磁共振引导下聚焦超声治疗子宫肌瘤前影像学筛查标准的建立研究

摘要

目的：建立MR-HIFU治疗前对患者的影像学筛查标准以及治疗的意义。方法：收集医院自2012年9月-2013年12月临床确诊为子宫肌瘤、已生育、未绝经的育龄妇女105例，行盆腔MR检查并根据临床及影像学纳入和排除标准进行评价。结果：本组筛查的105例子宫肌瘤患者中，年龄36-49岁，平均年龄45.7岁。体内有节育环1例和下腹部有明显疤痕1例被直接排除。103例行磁共振平扫检查，87例行磁共振增强检查；肌瘤单发87例，其中I型54例，II型27例，III型6例；多发12例，其中I型7例，II型3例，III型2例，6例被排除。单发病例中子宫肌瘤位置偏后，靠近骶骨5例，肌瘤中心距皮肤≥10cm的7例；子宫腺肌症4例；超声聚焦野内有肠管无法避开2例；T2加权像显示高信号和混杂信号的子宫肌瘤38例。合计排除62例，排除率59.05%。43例纳入MR-HIFU治疗，入组率40.95%。结论：通过对子宫肌瘤患者的磁共振影像学筛查标准的建立，提高了MR-HIFU治疗的安全性。%Objective: The significance for establishing the imaging screening criteria for patients before we use Magnetic Resonance -guided high-intensity focused ultrasound ablation therapy. Methods: Collecting one hundred and five child-bearing age women patients who clinically diagnosed as uterine fibroid, born and pre-menopausal from our hospital since the 2012-09 to 2013-012, for enrolled patients, we performed MR exam, meanwhile evaluating according to clinical and imaging inclusion and exclusion criteria. Results: Among 105 patients with uterine fibroid our team screened, whose age is from 36 to 49, average age is 45.7.one with intrauterine contraceptive ring and another with obvious scar in lower abdomen were directly excluded. One hundred and three patients underwent MR plain scan, eight-seven patients underwent MR enhanced scan; Among eight-seven patients with single fibroid,there are fifty-four type I, twenty-seven type II, six type III; twelve patients have multiple fibroid, there are seven type I, three type II, two type III, six patients were excluded. Among patients with single fibroid, five patients with fibroid locating posteriorly, close to sacrum, seven patients with the distance from the center of fibroid to skin is greater than or equal to ten centimeter, four ones suffering from adenomyosis; there is unavoidable bowel in ultrasonic focusing field for two patients; thirty-seven examples with fibroid displaying as high and mixed signal in MR T2-weighted image. We totally excluded sixty-two patients, the exclusion ratio is 59.05%. Forty-three ones are included for Magnetic Resonance-guided high-intensity focused ultrasound ablation therapy, the enrollment ratio is 40.95%. Conclusions: Through building Magnetic Resonance Imaging screening criteria for patients suffering from uterine fibroids, the safety of MR-HIFU ablation therapy has been enhanced.