival were recorded. Results: HIFU significantly increased peripheral blood CD3⁺, CD4⁺ levels and CD4⁺/CD8⁺ ratio (P?<?0.05), CTL cytotoxicity (P?<?0.01) and IFN-γ and TNF-α secretion (P?<?0.01) in H22 tumour-bearing mice. Adoptive transfer of HIFU-activated T lymphocytes into the autologous tumour-bearing mice induced a significant increase of tumour-infiltrating T lymphocytes and IFN-γ-secreting cells (P?<?0.001). Compared to the control and sham-HIFU groups, HIFU-activated lymphocytes elicited significant inhibition of in vivo tumour growth (P?<?0.01) and progression (P?<?0.0001), and longer survival time in the tumour-bearing mice (P?<?0.001). Conclusions: HIFU could enhance CTL’s specific antitumour immunity. Adoptive transfer of HIFU-activated T lymphocytes could increase local antitumour immunity, and elicit stronger inhibition on tumour growth and progression, with more survival benefit in the autologous tumour-bearing mice.     

高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤的初步研究

目的探讨高强度聚焦超声(High intensity focused ultrasound, HIFU)结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤的可行性。方法 选取大庆油田总医院超声科2010年8月—2011年4月收治入院的子宫肌瘤患者40例, 给予高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗, 通过治疗前后彩色多普勒超声、超声造影、增强MRI图像对比, 以及治疗后1个月、6个月随访超声造影及月经改变、腹痛、尿频等症状的缓解程度, 评价治疗效果。结果 高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗后, 彩色超声、超声造影、增强MRI均显示子宫肌瘤内无血流灌注, 治疗后一个月和治疗后六个月分别与治疗前体积比较以及治疗后一个月与治疗后六个月体积比较, 差异均有统计学意义(P＜0.01)。治疗后1个月、6个月随访超声造影, 肌瘤内仍无血流灌注, 肌瘤体积明显缩小(P＜0.01)。患者月经量较治疗前明显减少, 周期变化规律, 腹痛、尿频等症状明显缓解, 无一例患者出现严重并发症。结论 高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤是一种可行、有效的治疗方式。     

Effectiveness of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids: a multicentre study in China

Purpose: To evaluate the clinical efficacy of ultrasound-guided percutaneous microwave ablation (PMWA) therapy for symptomatic uterine fibroids in a multicentre study.

Materials and methods: Patients with symptomatic uterine fibroids who underwent PMWA at multiple treatment centres in China between January 2013 and August 2015 were prospectively studied to compare the reduction rate of uterine fibroids, haemoglobin level and uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL) scores before and at 3, 6 and 12 months after ablation.

Results: A total of 311 patients (405 leiomyomas) from eight treatment centres underwent the treatment (age, 29–55 years; mean?±?SD, 41?±?5.11 years). The mean diameter of the myomas ranged from 2.03 to 12.50?cm (mean, 5.10?±?1.28?cm) and the volume ranged from 4.40 to 1022.14?cm³ (mean, 95.01?±?70.29?cm³). Forty-eight myomas were identified as FIGO type 1/2 fibroids, 256 as type 3/4 fibroids and 101 as type 5/6 fibroids. The mean ablation rate was 86.6% (54.0–100%). The mean reduction rate was 63.5%, 78.5% and 86.7% at 3, 6 and 12 months posttreatment, respectively. The haemoglobin level increased significantly from 88.84?±?9.31?g/L before treatment to 107.14?±?13.32, 116.05?±?7.66 and 117.79?±?6.51?g/L at 3, 6 and 12 months posttreatment, respectively (p?=?.000). The symptom severity score (SSS) and health-related quality of life (HRQL) scores were also significantly improved posttreatment compared with before treatment (p?=?.000).

Conclusion: PMWA is an effective, minimally invasive treatment for symptomatic leiomyomas that can significantly improve the quality of life of patients.     

Value of dynamic enhanced MR imaging for the differential diagnosis between ovarian fibroma and subserosal leiomyoma

Objective To study the value of dynamic enhanced MR imaging in the differential diagnosis between ovarian fibroma and subserosai leiomyoma, both of which produce a intermediate to tow signal intensity on T2WI. Methods Plain and dynamic enhanced MRI results of 45 patients were analyzed, 35 cases of which were subserosal leiomyoma and 10 were ovarian fibroma. All of the tumors were verified by histologic analysis. Results The 10 ovarian fibroma cases showed low signai intensities on T1WI, but 2 produced intermediate signal intensities and 8 showed low signal intensities on T2WI. There was little enhancement of the early phase and the delayed phase was long, so the enhancement index of the early phase (SHOO) was low and the time to peak (TTP200) was long. Of the 35 subserosal leiomyoma cases, all showed low signal intensity on T1WI, 7 were intermediate in signal intensity and 28 generated a low signal intensity on T2WI. The enhancement of the early phase was moderate to highly evident and the index was high. The time to peak was short (TTP200). The enhancement -time curve was different in the two groups, and the difference had statistical significance (P<0.001). Conclusion Dynamic enhanced MR imaging was helpful in the differential diagnosis between ovarian fibroma and subserosal leiomyoma by the difference of the early phase enhancement.     

Value of Dynamic Enhanced MR Imaging for the Differential Diagnosis between Ovarian Fibroma and Subserosal Leiomyoma

Objective  To study the value of dynamic enhanced MR imaging in the differential diagnosis between ovarian fibroma and subserosai leiomyoma, both of which produce a intermediate to tow signal intensity on T2WI. Methods  Plain and dynamic enhanced MRI results of 45 patients were analyzed, 35 cases of which were subserosal leiomyoma and 10 were ovarian fibroma. All of the tumors were verified by histologic analysis. Results  The 10 ovarian fibroma cases showed low signai intensities on T1WI, but 2 produced intermediate signal intensities and 8 showed low signal intensities on T2WI. There was little enhancement of the early phase and the delayed phase was long, so the enhancement index of the early phase (SHOO) was low and the time to peak (TTP200) was long. Of the 35 subserosal leiomyoma cases, all showed low signal intensity on T1WI, 7 were intermediate in signal intensity and 28 generated a low signal intensity on T2WI. The enhancement of the early phase was moderate to highly evident and the index was high. The time to peak was short (TTP200). The enhancement -time curve was different in the two groups, and the difference had statistical significance (P<0.001). Conclusion  Dynamic enhanced MR imaging was helpful in the differential diagnosis between ovarian fibroma and subserosal leiomyoma by the difference of the early phase enhancement.     

Ⅰ、Ⅱ期子宫内膜癌MRI表现与病理对照研究

Objective： To analyze MRI features of FIGO stage Ⅰ and Ⅱ endometrial carcinoma and to study the value of MRI in assessing myometrial and cervical invasion of endometrial carcinoma. Methods： Thirty patients with surgicopathologically proven endometrial carcinoma were included in this retrospective study. All patients underwent Tl-weighted spin-echo, T2-weighted fast spin-echo and dynamic contrastenhanced fast multiplanar spoiled gradient echo sequences before surgery. The type, signal intensity and enhancement features of the tumors and the appearance of junctional zone or subendometrial enhancement were analyzed. The MRI diagnosis of myometrial and cervical invasion was correlated with pathologic findings.Results： Endometrial carcinoma demonstrated diffuse widening of endometrial stripe （n=14） or polypoid or large mass in the endometrial cavity （n=16）. The tumors were usually isointense relative to the myometrium on TlWI and hyperintensity on T2WI. In the first phase of dynamic contrast-enhanced sequences, diffuse endometrial carcinoma usually showed mild （n=8） or moderate （n=5） enhancement, while focal endometrial carcinoma tended to enhance markedly （n=6） or moderately （n=9）. On T2WI junctional zone was seen in 18 cases. On dynamic contrast-enhanced images subendometrial enhancement was seen in 17 cases. The sensitivity, specificity and diagnostic accuracy of dynamic contrast-enhanced images in combination with T2WI were 87.5%, 95.5% and 93.3% for assessing deep myometrial invasion, and 75%, 95.5% and 90% for assessing cervical invasion. Conclusion： MRI is accurate and reliable in the evaluation of myometrial and cervical invasion of endometrial carcinoma, and should be performed as preoperative routine examination.     

高强度聚焦超声对前列腺癌小鼠的疗效及T细胞亚群的影响

目的探讨高强度聚焦超声（high intensity focused ultrasound, HIFU）对前列腺癌荷瘤小鼠的疗效及T细胞亚群的影响。方法RM-1细胞接种于C57BL6小鼠建立小鼠前列腺癌皮下移植瘤模型,随机分为肿瘤对照组、HIFU组、放疗组和HIFU联合放疗组。观察治疗后各组的肿瘤生长曲线,计算肿瘤体积倍增时间（DT）。2周后,通过流式细胞仪检测正常小鼠和荷瘤小鼠外周血CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺ 细胞占白细胞总数的百分比。结果与肿瘤对照组相比,HIFU组、放疗组肿瘤生长延缓,DT显著延长。HIFU组小鼠的CD3⁺(%)、CD4⁺(%)显著高于肿瘤对照组,而放疗组与肿瘤对照组差异无统计学意义。HIFU联合放疗组的DT较HIFU组显著延长,小鼠的CD3⁺(%)、CD4⁺(%)显著高于HIFU组,且CD4⁺(%)显著高于正常小鼠。结论HIFU治疗前列腺癌不仅能局部抑制肿瘤生长,而且能通过对T细胞亚群的影响提高机体的细胞免疫水平。HIFU联合放疗能进一步提高疗效。