探讨实时超声弹性成像（RTE）技术评估不同回声水平子宫肌瘤射频消融治疗（RFA）前、后消融灶特征及弹性指数变化的价值。

收集2013年9月至2015年1月到哈尔滨医科大学附属第四医院行超声引导下RFA治疗的患者43例，共55个病灶，均于术后1 h内行超声造影确定无灌注。病灶直径1.0~3.0 cm，平均直径（1.9±1.2）cm。根据回声类型于术前将子宫肌瘤分为低回声组（30个）、高回声组（13个）与混合回声组（12个）。于RFA术前、术后1 h、术后3个月行RTE检查及Q-analysis实时组织弹性定量分析治疗前后病灶的硬度变化（E值）及内部均匀程度（△E值）。低回声组、高回声组及混合回声组E值、△E值等连续型变量采用重复测量的方差分析。射频消融术前、术后1 h及术后3个月的弹性成像图谱特征采用χ²检验中的Fisher检验比较同一时间点的组间差异。

（1）RFA术前，3组RTE图谱中不同回声类型图谱特征不同，低回声组弹性图谱特征中蓝绿相间绿色为主占70%（21/30）；高回声组中完全被蓝色覆盖占50%（6/12），混合回声组中蓝绿相间，蓝色为主占53.9%（7/13）；同一时间点3组比较，差异有统计学意义（P<0.01）。术后1 h，3组均以完全被蓝色覆盖为主，占74.5%（41/55），3组间弹性图谱特征的比较，差异均无统计学意义（P>0.05）。术后3个月，3组以完全被蓝色覆盖为主，占83.6 %（46/55）。3组间弹性图谱特征的比较，差异均无统计学意义（P均>0.05）。（2）E值比较，RFA术前低回声组最低，高回声组最高，混合回声组介于二者之间，高回声组与低回声组比较，差异有统计学意义（F=19.25，P<0.01）。术后1 h，3组E值均升高，低回声组术后1 h、3个月与治疗前比较，差异有统计学意义（F=386.75、294.68，P均<0.01）；高回声组术后1 h、3个月与治疗前比较，差异有统计学意义（F=29.98、45.88，P均<0.01）；混合回声组术后1 h、3个月与治疗前比较，差异有统计学意义（F=120.29、139.64，P均<0.01）。术后3个月，3组E值进一步增高，同一时间点不同组别之间比较，差异无统计学意义（P>0.05）。（3）△E值比较，RFA术前，低回声组与高回声组较低，混合回声组较高，混合回声组与低回声组、高回声组比较，差异有统计学意义（F=484.68、344.15，P均<0.01）。术后1 h，低回声组与混合回声组△E值较高，高回声组相对较低，高回声组与混合回声组、低回声组比较，差异有统计学意义（F=53.58、94.79，P均<0.01）。低回声组术前与术后1 h比较，差异有统计学意义（F=154.35，P<0.01）。低回声组术后1 h与术后3个月比较，差异有统计学意义（F=266.85，P<0.01）。混合回声组术前、后1 h与术后3个月比较，差异有统计学意义（F=103.24、76.53，P均<0.01）。术后3个月，3组△E值均降低，同一时间点不同组别之间比较，差异均无统计学意义（P均>0.05）。

不同回声水平肌瘤RTE特征与弹性指数明显不同。RTE可以判断RFA前后的硬度变化，应用RTE对病灶硬度与均匀程度定量比较可作为评估射频治疗疗效的依据。

To investigate the value of real-time elastography (RTE) in evaluating the characteristics and elasticity index (E-index) changes at different echo level of uterine fibroids before and after radiofrequency ablation (RFA).

A total of 43 patients (with 55 lesions) accepted RFA under ultrasound guidance in the Fourth Affiliated Hospital of Harbin Medical University from September 2013 to January 2015. All lesions were confirmed to have no perfusion through ultrasonography 1 h after RFA. The diameter of lesions ranging from 1.0 cm to 3.0 cm (with an average of 1.9±1.2 cm). Preoperative lesions were classified into 3 groups for comparison based on ultrasonic echo type, group A: hypo echo (n=30); group B: hyper echo (n=12); and group C: mixed echo (n=12). Measured elasticity index E-index and internal uniformity (△E) were analyzed. Comparisons of E value and △E value were performed with repeated measures. RTE images features using χ² test of Fisher inspection comparison at the same time differences between groups.

(1) Before RFA, RTE images showed blue alternating with green with green being dominated accounting for 70% (21/30). 50% of RTE images in group B were completely covered in blue (6/12), while group C exhibited 53.9% blue alternating with green with blue being dominated (7/13). There were statistically significant characteristics of RTE images among 3 groups (P<0.01). 1 h after RFA, 74.5% lesions exhibited with blue being dominated (41/55). However, 83.6% (41/55) exhibited with blue 3 months after RFA. The difference in characteristics of RTE among 3 groups displayed no statistical significance (P>0.05). (2) The comparison of E-index revealed that before RFA, the E value was the lowest in the group A and the highest in the group B, while the group C was between them. There was significant difference between group A and B (F=19.25, P<0.01). E-index elevated in all the three groups and significant differences were found 1 h, 3 month after RFA in comparison with that before RFA in the group A (F=386.75, 294.68, both P<0.01). In addition, significant differences were also found 1 h, 3 month after RFA in comparison with the treatment in the group B (F=29.98, 45.88, both P<0.01). As for the group C, there were significant differences in E-index 1 h, 3 month after RFA compared with before RFA (F=120.29, 139.64, both P<0.01). 3 months after RFA, E-index further elevated in the three groups and no significant inter-group difference was found at the same time points (P> 0.05). (3)Before RFA, the △E value was lower in group A and group B, while higher in the group C, group C presenting significant difference from group A and B (F=484.68, 344.15, both P<0.01). At 1 h after RFA , △E value was higher in group A and group C, while lower in group B, with group B showing significant difference from the low and mixed echo groups (F=53.58, 94.79, both P<0.01). Significant difference was observed 1 h after surgery compared to before RFA in group A (F=154.35, P<0.01). Significant difference was also found 1 h after RFA compared to 3 month after RFA in group A (F=266.85, P<0.01). As for group C, there were also significant differences in △E-index before treatment and 1 h after RFA compared with 3 month after RFA (F=103.24, 76.53, both P<0.01). At 3 months after RFA, △E-index decreased in all three groups. No significant inter-group difference was found at the same time points (all P>0.05).

RTE characteristics and the elasticity index are distinctly different among uterine fibroid at various echo intensities. RTE contributes to judging changes in hardness before and after RFA. The application of RTE for quantitative comparison of lesion hardness and uniformity can be served as the foundation for evaluating therapeutic effects of RFA.