目的探讨高强度聚焦超声(mFu)治疗子宫肌瘤的有效性和影像学特征。方法对.2010年1月--2012年12月收治的47例子宫肌瘤患者(53个肌瘤)进行HIFU治疗,在治疗前及治疗后1、3、6、12个月,采用UFS.QOL调查表评估患者的症状及生活质量,采用MRI、彩超观察治疗前后子宫肌瘤体积的变化,并分析子宫肌瘤体积变化与MRI、彩超影像学特征的关系。结果38例症状性子宫肌瘤患者治疗前后的症状评分和UFS—Q.OL评分明显升高,差异具有统计学意义(P〈0.05)。53个子宫肌瘤中,4s个治疗后体积缩小,MRI和彩超两种方法所测子宫肌瘤体积变化率差异无统计学意义(P〉0.05)。治疗前子宫肌瘤MRI增强扫描强化信号越低、彩超所见瘤体内血流信号越少,治疗后子宫肌瘤体积缩小越显著(P〉0.05)。治疗前子宫肌瘤MRI增强扫描信号低、治疗中实时超声监测到灰度变化者,治疗后易出现肌瘤内无灌注区(P〈0.05)。结论HIFU治疗后可有效减小子宫肌瘤体积,改善患者症状并提高生活质量,可作为子宫肌瘤的一种无创治疗方式。
Objective To investigate the efficacy and imaging characteristics of high intensity focused ultrasound (HIFU) in treatment of uterine fibroid. Methods Forty seven patients with fifty three uterine fibroids were treated with HIFU from Jan. 2010 to Dec. 2012. UFS-QOL, a disease-specific symptom and health-related quality of life questionnaire for fibroid, enhanced magnetic resonance imaging (MRI), and Doppler ultrasound were performed before and 1, 3, 6, 12 months after the treatment. Scores of symptoms and UFS-QOL of patients, and the size of uterine fibroid detected by MRI and Doppler ultrasound were assessed to study the efficacy of the treatment. The relationship between the shrinkage of the uterine fibroid, and the imaging characteristics of the MRI and ultrasound were also assessed. Results The symptoms in 38 patients were improved as reflected by the scores of symptoms and UFS-QOL after treatment with HIFU (P〈0.05). Of the 53 tumors, the size of 45 fibroids was decreased gradually in 12 months after the treatment, the shrinkage of fibroids by two methods at 1, 3, 6 and 12 months post-treatment was significantly identical (P〉0.05). The low signal intensity in the target fibroids on MRI and the decrease of blood flow on Doppler ultrasound before the treatment were associated with the shrinkage of the fibroids. The more enhanced signal in MRI and the more blood flow in fibroids detected by Doppler ultrasound before treatment were, the less degree of shrinkage after the treatment was (P〈0.05). The non-perfusion area in the fibroids increased if there was less enhanced signal on MRI before treatment or intensity change as monitored by real-time ultrasound (P〈0.05). Conclusion HIFU could reduce the fibroid volume and improve the patients' symptoms and life quality, and it may be used as an effective treatment for uterine fibroid.