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目的探讨磁共振扩散加权成像在子宫肌瘤高能聚焦超声刀(HIFU)疗效监测中的应用价值。方法经HIFU治疗子宫肌瘤患者35例,分别于术前、术后1周、1个月、3个月、6个月、12个月行磁共振及超声检查,磁共振检查包括常规自旋回波与扩散加权成像,并与术前、术后1周超声引导下穿刺活检病理结果对照,观察肌瘤的常规磁共振信号与扩散加权成像ADC值变化。结果在常规MRI,肌瘤T1信号在术后1个月开始升高,T2信号在术后1个月开始降低。HIFU治疗前肌瘤体积平均值为(86.3±7.5)cm3,术后1周为(84.8±6.9)cm3,缩小率为1.8%,术后1个月为(71.5±8.6)cm3,缩小率为17.1%,术后6个月为(52.4±7.8)cm3,缩小率为39.3%,6个月后肌瘤体积变化不明显。HIFU治疗前肌瘤的ADC值平均值为1.78×10-3mm2/s,术后1周平均值降低为1.49×10-3mm2/s,并一直持续降低至术后6个月,术后6个月又轻度升高。肌瘤在DWI呈高信号,并于术后1月进一步升高,在术后6个月稍有降低。结论与超声及常规磁共振比较,扩散加权成像能更早、更敏感、更特异地反映HI-FU术后子宫肌瘤的病理改变,可作为监测其疗效的重要指标之一。
Objective To investigate the value of diffusion-weighted MR imaging in monitoring the efficacy of high-intensity focused ultrasound knife (HIFU) of uterine fibroids. Methods 35 cases of uterine fibroids were treated with HIFU. MRI and MRI were performed preoperatively, 1 week, 1 month, 3 months, 6 months and 12 months after operation. The results of MR examination included routine spin-back Wave and diffusion weighted imaging, and with preoperative and postoperative 1 week under the guidance of ultrasound-guided biopsy pathological findings observed fibroids conventional MRI and diffusion-weighted imaging ADC value changes. Results In conventional MRI, T1 signal of fibroids began to increase at 1 month after operation, and T2 signal began to decrease at 1 month after operation. The average volume of fibroids before HIFU treatment was (86.3 ± 7.5) cm3, (84.8 ± 6.9) cm3 at 1 week after surgery, and the reduction rate was 1.8% at 1 week and 71.5 ± 8.6 cm3 at 1 month after surgery. The reduction rate was 17.1% after 6 months and 52.4 ± 7.8 cm3 at 6 months after operation. The reduction rate was 39.3%. There was no obvious change in myoma volume after 6 months. The average ADC value of HIFU before treatment was 1.78 × 10-3mm2 / s, and the average value of 1 week after operation decreased to 1.49 × 10-3mm2 / s, and continued to decrease to 6 months after operation, 6 Month and slightly increased. Myomas showed high signal intensity at DWI and further increased in January and slightly decreased at 6 months. Conclusion Compared with ultrasound and conventional magnetic resonance imaging, diffusion-weighted imaging can be an earlier, more sensitive and more specific reflection of pathological changes of hysteromyoma after HI-FU surgery, which may be used as an important indicator to monitor its efficacy.