ABSTRACT
Objective To investigate the value of whole-tumor histogram analysis of quantitative perfusion in the prediction of ablation response in MR-guided high-intensity focused ultrasound (MR-HIFU)treatment for uterine fibroids.Methods A total of 31 fibroids in 28 eligible patients were treated with MR-HIFU.Four histogram parameters of the quantitative perfusion parameter (Ktrans )were obtained prior to MR-HIFU treatment:mean,median,skewness and kurtosis.T1 contrast-enhanced MRI immediately after MR-HIFU was performed to determine the non-perfused volume (NPV)and acquire non-perfused volume ratio (NPVR).The relationship between NPVR and all fibroid characteristics was determined by Spearman correlation analysis.Results The 3 1 fibroids were divided into high-response group and low-response group according to whether NPVR was higher than 60%.Four histogram metrics of Ktrans showed statistical difference between the two groups.The mean and median of Ktrans ,fibroid maximum diameter and T2 signal intensity type were correlated with NPVR.The Spearman correlation coefficient were －0.60,－0.66,－0.45 and －0.39,respectively (P＜0.05).Conclusion Uterine fibroids with lower whole-tumor Ktrans can achieve higher immediate ablation efficiency in MR-HIFU.Together with its histogram metrics,it might be a valuable indicator for patient selecting.
ABSTRACT
Objective To explore the clinical effects of magnetic resonance guided high intensity focused ultrasound ( MRgHIFU ) and gonadotropin releasing hormone agonist ( GnRH-a ) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent uterine fibroids. Methods Eighty patients of recurrent uterine fibroids from April 2015 to June2017 in the First Hospital of Harbin were collected and randomly divided into the observation group and control group. MRgHIFU was used in the observation group were employed,and patients in the control group were treated with ING-IUS after first injecting GnRH-a. The tumor volume,hemoglobin level,menstrual quantity and adverse reactions were compared before and at 3 months,6 months after treatment. Results After 6 months,the size of the uterine myoma in the observation group was ((80. 23 ± 4. 35) cm3 ),significantly lower than that of the control group (( 135. 46 ±9. 25) cm3 ),and the difference was statistically significant ( t = 6. 01,P < 0. 05) . At 3 and 6 months after treatment,the amount of menstruation in the observation group was significantly lower than that of the control group( (66. 37 ± 12. 12) points vs. (40. 46 ± 10. 15) points; (98. 42 ± 14. 12) points vs. ( 68. 26 ± 11. 38) points). The difference was statistically significant (t at 3 months after treatment= 4. 52,P<0. 05,t at 6 months after treatment= 3. 53,P<0. 05). After 6 months of treatment,the hemoglobin value of the observation group was significantly higher than that of the control group (( 142. 12 ± 4. 24) g/ L vs. ( 108. 27 ± 3. 09) g/ L), the difference was statistically significant (t= 5. 02,P<0. 05),while the adverse reactions such as vaginal bleeding, hot flashes and night sweats were lower than those of the control group (2. 5% (1/ 40) vs. 7. 5% (3/ 40)) (χ2= 3. 99,P<0. 05). Conclusion Magnetic resonance guided high intensity focused ultrasound was considered as safe and effective in treating uterine fibroids,which is a new and noninvasive therapeutic methed,