DCE-MRI在高强度聚焦子宫肌瘤消融术疗效评估中的应用价值

目的探讨磁共振成像动态增强(DCE-MRI)在高强度聚焦子宫肌瘤消融术(HIFU)疗效评估中的应用价值。方法将我院53例接受HIFU治疗的子宫肌瘤患者作为研究对象,所有患者在治疗前1周和治疗后3d行DCE-MRI检查,记录治疗前DCE-MRI检查所获相关参数速率常数(Kep)、容量转移常数(Ktrans)、细胞外血管外间隙容积比(Ve)、血浆容积指数(Vp)、最大强化率(SERmax)、增强峰值(PH)],HIFU治疗效果以消融体积来评估,根据消融体积将患者分为完全消融组和部分消融组,对比两组DCE-MRI相关参数,并采用ROC曲线分析DCE-MRI有意义的相关参数对HIFU疗效的预测价值。结果 HIFU治疗结果显示,完全消融例数为27例,部分消融例数为26例。完全消融组Kep、Ktrans、Ve、SERmax均低于部分消融组(P<0.05),Vp、PH与部分消融组差异无统计学意义(P>0.05)。Kep、Ktrans、Ve、SERmax预测HIFU疗效ROC曲线下面积依次为0.792、0.856、0.735、0.721(P<0.05),预测敏感度依次为70.37%、92.59%、81.48%、55.56%,特异度依次为81.48%、80.77%、46.15%、76.92%。结论术前DCE-MRI参数Kep、Ktrans、Ve、SERmax可有效预测HIFU疗效。

Application Value of DCE-MRI in Evaluating the Efficacy of High-intensity Focused Ultrasound Ablation of Uterine Fibroids

Objective To explore the application value of dynamic contrast enhance-magnetic resonance imaging(DCE-MRI) in evaluating the efficacy of high-intensity focused ultrasound ablation(HIFU) of uterine fibroids.Methods A total of 53 patients with uterine fibroids who underwent HIFU in our hospital were selected for the study.All patients underwent DCE-MRI at one week before treatment and at 3 days after treatment.The relevant parameters obtained by DCE-MRI before treatment rate constant(Kep),volume transfer constant(Ktrans),extracellular extravascular space volume ratio(Ve),plasma volume index(Vp),maximum enhancement rate(SERmax),peak height(PH)] were recorded,and HIFU treatment effects were evaluated by ablation volume.The patients were divided into complete ablation group and partial ablation group according to the ablation volume.The DCE-MRI related parameters were compared between the two groups,and the ROC curve was used to analyze the predictive value of related parameters with DCE-MRI significance on efficacy of HIFU.Results HIFU treatment showed that there were 27 cases of complete ablation and 26 cases of partial ablation.The Kep,Ktrans, Ve, and SERmax in entire a blation groups were lower than those in the partial ablation group(P<0.05),and there were no significant differences in the Vp and PH compared with those in the pa rtial ablation group(P>0.05).The values of a rea under the ROC cu rve of Kep,Ktrans,Ve and SERmax in predicting HIFU were 0.792,0.856,0.735,and 0.721(all P<0.05),and the predicted sensitivities were70.37%,92.59%,81.48% a nd 55.56% respectively,and the specificities were 81.48%,80.77%,46.15%,and 76.92%.Conclusion Preoperative DCE-MRI parameters Kep,Ktrans,Ve,and SERmax can effectively predict the efficacy of HIFU.