作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Minimally Invasive Therapeutics Group of MRI Application Committee of China Medical Equipment Association
-
摘要: 子宫肌瘤是育龄期女性最常见的妇科良性肿瘤，MR引导下聚焦超声(MR-guided focused ultrasound，MRgFUS)是一种无创治疗子宫肌瘤的新手段，其以MRI为引导，精准地将超声波聚焦于肌瘤瘤体组织，产生65~85 ℃的高温，使肿瘤细胞蛋白质失活、细胞凋亡并凝固坏死，在精准消融肌瘤组织的同时避免损伤治疗区域以外的正常组织。为了进一步提高我国子宫肌瘤的MRgFUS治疗水平，减少和避免并发症的发生，为患者提供更加安全、有效、规范的治疗，由中国医学装备协会磁共振应用专业委员会微创治疗学组组织相关专家在总结国内外临床应用经验的基础上，制定了《MR引导聚焦超声治疗子宫肌瘤的中国专家共识》。Abstract: Uterine fibroid is the most common benign tumor in women of a childbearing age. MR-guided focused ultrasound (MRgFUS) is a new non-invasive method for the treatment of uterine fibroids. Guided by MRI, the ultrasound can focus on the fibroid tissue accurately, producing a high temperature(65-85 ℃)to inactivate protein, induce apoptosis and coagulate necrosis of tumor cells. MRgFUS can accurately ablate fibroid tissue and avoid damage to normal tissue outside the treatment area. In order to further improve the level of MRgFUS treatment of uterine fibroid in China, reduce and avoid the occurrence of complications, and provide safe, effective and standardized treatment to patients, the Minimally Invasive Therapeutics Group of MRI Application Committee of China Medical Equipment Association organized relevant experts to formulate the "China consensus on MR-guided focused ultrasound for uterine fibroids".
-
Key words:
- uterine fibroid /
- magnetic resonance imaging /
- focused ultrasound
利益冲突：无本共识同期发布于《中华放射学杂志》 -
图 1 根据T2WI不同信号强度，子宫肌瘤分为3种类型
A.Ⅰ型：子宫肌瘤(△)T2WI信号低于骨骼肌(箭头)；B.Ⅱ型：子宫肌瘤(△)T2WI信号低于子宫平滑肌信号(红色箭头)但高于骨骼肌信号(白色箭头)C.Ⅲ型：子宫肌瘤(△)T2WI信号强度高于子宫平滑肌信号(箭头)
-
[1] 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].中华妇产科杂志, 2017, 52:793-800. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfck201712001 [2] Stewart EA. Uterine fibroids[J]. Lancet, 2001, 357:293-298. doi: 10.1016/S0140-6736(00)03622-9 [3] Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up[J]. BJOG, 2002, 109:1262-1272. doi: 10.1046/j.1471-0528.2002.01449.x [4] 张俊海, 刘晓霞, 熊海芮, 等.磁共振引导超声聚焦治疗子宫肌瘤患者的MRI筛选[J].中国医学计算机成像杂志, 2017, 23:539-543. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyxjsjcx201706011 [5] 苏佰燕, 范融, 薛华丹, 等.MR引导下聚焦超声术治疗症状性子宫肌瘤的安全性及有效性[J].中华放射学杂志, 2017, 51:149-153. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfsx201702015 [6] 吴光耀, 董国礼, 杨汉丰, 等.MR引导高强度聚焦超声治疗子宫肌瘤的Meta分析[J].中华放射学杂志, 2015, 49:391-394. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfsx201505018 [7] 薛华丹, 苏佰燕, 范融, 等.MR引导下聚焦超声术治疗症状性子宫肌瘤安全性及有效性的初步研究[J].中华放射学杂志, 2012, 46:851-853. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhfsx201209017 [8] Funaki K, Fukunishi H, Funaki T, et al. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2 weighted magnetic resonance images[J]. Am J Obstet Gynecol, 2007, 196:184.e1-e6. doi: 10.1016/j.ajog.2006.08.030 [9] Zhao WP, Chen JY, Zhang L, et al. Feasibility of ultrasound-guided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging[J]. Eur J Radiol, 2013, 82:e43-e49. doi: 10.1016/j.ejrad.2012.08.020 [10] Mikami K, Murakami T, Okada A, et al. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience[J]. Radiat Med, 2008, 26:198-205. doi: 10.1007/s11604-007-0215-6 [11] Pennes HH. Analysis of tissue and arterial blood temperatures in the resting human forearm[J]. J Appl Physiol, 1948, 1:93-122. doi: 10.1152/jappl.1948.1.2.93 [12] Kim YS, Lim HK, Kim JH, et al. Dynamic contrast-enhanced magnetic resonance imaging predicts immediate therapeutic response of magnetic resonance-guided high-intensity focused ultrasound ablation of symptomatic uterine fibroids[J]. Invest Radiol, 2011, 46:639-647. doi: 10.1097/RLI.0b013e318220785c [13] Kim YS, Kim TJ, Lim HK, et al. Preservation of the endometrial enhancement after magnetic ultrasound ablation of submucosal uterine fibroids[J]. Eur Radiol, 2017, 27:3956-3965. doi: 10.1007/s00330-017-4765-4 [14] Pron G. Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment of symptomatic uterine fibroids: an evidence-based analysis[J]. Ont Health Technol Assess Ser, 2015, 15:1-86. http://europepmc.org/articles/PMC4558769 [15] Park MJ, Kim YS, Rhim H, et al. Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused US therapy[J]. J Vasc Interv Radiol, 2014, 25:231-239. doi: 10.1016/j.jvir.2013.11.011 [16] Yoon SW, Seong SJ, Jung SG, et al. Mitigation of abdominal scars during MR-guided high-intensity focused ultrasound treatment of uterine leiomyomas with the use of an energy-blocking scar patch[J]. J Vasc Interv Radiol, 2011, 22:1747-1750. doi: 10.1016/j.jvir.2011.07.005 [17] Chen R, Keserci B, Bi H, et al. The safety and effectiveness of volumetric magnetic resonance-guided high intensity focused ultrasound treatment of symptomatic uterine fibroids: early clinical experience in China[J]. J Ther Ultrasound, 2016, 4:27. doi: 10.1186/s40349-016-0072-9 [18] Park MJ, Kim YS, Rhim H, et al. Technique to displace bowel loops in MRI-guided high-intensity focused ultrasound ablation of fibroids in the anteverted or anteflexed uterus[J]. AJR Am J Roentgenol, 2013, 201:W761-W764. doi: 10.2214/AJR.12.10081 [19] Duc NM, Keserci B. Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids[J]. Diagn Interv Radiol, 2018, 24:283-291. doi: 10.5152/dir.2018.18111 [20] Machtinger R, Inbar Y, Cohen-Eylon S, et al. MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success[J]. Hum Reprod, 2012, 27:3425-3431. doi: 10.1093/humrep/des333 [21] Park H, Yoon SW, Sokolov A. Scaled signal intensity of uterine fibroids based on T2-weighted MR images: a potential objective method to determine the suitability for magnetic resonance-guided focused ultrasound surgery of uterine fibroids[J]. Eur Radiol, 2015, 25:3455-3458. doi: 10.1007/s00330-015-3806-0 [22] Yoon SW, Lee C, Cha SH, et al. Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI[J]. Eur Radiol, 2008, 18:2997-3006. doi: 10.1007/s00330-008-1086-7 [23] Rueff LE, Raman SS. Clinical and technical aspects of MR-guided high intensity focused ultrasound for treatment of symptomatic uterine fibroids[J]. Semin Intervent Radiol, 2013, 30:347-353. doi: 10.1055/s-0033-1359728 [24] Quinn SD, Vedelago J, Gedroyc W, et al. Safety and five-year re-intervention following magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids[J]. Eur J Obstet Gynecol Reprod Biol, 2014, 182:243-247. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=f53aa45965e67b6ac19a8f45a5d00444 [25] Ticca C, Bignardi T, Zucconi F, et al. Efficacy of MR-guided focused ultrasound surgery (MRgFUS) of uterine fibroids: evaluation of non perfused volume (NPV), fibroid shrinkage and clinical improvement at 6 months follow-up[J]. Transl Cancer Res, 2014, 3:413-420. http://www.researchgate.net/publication/301633770_Efficacy_of_MR-guided_focused_ultrasound_surgery_MRgFUS_of_uterine_fibroids_Evaluation_of_non_perfused_volume_NPV_fibroid_shrinkage_and_clinical_improvement_at_6_months_follow-up [26] Mindjuk I, Trumm CG, Herzog P, et al. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre[J]. Eur Radiol, 2015, 25:1317-1328. doi: 10.1007/s00330-014-3538-6 [27] Sridhar D, Kohi MP. Updates on MR-guided focused ultrasound for symptomatic uterine fibroids[J]. Semin Intervent Radiol, 2018, 35:17-22. doi: 10.1055/s-0038-1636516 [28] Mashiach R, Inbar Y, Rabinovici J, et al. Outcome of magnetic resonance-guided focused ultrasound surgery (MRgFUS) for FIGO class 1 fibroids[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 221:119-122. doi: 10.1016/j.ejogrb.2017.12.025 [29] Mascaretti S, Ferrari F, Miccoli A, et al. Feasibility of magnetic resonance-guided focus ultrasound surgery (MRgFUS) in the uterine fibroid treatment: evaluation of the treatment radicalization in single and multiple fibroids correlated to clinical outcome[J]. Clin Exp Obstet Gynecol, 2018, 45:84-87. http://smartsearch.nstl.gov.cn/paper_detail.html?id=53c46ce3284fa40ce89e12130b5aa394 [30] Fukunishi H, Funaki K, Sawada K, et al. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases[J]. J Minim Invasive Gynecol, 2008, 15:571-579. doi: 10.1016/j.jmig.2008.06.010 [31] Ferrari F, Arrigoni F, Miccoli A, et al. Effectiveness of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation[J]. Radiol Med, 2016, 121:153-161. doi: 10.1007/s11547-015-0580-7 [32] Polina L, Nyapathy V, Mishra A, et al. Noninvasive treatment of focal adenomyosis with MR-guided focused ultrasound in two patients[J]. Indian J Radiol Imaging, 2012, 22: 93-97. doi: 10.4103/0971-3026.101078 -
下载:
点击查看大图
图(2)
计量
- 文章访问数: 365
- HTML全文浏览量: 117
- PDF下载量: 58
- 被引次数: 0
