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

子宫肌瘤影响了美国大约30%的女性，约4500万人 个人。子宫肌瘤的临床诊断比其他疾病常见两到三倍 非裔美国女性比高加索女性多。子宫动脉栓塞术(UAE)是一种 通过阻断流向肌瘤的动脉血来缩小肌瘤的非手术疗法。的目标是 这项技术是闭塞或明显减少流向肌瘤的血液，导致选择性 作用于小动脉水平的缺血性坏死，以最大限度地减少子宫损伤。阿联酋也有类似的 症状减轻，生活质量提高，感染风险低于 子宫切除术。在阿联酋之后，目前的战略是请求Gd增强MRI以 评估治疗效果。然而，核磁共振并不总是可用的，而且仍然非常 昂贵，这导致允许这种后续行动的保险公司越来越少 这使得医生和患者都要依靠临床症状来确定治疗的成功。 超声造影在子宫肌瘤诊断中的应用 UAE前后的微血管形成可能与MRI结果相似。最近，一次超声波检查 这项技术在不使用造影剂的情况下提供了精确的微血管图- 高超的微血管成像(SMI)已经被开发出来。SMI结合了多维 滤波和先进的杂波抑制，以提取从大到小的血管和 以高帧速率将此信息描述为彩色叠加图像(彩色SMI)或灰度 流程图(单色SMI)。因此，该项目的科学前提是CEU和/或 SMI可以用来描述肌瘤微血管形成前后的特征 阿联酋方面，以确定手术是否成功。我们预计招收40个科目 计划进行阿联酋程序，其中绝大多数将是非洲裔美国人(大约 35名受试者)，因为阿联酋TJU程序的特定人口统计数字是80%-85%是非洲人- 美国女性和15%-20%的其他人(高加索人、亚洲人和西班牙人)。这些女人将会是 使用腹部和/或阴道内CEU和SMI(彩色和单色)进行研究以评估 子宫动脉栓塞术前、术后2周和3个月肌瘤微血管(与患者临床一致 后续行动)，以评价阿联酋的成功(具体目标1)。结果将与临床进行比较。 结果和MRI研究的结果(特定目标2)。因此，这个项目将决定 子宫动脉栓塞术前后子宫肌瘤微血管形态的CEUS和SMI研究 Gd增强MRI的替代方案更便宜，禁忌症更少， 副作用，以及非侵入性帮助医生评估阿联酋手术的结果。

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.