ABSTRACT
:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging ï¼DCE-MRIï¼ in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression. Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People's Hospital from October 2015 to September 2017 were analyzed retrospectivelyï¼including 15 cases of ordinary typeï¼8 cases of cellular type and 12 cases of degenerative type. All patients were examined by pelvic DCE-MRI before operationï¼and the histogram parameters ï¼medianï¼meanï¼skewnessï¼kurtosisï¼energyï¼entropyï¼ of various quantitative perfusion parametersï¼including volume transport constant ï¼Kï¼ï¼rate constant ï¼Kï¼ï¼extravascular extracellular space distribute volume per unit tissue volume ï¼Vï¼ï¼blood plasma volume per unit volume of tissue ï¼Vï¼ were calculatedï¼and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve. The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical methodï¼and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis. The median and mean values of Kï¼Kï¼V and V in the cellular group were higher than those in the degenerative group and the ordinary groupï¼<0.05 or <0.01ï¼ï¼while the skewness of Vï¼the skewness and kurtosis of K in the cellular group were lower than those in the ordinary group ï¼all <0.05ï¼. The entropy of K in the cellular group was higher than that in the degenerative group and the ordinary group ï¼all < 0.05ï¼. The entropy of V in the cellular group was higher than that in the ordinary group ï¼<0.01ï¼. The medianï¼meanï¼skewness of Kï¼median and mean of Kï¼median and mean of Vï¼medianï¼meanï¼energy and entropy of V were correlated with Ki-67 expressionï¼all <0.05ï¼. The results of ROC curve analysis showed that the median threshold of K was 0.994/minï¼the sensitivity and specificity for the diagnosis of cellular uterine leiomyoma were 100.0% and 77.8% respectivelyï¼and the area under the ROC curve was 0.949. When the mean threshold of K was 1.170/minï¼the sensitivity and specificity for diagnosing cellular uterine leiomyoma were 100.0% and 77.8% respectivelyï¼and the area under the ROC curve was 0.958. The area under the ROC curve of K ï¼entropyï¼ï¼K ï¼medianï¼meanï¼ï¼V ï¼medianï¼meanï¼entropyï¼ in the diagnosis of cellular uterine leiomyoma were 0.755-0.907. :DCE-MRI quantitative perfusion histogram parameters have high diagnostic value in differentiating pathological types of uterine leiomyomaï¼especially for cellular uterine leiomyoma.
Subject(s)
Contrast Media , Leiomyoma , Humans , Leiomyoma/diagnostic imaging , Magnetic Resonance Imaging , Perfusion , Retrospective StudiesABSTRACT
:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression. Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People's Hospital from October 2015 to September 2017 were analyzed retrospectively，including 15 cases of ordinary type，8 cases of cellular type and 12 cases of degenerative type. All patients were examined by pelvic DCE-MRI before operation，and the histogram parameters （median，mean，skewness，kurtosis，energy，entropy） of various quantitative perfusion parameters，including volume transport constant （K），rate constant （K），extravascular extracellular space distribute volume per unit tissue volume （V），blood plasma volume per unit volume of tissue （V） were calculated，and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve. The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical method，and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis. The median and mean values of K，K，V and V in the cellular group were higher than those in the degenerative group and the ordinary group（<0.05 or <0.01），while the skewness of V，the skewness and kurtosis of K in the cellular group were lower than those in the ordinary group （all <0.05）. The entropy of K in the cellular group was higher than that in the degenerative group and the ordinary group （all < 0.05）. The entropy of V in the cellular group was higher than that in the ordinary group （<0.01）. The median，mean，skewness of K，median and mean of K，median and mean of V，median，mean，energy and entropy of V were correlated with Ki-67 expression（all <0.05）. The results of ROC curve analysis showed that the median threshold of K was 0.994/min，the sensitivity and specificity for the diagnosis of cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.949. When the mean threshold of K was 1.170/min，the sensitivity and specificity for diagnosing cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.958. The area under the ROC curve of K （entropy），K （median，mean），V （median，mean，entropy） in the diagnosis of cellular uterine leiomyoma were 0.755-0.907. :DCE-MRI quantitative perfusion histogram parameters have high diagnostic value in differentiating pathological types of uterine leiomyoma，especially for cellular uterine leiomyoma.
Subject(s)
Humans , Contrast Media , Leiomyoma/diagnostic imaging , Magnetic Resonance Imaging , Perfusion , Retrospective StudiesABSTRACT
The prospective observation of women with uterus myoma being on operative treatment in gynecological department of the Tula oblast clinical hospital during 2011-2012 was implemented. The regular female donors of the department of transfusiology of the given medical institution were used as the comparison group. It is established that female contingent with uterus myoma has a complex of such predisposing medical social risk factors as lower motion activity, financial neediness, increased stress load, diet of lower quality and its limitations, increased liquid intake, inobservance of work and rest regime, with passive character of longer day rest, certain occupational hazards. The unfavorable effect of forced body position, electromagnetic radiation and psycho-emotional over-strain on development of uterus myoma is reliably established. According data of component analysis, possible complex prevention of uterus myoma is presented by higher level of intellectual strain during working activities, maintenance of work and rest regime, long-term day rest, regular intake of fruits and cultured milk food, availability of quality preferences in diet, regular exercises, frequent foot walks at clean air. The established characteristics of life-style and occupational hazards in women with uterus myoma testify their pathogenic involvement in development of disease and availability of opportunities of their usage in development of programs of individual prevention.
Subject(s)
Leiomyoma , Female , Humans , Prospective StudiesABSTRACT
Objective To evaluate the curative effect of laparoscopic myomectomy combined with preoperative gonadotropin releasing hormone agonists (GnRH-a) in treating myoma patients with uterus volume large than 12 weeks of pregnancy size. Methods 46 patients with uterine volume over 12 gestational weeks from August 2009 to August 2016 were selected as research objects. Leuprolide was injected subcutaneously for three to six times, and then laparoscopic myomectomy was performed one month later. The changes of volumes in uterus and myoma before and after medication were observed as well as the changes of hemoglobin. And postoperative recurrence of uterus myoma was followed up. Results The average volume of the uterus in the 46 patients, detected by B ultrasound, before GnRH-a treatment was (705.47 ± 282.37) cm3, and the average volume of the uterus after GnRH-a treatment was (331.95 ± 84.53) cm3, which was shortened by 59.35%, with significant difference (P < 0.05). The volume of uterus myoma was (237.59 ± 138.46) cm3 before GnRH-a treatment and (81.59 ± 46.44) cm3 after GnRH-a treatment, shortened by 65.66%, with significant difference (P < 0.05). The hemoglobin value was (97.80 ± 20.19) g/L before GnRH-a and (119.63 ± 12.06) g/L after GnRH-a treatment, with significant difference (P < 0.05). Follow-up for 3 weeks to 5 years, the surgeries were accomplished successfully, and no case was transferred to laparotomy. Conclusion Preoperative GnRH-a could shorten volume of uterus myoma, increase hemoglobin value and ensure performance of laparoscopic myomectomy for myoma patients with uterus volume large than 12 weeks of pregnancy size.
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Objective To summarize the tending physique of hysteromyoma patients and thus to provide the clinical prevention and treatment methods for the disease.Methods Clinical epidemiology investigation and study methods were adopted to design the unified investigation and study table.Questionnaire survey were performed stochastically to 150 hysteromyoma patients and 150 normal females.Various physique characteristics were recorded.Results Ecchymosis physique were commonly seen in hysteromyoma patients,accounting for 36.7％ in all patients.Conclusion The occurrence of hysteromyoma was closely related to ecchymosis physique.
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Objective To explore the clinical effect of laparoscopic myomectomy.Methods According to the digital table method,75 myoma patients were divided into the study group (42 cases received laparoscopic myomectomy) and the control group(33 cases received transabdonmial myomectomy).The operation time,the time of intestinal function recovery,the amount of bleeding and the postoperative hospital stay time of the two groups were recorded and compared.Results The amount of bleeding,the time of intestinal function recovery and the postoperative hospital stay time of the study group were (111.50 ± 19.38) ml,(17.76 ± 3.64),(4.95 ± 0.54) d,respectively,which were significantly less than those of the control group [(131.15 ± 27.85) ml,(31.64 ± 5.70) h,(7.12± 1.08)d] (t =3.60,12.81,11.35,all P ＜ 0.01).Conclusion Laparoscopic myomectomy has the advantages of less trauma,quicker recovery,shorter hospitalization time etc,so it is worthy of promotion and application in clinic.
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Objective To study the related factors of recurrence after myomectomy. Methods The clinical data of 441 cases with myomectomy were collected. The age at the time of operation, body mass index(BMI), preoperative parity, and the location, size and number of myomas were recorded, and the postoperative recurrence rate was calculated. Univariate and multivariate analysis were performed for possible factors related to recurrence. Results The average time of follow-up was(37.79?18.64) months. Recurrence was found in 125 cases, and 5-year cumulative rate of recurrence was 38.9%. The age at the time of operation, BMI, number of myomas and preoperative parity were related factors of recurrence(P
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100 u/L 24 months later and another 38 year-old patient underwent surgical operation of ovaries bilaterally before UAE. Conclusions Temporary amenorrhea may not mean ovarian dysfunction or failure. The probability of ovarian dysfunction or failure after UAE is low, which mainly occur in the peirmenopausal patients. Consideration of the probability of inducing early ovarian failure, caution should be taken for UAE on the patients having ovarian surgery before. (J Intervent Radiol, 2006, 15: 472-475)
