Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids

Qing WEI; Jinyun CHEN; Yinuo LIU; Shaojiang MO; Rong ZHANG; Wenzhi CHEN

doi:10.16016/j.1000-5404.201812060

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Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids

Clinical Medicine | 更新时间：2026-01-09

- Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids
- Journal of Third Military Medical University Vol. 41, Issue 12, Pages: 1161-1166(2019)
- 作者机构：
  
  1.400016 重庆，重庆医科大学生物医学工程学院, 省部共建国家重点实验室培育基地—重庆市超声医学工程重点实验室, 重庆市生物医学工程学重点实验室，重庆市微无创医学协同创新中心
  2.400042 重庆, 重庆医科大学附属第一医院超声消融治疗中心
- 作者简介：
- 基金信息：
  
  the National Basic Research and Development Program(973计划);Supported by the Project of National Key Basic Research Program of China(2012CB722402);the Program of "Twelfth Five-year Plan"of Science and Technology of China(2011BAI14B01)
- DOI：10.16016/j.1000-5404.201812060
  CLC： R445.2;R454.3;R711.74
- Received：06 December 2018，
  
  Revised：2019-02-15，
  
  Published：30 June 2019
- 稿件说明：
移动端阅览
Qing WEI, Jinyun CHEN, Yinuo LIU, et al. Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids[J]. Journal of Third Military Medical University, 2019, 41(12): 1161-1166.
DOI：

Qing WEI, Jinyun CHEN, Yinuo LIU, et al. Magnetic resonance imaging-based assessment of seromuscular layer injuries early after ultrasound ablation of uterine fibroids[J]. Journal of Third Military Medical University, 2019, 41(12): 1161-1166. DOI： 10.16016/j.1000-5404.201812060.

摘要

目的

研究子宫肌瘤超声消融后子宫浆肌层损伤的早期MRI影像学特征及损伤发生情况。

方法

选择2013-2017年在重庆医科大学附属第一医院接受高强度聚焦超声(high intensity focused ultrasound

HIFU)消融治疗子宫肌瘤且术前、术后MRI资料完整的患者671例，其中符合纳入标准的有400例。根据术后3 d内的MRI图像，造影剂注射后120 s内始终无强化确定为损伤，观察损伤的形态特点并测量其范围。

结果

子宫肌瘤所在肌壁的浆肌层无损伤表现为完整的环状强化，有损伤表现为强化局部缺损。浆肌层损伤者90例(22.50%)，浆肌层损伤范围为3.9~66.3(25.9±14.8)mm。子宫肌瘤体积消融率为(86.91±17.78)%，高于未发生浆肌层损伤者[(80.93±16.25)%

0.05

]

；子宫浆肌层损伤多发生于声通道的前场，也可发生于近骶骨的位置。浆膜下肌瘤浆肌层损伤发生率(43.09%)高于肌壁间肌瘤(14.18%

0.05)，且浆膜下肌瘤子宫浆肌层损伤范围[(26.8±15.5)mm

]

高于肌壁间肌瘤[(24.6±14.0)mm

]

。患者均未发生严重并发症。90例子宫浆肌层损伤患者中，均无阴道持续出血、血尿、血便等表现。HIFU术后3、6个月随访MRI，显示子宫浆肌层强化完整。

结论

子宫肌瘤超声消融后早期会出现MRI可见的子宫浆肌层损伤，且损伤位置多发生与声通道的前场，未出现相关临床不良反应。

Abstract

Objective

To investigate the magnetic resonance imaging (MRI) features of uterine seromuscular layer injuries early after ultrasound ablation of uterine fibroids.

Methods

Between 2013 and 2017

a total of 671 women received high-intensity focused ultrasound (HIFU) ablation of uterine fibroids in the First Affiliated Hospital of Chongqing Medical University and underwent MRI examinations both before and after the ablation. After screening for eligibility

400 patients were enrolled in this study. Uterine seromuscular layer injuries following HIFU were defined as the presence of non-perfused area within 120 s after contrast medium injection on enhanced MRI images within 3 d after HIFU. The morphological features and extension of the injuries were analyzed in these patients.

Results

The uterine seromuscular layer without injuries showed intact circular enhancement on MRI

and injuries were manifested as local enhancement deficits. Of the 400 cases included in this analysis

90 (22.50%) showed seromuscular layer injuries following HIFU

and the lesions ranged from 3.9 mm to 66.3 mm in size (mean 25.92

±14.84 mm); the valume ablation rate was significantly higher in cases with seromuscular layer injuries than in cases without injuries [(86.91±17.78)%

(80.93±16.25)%

0.05

]

. The seromuscular layer injuries occurred most frequently in the anterior field of the acoustic pathway and occasionally in the proximal sacrum. The incidence of seromuscular layer injuries was significantly higher in cases of subserosal fibroids than in cases of intramural myoma (43.09%

14.18%

0.05)

and the size of lesions was greater in the former cases (26.8±15.5

24.6±14.0 mm). No major complications occurred in these patients following the ablation. None of the 90 patients with seromuscular layer injuries had persistent vaginal bleeding

hematuria

or hematoplegia

and follow-up MRI at 3 and 6 months after HIFU showed complete enhancement of the seromuscular layer in all these cases.

Conclusion

Seromuscular layer injuries visible on MRI can occur early after ultrasound ablation of uterine fibroids

and the injury sites locate often in the anterior field of the acoustic pathway but do not cause significant clinical adverse reactions.

关键词

Keywords

references

CHEN J, LI Y, WANG Z, et al. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study[J]. BJOG, 2018, 125(3): 354-364. DOI: 10.1111/1471-0528.14689.

陈文直, 唐良萏, 杨武威, 等.超声消融治疗子宫肌瘤的安全性及有效性[J].中华妇产科杂志, 2010, 45(12): 909-912. DOI: 10.3760/cma.j.issn.0529-567x.2010.12.007.

CHEN W Z, TANG L D, YANG W W, et al. Study on the efficacy and safety of ultrasound ablation in treatment of uterine fibroids[J]. Chin J Obst Gynecol, 2010, 45(12): 909-912. DOI: 10.3760/cma.j.issn.0529-567x.2010.12.007.

朱丽, 陈文直, 陈锦云, 等.子宫肌瘤超声消融与MRI信号特征关系的研究[J].第三军医大学学报, 2009, 31(14): 1370-1373.

ZHU L, CHEN W Z, CHEN J Y, et al. MR image features of uterine fibroids afterultrasound ablation: report of 80 fibroids[J].J Third Mil Med Univ, 2009, 31(14): 1370-1373.

汤顾航, 周杨洋, 王健, 等.高强度聚焦超声治疗子宫黏膜下肌瘤[J].中国介入影像与治疗学, 2014, 11(5): 294-297. DOI: 10.13929/j.1672-8475.2014.05.010.

TANG G H, ZHOU Y Y, WANG J,et al. High-intensity focused ultrasound in treatment of submucosal fibroid[J]. Chin J Interv Imaging Ther, 2014, 11(5): 294-297. DOI: 10.13929/j.1672-8475.2014.05.010.

YIN N, HU L, XIAO Z B, et al. Factors influencing thermal injury to skin and abdominal wall structures in HIFU ablation of uterine fibroids[J]. Int J Hyperthermia, 2018, 34(8): 1298-1303. DOI: 10.1080/02656736.2018.1433880.

张学花, 翟昭华, 董国礼, 等. MRI评价子宫肌瘤高强度聚焦超声消融术后盆底筋膜改变[J].中国医学影像技术, 2017, 33(10): 1540-1544. DOI: 10.13929/j.1003-3289.201703126.

ZHANG X H, ZHAI Z H, DONG G L, et al. MRI evaluating changes of pelvic fascia after high intensity focused ultrasound ablation of uterine fibroids[J]. Chin J Med Imaging Technol, 2017, 33(10): 1540-1544. DOI: 10.13929/j.1003-3289.201703126.

尹娜, 王玲, 胡亮, 等. HIFU治疗超声衰减宽度<10 mm声通道腹壁瘢痕子宫肌瘤患者的有效性及安全性[J].中国介入影像与治疗学, 2018, 15(4): 221-225. DOI: 10.13929/j.1672-8475.201708039.

YIN N, WANG L, HU L, et al. Efficacy and safety of HIFU ablation for uterine fibroids in patients with abdominal surgical scars in acoustic pathway causing acoustic attenuation width<10 mm[J]. Chin J Interv Imaging Ther, 2018, 15(4): 221-225. DOI: 10.13929/j.1672-8475.201708039.

崔运能, 田橄, 陈向东, 等.高强度聚焦超声治疗子宫肌瘤及子宫腺肌瘤术后早期并发症的MR表现[J].临床放射学杂志, 2018, 37(3): 461-465. DOI: 10.13437/j.cnki.jcr.2018.03.025.

CUI Y N, TIAN G, CHEN X D, et al. MR features of complications after high intensity focused ultrasound treatment in uterine fibroids and adenomyomas[J]. J Clin Radiol, 2018, 37(3): 461-465. DOI: 10.13437/j.cnki.jcr.2018.03.025.

王玲, 胡亮, 刘畅, 等. 267例无生育史的子宫肌瘤患者经高强度聚焦超声消融治疗术后妊娠结局分析[J].第三军医大学学报, 2018, 40(20): 1865-1869. DOI: 10.16016/j.1000-5404.201803109.

WANG L, HU L, LIU C, et al. Analysis of pregnancy outcomes in 267 nulliparous women after high-intensity focused ultrasound ablation of uterine fibroids[J]. J Third Mil Med Univ, 2018, 40(20): 1865-1869. DOI: 10.16016/j.1000-5404.201803109.

何佳.子宫黏膜下肌瘤高强度聚焦超声治疗[J].中国实用妇科与产科杂志, 2016, 32(2): 145-148.

HE J. High intensity focused ultrasound(HIFU)for submucosal fibroids[J]. Chin J Pract Gynecol Obstet, 2016, 32(2): 145-148.

李俊书, 陈文直, 胡亮, 等.不孕症患者子宫肌瘤HIFU消融术后妊娠相关影响因素分析[J].中国超声医学杂志, 2016, 32(11): 1018-1022.

LI J S, CHEN W Z, HU L, et al. Analyze relevant influence factors on reproductive outcomes after HIFU ablation treatment for infertile women with uterine fibroids[J]. Chin J Ultrasound Med, 2016, 32(11): 1018-1022.

WANG W, WANG Y, WANG T, et al. Safety and efficacy of US-guided high-intensity focused ultrasound for treatment of submucosal fibroids[J]. Eur Radiol, 2012, 22(11): 2553-2558. DOI: 10.1007/s00330-012-2517-z.

QIN J, CHEN J Y, ZHAO W P, et al. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids[J]. Int J Gynaecol Obstet, 2012, 117(3): 273-277. DOI: 10.1016/j.ijgo.2012.01.011.

王智彪, 李发琪, 冯若.治疗超声原理与应用[M].南京:南京大学出版社, 2008: 197.

WANG Z B, LI F Q, FENG R. The principle and application of therapeutic ultrasound[M]. Nanjing: Nanjing University Press, 2008: 197.

邓凤莲, 邹建中, 李锐, 等.高强度聚焦超声治疗子宫肌瘤对骶骨影响因素探讨[J].中国介入影像与治疗学, 2009, 6(5): 457-460. DOI: 10.13929/j.1672-8475.2009.05.021.

DENG F L, ZOU J Z, LI R, et al. Impact factors of high intensity focused ultrasound treatment of uterine leiomyoma on the sacrum[J]. Chin J Interv Imaging Ther, 2009, 6(5): 457-460. DOI: 10.13929/j.1672-8475.2009.05.021.

子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科学杂志, 2017, 52(12): 793-800. DOI: 10.3760/cma.j.issn.0529-567x.2017.12.001.

Chinese Expert Consensus Expert Group on the Diagnosis and Treatment of Uterine Fibroids. Chinese Expert consensus on diagnosis and treatment of uterine leiomyoma[J]. Chin J Obstet Gynecol, 2017, 52(12):793-800. DOI:10.3760/ca.j.issn. 0529-567x.2017.12.001.

牟燕, 刘晓芳, 何佳.高强度聚焦超声治疗子宫肌瘤和子宫腺肌病后盆腔黏连情况分析[J].重庆医学, 2016, 45(10): 1339-1342. DOI: 10.3969/j.issn.1671-8348.2016.10.013.

MU Y, LIU X F, HE J. Analysis on pelvic adhesion situation patients after treatment of uterine fibroids and adenomyosis by high intensity focused ultrasound[J]. Chongqing Med, 2016, 45(10): 1339-1342. DOI: 10.3969/j.issn.1671-8348. 2016.10.013.

CHENG H L, HAIDER M A, DILL-MACKY M J, et al. MRI and contrast-enhanced ultrasound monitoring of prostate microwave focal thermal therapy: an in vivo canine study[J ] . J Magn Reson Imaging, 2008, 28(1): 136-143. DOI: 10.1002/jmri.21415.

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