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目的:探讨实时超声弹性成像(Real-time ultrasound elastography,RTE)在子宫肌瘤射频消融治疗(radiofrequency ablation,RFA)中的应用价值。方法:对34例行RFA治疗的子宫肌瘤患者(共38个病灶)于术前、术后1小时、术后3个月进行阴式超声、RTE及超声造影(contrast-enhanced ultrasonography,CEUS)检查。在2D、RTE、CEUS三种条件下分别测量病灶的直径。分析术前弹性图特征并分组,测量病灶弹性应变比率(E/E_0),对比分析组间、组内的E/E_0。比较2D、RTE、CEUS条件下病灶直径之间的差异。术后以弹性图像上病灶显示蓝绿相间为判定消融不全的标准,与CEUS对比,分析RTE与CEUS对消融程度评估的一致性。结果:根据术前肌瘤弹性图像将病灶分为蓝色组8个(21.1%),蓝色为主组20个(52.6%),绿色为主组10个(26.3%),术前3组病灶之间E/E_0差异明显,术后1小时、术后3个月E/E_0差异无统计学意义(P>0.05),组内RFA术后1小时、3个月病灶E/E_0较术前明显增大,术后3个月E/E_0大于术后1小时(P<0.05);术前RTE检测病灶直径大于2D及CEUS(P<0.05),术后1小时2D测量直径大于RTE及CEUS(P<0.05),三种成像技术在术后3个月测量病灶直径差异无统计学意义(P>0.05);RFA术后1小时及术后3个月RTE对病灶消融程度评估结果与CEUS基本一致,Kappa值分别为0.46、0.54。结论:RFA术后肌瘤逐步变硬,RTE检查能够反映这种硬度变化,并且能够评估消融病灶的范围并预估消融程度,因此RTE在子宫肌瘤RFA治疗中有一定的应用价值。
Objective: To investigate the value of real-time ultrasound elastography (RTE) in the radiofrequency ablation (RFA) of uterine fibroids. Methods: 34 cases of uterine leiomyoma treated by RFA (38 lesions in total) underwent ultrasonography, RTE and contrast-enhanced ultrasonography (CEUS) before operation, 1 hour after operation and 3 months after operation. an examination. In 2D, RTE, CEUS three conditions were measured lesion diameter. The characteristics of preoperative elastography were analyzed and grouped. The elastic strain ratio (E / E 0) of the lesion was measured. The E / E 0 was compared between the groups. Differences in lesion diameters between 2D, RTE and CEUS were compared. After the surgery, the lesions on the elastic images showed blue-green phase as the criterion for the determination of ablation. Compared with CEUS, the consistency between RTE and CEUS in assessing ablation degree was analyzed. Results: According to the preoperative fibroid elastography, the lesions were divided into 8 groups (21.1%) in the blue group, 20 (52.6%) in the blue group, 10 (26.3%) in the green group, The difference of E / E 0 between the lesions was significant. There was no significant difference in E / E 0 between 1 hour and 3 months after operation (P> 0.05). E / E 0 was significantly higher at 1 hour and 3 months after RFA (P <0.05). The diameter of the lesion detected by RTE was greater than that of 2D and CEUS before operation (P <0.05), and the diameters of 2D measured at 1 hour after operation were larger than those of RTE and CEUS (P <0.05). There was no significant difference in the diameter of lesion measured by three imaging techniques at 3 months after operation (P> 0.05). The results of RTE evaluation of lesion ablation at 1 hour and 3 months after RFA CEUS basically the same, Kappa values were 0.46,0.54. Conclusion: The fibroids gradually harden after RFA, RTE can reflect the change of hardness, and can assess the scope of ablation lesions and predict the degree of ablation, so RTE has certain value in the treatment of uterine fibroids RFA.