本文選題：磁共振成像 + 高強度聚焦超聲　； 參考：《川北醫(yī)學院》2014年碩士論文

【摘要】：目的：探討3.0T MRI功能成像（functional magnetic resonanceimaging,fMRI）對高強度聚焦超聲（High intensity focused ultrasound,HIFU）治療子宮肌瘤療效判斷與預后評估的價值。 材料與方法：采用GE3.0T磁共振成像儀，對行子宮肌瘤HIFU治療的192例病人共522個肌瘤分別在治療前一天、治療后一天進行常規(guī)MRI掃描、動態(tài)增強（Dynamic contrast-enhanced magnetic resonance, DCE-MR）掃描、多b值彌散加權成像（diffusion-weighted imaging,DWI）掃描。其中，對48例患者共111個肌瘤定期隨訪復查，在術后三個月、六個月、一年行相同序列及參數MRI掃描。觀察并記錄肌瘤在治療前后的數目、體積、位置、類型、無灌注區(qū)率、多b值平均ADC值、T1WI增強掃描、T1WI及T2WI絕對信號強度改變，患者臨床癥狀用癥狀嚴重程度評分（symptom severity scoress,SSS）表示。 結果：本研究收集192例患者共522個子宮肌瘤，其中486個肌瘤完成了高強度聚焦超聲消融治療，其余病灶因體積小，位置靠后無法進行機載超聲定位而未進行治療。所有患者在術中術后未出現嚴重并發(fā)癥，術后一天增強磁共振顯示所有消融灶均出現明顯無灌注區(qū)，邊緣輕度環(huán)形強化，肌瘤血供阻斷。在定期隨訪的48例患者共111個肌瘤中：1、肌瘤位于底壁、前壁、后壁、側壁分別占15.3%（17/111）、39.6%（44/111）、24.3%（27/111）、20.7%（23/111），術后肌瘤消融率與肌瘤位置有顯著相關，前壁肌瘤療效更好，后壁、底壁、側壁肌瘤療效無顯著差異。2、HIFU治療前肌瘤平均體積值為96.75cm3，術后一天、三個月、六個月、一年平均體積分別為93.25cm3、48.62cm3、28.88cm3、20.75cm3；縮小率分別為3.6%、49.7%、70.1%、78.6%，分別進行兩兩比較SNK檢驗，除術前與術后一天、術后六個月與術后一年比較差異無統計學意義外，其余兩兩比較均有統計學意義。對不同消融體積分組，再與術后不同時間隨訪SSS評分進行重復測量方差分析，結果表明消融體積大于75%，患者恢復情況最好。3、子宮肌瘤HIFU治療前T2WI呈低信號72個，等信號7個，高信號4個，，高低混雜信號28個，肌瘤在不同T2WI信號強度上療效有統計學意義，T2WI呈低信號的肌瘤療效最好，部分T2WI呈高信號的肌瘤療效較好。4、子宮肌瘤HIFU治療前，T1WI、T2WI、DCE-MRI增強掃描的平均絕對信號強度分別為996.45±190.99、480.18±162.20、1954.56±238.84，治療后一天分別為1107.67±214.94、429.41±139.16、1249.07±159.77，T1WI絕對信號強度在治療后明顯升高，T2WI輕度下降，DCE-MRI絕對信號強度明顯下降。5、子宮肌瘤HIFU治療前，多b值平均ADC值為（1.018±0.177）×10 3mm2/s，術后一天、三個月、六個月、一年平均ADC為(0.965±0.172)×10 3mm2/s、(0.870±0.136)×10 3mm2/s、(0.773±0.091)×10 3mm2/s、(0.862±0.035)×10 3mm2/s，結果表明平均ADC值術后明顯下降，后持續(xù)降至六個月，一年后ADC稍回升。 結論：1、HIFU治療子宮肌瘤療效顯著，無創(chuàng)又安全，患者接受度高。2、3.0T MRI功能成像能有效判斷高強度聚焦超聲治療子宮肌瘤的療效，評估預后轉歸，可用于長期隨訪觀察，對臨床有很好的指導意義。3、子宮肌瘤的位置、信號強度對消融療效有影響。
[Abstract]:Objective : To evaluate the diagnostic value of high intensity focused ultrasound ( HIFU ) in the treatment of uterine fibroids with high intensity focused ultrasound ( HIFU ) .

Materials and Methods : Two hundred and twenty - one hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred twenty - two hundred and twenty - two hundred forty - eight ( 48 ) patients were followed up for three months , six months , one year with same sequence and parameter MRI scans .

Results : A total of 522 uterine fibroids were collected in 192 patients , 486 of them completed high intensity focused ultrasound ablation . All patients had no serious complications after operation . All the patients had no significant complications after operation . The average volume of myomas was 96.75 cm3 , the postoperative day was 3 months , and the average volume was 93.25 cm3 , 48.62 cm3 , 28.88 cm3 and 20.75 cm3 respectively .
緙╁皬鐜囧垎鍒負3.6%,49.7%,70.1%,78.6%,鍒嗗埆榪涜涓や袱姣旇緝SNK媯

本文編號：2014292