Evaluating uterine fibroids with contrast-enhanced ultrasound imaging (CEUS) and superb microvascular imaging (SMI) pre and post uterine artery embolization (UAE)

在子宫动脉栓塞术 (UAE) 前后使用对比增强超声成像 (CEUS) 和卓越的微血管成像 (SMI) 评估子宫肌瘤

• 批准号: 9808678
• 负责人: Carin F Gonsalves
• 金额: $ 7.8万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-05 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9808678
• 关键词: Abdomen; Affect; African American; Arteries; Asians; Benign; Blood Vessels; Blood flow; Catheters; Caucasians; Characteristics; Clinical; Color; Contrast Media; Diagnosis; Enrollment; Feeling; Fibroid Tumor; Gadolinium; Gastrointestinal tract structure; Goals; Hispanics; Hysterectomy; Image; Individual; Infertility; Injections; Insurance; Kinetics; Magnetic Resonance Imaging; Maps; Menorrhagia; Monitor; Necrosis; Outcome; Patients; Pattern; Pelvic Pain; Pelvis; Physicians; Pilot Projects; Predictive Factor; Probability; Procedures; Quality of life; Radiology Specialty; Schedule; Signal Transduction; Smooth Muscle Myocytes; Symptoms; Techniques; Therapeutic Embolization; Time; Treatment Efficacy; Ultrasonography; United States; Urinary tract; Uterine Fibroids; Uterine myomectomy; Uterus; Vascular blood supply; Vascularization; Woman; base; clinical Diagnosis; contrast enhanced; demographics; diagnosis evaluation; follow-up; imaging modality; infection risk; low socioeconomic status; myometrium; pressure; side effect; success; symptomatic improvement; targeted agent; treatment response; tumor

Uterine fibroids affect approximately 30% of all women in the United States or about 45 million individuals. The clinical diagnoses of uterine fibroids are from two to three times more common in African-American women than in Caucasian women. Uterine artery embolization (UAE) is a nonsurgical therapy that shrinks fibroids by blocking arterial blood flow to the fibroids. The goal of the technique is the occlusion or marked reduction in blood flow to the fibroids causing selective ischemic necrosis acting at the arteriolar level to minimize uterine damage. UAE has equivalent reduction in symptoms, improvement in quality of life, and lower risk of infection than a hysterectomy. After the UAE, the current strategy is to request a gadolinium-enhanced MRI to evaluate the efficacy of the treatment. However, an MRI is not always available and remains very expensive, which has resulted in fewer and fewer insurance companies allowing this follow-up leaving physicians as well as patients to rely on clinical signs to determine successful of treatment. Using contrast-enhanced ultrasound imaging (CEUS) to characterize uterine fibroid microvascularization before and after UAE may be similar to MRI results. Recently, an ultrasound technique, which provides a precise microvascular map without the use of contrast agents – superb microvascular imaging (SMI), has been developed. SMI combines multi-dimensional filtering and advanced clutter suppression to extract flow signals from large to small vessels and depicts this information at high frame rates as a color overlay image (color SMI) or as a grayscale map of flow (monochrome SMI). Thus, the scientific premise of this project is that CEUS and/or SMI can be used to describe the characteristics of fibroid microvascularization before and after UAE in order to determine the success of the procedure. We expect to enroll 40 subjects scheduled for a UAE procedure, out of which the vast majority will be African-American (around 35 subjects), since the demographics specific for UAE procedures at TJU is 80-85% African- American women and 15-20% other (Caucasian, Asian and Hispanic). These women will be studied with abdominal and/or endovaginal CEUS and SMI (color and monochrome) to evaluate fibroid microvascularity before, 2 weeks and 3 months after UAE (consistent with patient's clinical follow-up) to evaluate the success of the UAE (specific aim 1). Results will be compare with clinical outcomes and when available with MRI studies (specific aim 2). Hence, this project will determine patterns of uterine fibroids microvasculation pre and post UAE using CEUS and SMI as an alternative to gadolinium-enhanced MRI that is less expensive, has less contra-indications and side effects, and noninvasive helping physicians to evaluate the result of UAE procedures.

子宫肌瘤影响美国约30%的女性或约4500万人 个体子宫肌瘤的临床诊断是从两到三倍更常见的， 非裔美国女性多于白人女性。子宫动脉栓塞术（UAE）是一种 通过阻断动脉血流向肌瘤来缩小肌瘤的非手术疗法。的目标 该技术是阻塞或显著减少流向肌瘤的血流， 缺血性坏死作用于小动脉水平以使子宫损伤最小化。阿联酋拥有相当于 减少症状，改善生活质量，降低感染风险 子宫切除术阿联酋之后，目前的策略是要求钆增强MRI， 评估治疗的效果。然而，MRI并不总是可用的， 昂贵，这导致越来越少的保险公司允许这种后续行动 使得医生和患者依靠临床体征来确定治疗的成功。 超声造影对子宫肌瘤的诊断价值 UAE前后微血管的变化与MRI结果相似。最近，超声波 技术，它提供了一个精确的微血管地图，而不使用造影剂- 极好的微血管成像（SMI）已经被开发出来。SMI结合了多维 滤波和先进的杂波抑制，以从大到小的血管中提取流量信号， 以高帧速率将此信息描述为彩色叠加图像（彩色SMI）或灰度 血流图（单色SMI）。因此，该项目的科学前提是CEUS和/或 SMI可用于描述子宫肌瘤微血管化前后的特点 阿联酋，以确定该程序的成功。我们预计招募40名受试者 计划进行阿联酋手术，其中绝大多数将是非洲裔美国人（约 35例受试者），因为TJU UAE手术的特定人口统计学特征为80-85%为非洲人- 美国女性和15-20%的其他（白人，亚洲和西班牙裔）。这些女人会 使用腹部和/或阴道内CEUS和SMI（彩色和单色）进行研究，以评估 UAE前、术后2周和3个月的肌瘤微血管分布（与患者的临床表现一致） 后续行动），以评估阿联酋的成功（具体目标1）。将结果与临床结果进行比较 结局和MRI研究（具体目标2）。因此，该项目将决定 使用CEUS和SMI作为UAE前后子宫肌瘤微血管的模式， 钆增强MRI的替代品，价格更便宜，禁忌症更少， 副作用和非侵入性帮助医生评估UAE手术的结果。