摘要
目的 探讨扩散加权成像(DWI)在治疗床上即刻评估子宫肌瘤的磁共振引导聚焦超声治疗(MRgFUS)消融效果的可行性和价值。方法 回顾性分析47例接受子宫肌瘤MRgFUS消融并在治疗床上即刻行DWI(b值为800 s/mm^(2))和增强MR成像的患者资料。对DWI的图像质量进行Likert 5分量表主观评分,分析消融坏死病变的DWI表现,同时与增强MR比较其最大面积的差异和一致性。结果 95.7%(45/47)DWI图像评分≥3分。67个目标肌瘤的消融后坏死灶均在DWI上显示出与增强MR对应的异常信号,表现为“牛眼征”和“亮斑征”。观察者内和观察者间测量DWI上坏死病灶最大面积的组内相关系数(ICC)均为0.98(P均<0.001)。使用DWI和增强MR测量消融坏死面积的ICC为0.92~0.98(P均<0.001)。DWI和增强MR测量消融坏死区平均面积分别为(19.09±12.66) cm^(2)和(18.47±12.57) cm^(2)(P<0.05)。结论 DWI可作为一种非增强的替代方法,在治疗床上即刻评估MRgFUS消融子宫肌瘤的效果。评估时需要注意DWI存在轻度高估非灌注区的可能。
Objective To investigate the feasibility and value of diffusion-weighted imaging(DWI) for immediate assessment of magnetic resonance-guided focused ultrasound(MRgFUS) ablation result of uterine fibroids on the MRgFUS treatment-table.Methods Data from 47 patients who underwent MRgFUS ablation of uterine fibroids and underwent DWI(b-value was 800 s/mm~2) and enhanced MR imaging immediately on the treatment-table were retrospectively analyzed.The image quality of DWI was scored by a Likert scale.The DWI performance of ablated necrotic lesions was analyzed,the difference and consistency of area measurements were compared with enhanced MR.Results 95.7%(45/47) of the DWI images were scored ≥3.All 67 ablated necrotic lesions of the targeted uterine fibroids showed abnormal signals on DWI that corresponded to contrast-enhanced MR,manifested as the “bull's eye sign” and the “bright patch sign”.The intra-and interobserver intraclass correlation coefficients for the maximum area of necrotic lesions measured on DWI were 0.98(both P< 0.001).The intraclass correlation coefficients for ablated necrosis measured by DWI and enhanced MR ranged from 0.92 to 0.98(all P< 0.001).The average areas of ablated necrotic lesions measured by DWI and enhanced MR were(19.09±12.66) cm~2 and(18.47±12.57) cm~2,respectively(P< 0.05).Conclusion DWI can be used as a non-enhanced alternative method to assess the effect of MRgFUS ablation of uterine fibroids directly on the treatment-table.The possibility of slight overestimation of non-perfused areas by DWI should be taken into account in the evaluation.
作者
蔡世华
马富强
林永强
周守国
黄耀渠
CAI Shihua;MA Fuqiang;LIN Yongqiang(Department of Radiology,Foshan Hospital of Traditional Chinese Medicine,Foshan,Guangdong Province 528000,P.R.China)
出处
《临床放射学杂志》
北大核心
2025年第4期678-683,共6页
Journal of Clinical Radiology
基金
佛山市医学类科技攻关项目(编号:2020001005371、2320001006633)。
关键词
磁共振引导聚焦超声治疗
子宫平滑肌瘤
热消融
扩散加权成像
增强成像
Magnetic resonance-guided focused ultrasound surgery
Uterine fibroids
Thermal ablation
Diffusion-weighted imaging
Contrast-enhanced imaging
