The aim of the dissertation is to increase the effectiveness of treatment of patients with uterine myoma by developing personalized diagnostic algorithms, focused ultrasound ablation of neoplasms and evaluating the effectiveness of therapy. The work is based on the results of examinations of 110 patients with uterine fibroids, of which 79 women underwent ultrasound ablation at the Kiev City Clinical Cancer Center, the Center for Nuclear Medicine for the period from 2016 to 2019. resonance imaging (MRI) to determine the criteria for inclusion and exclusion from the group of patients for ultrasound ablation. Control methods in the postoperative period were ultrasound, MRI of the pelvic organs using paramagnetics after 1, 3, 6 months. Taking into account the results of radiation methods, an algorithm was developed for examining patients before ultrasound ablation. It should be noted that only sonography makes it possible to determine a safe acoustic pathway for planning ultrasound ablation, as well as to detect the presence of calcifications. At the next stage, it is necessary to use MRI of the pelvic organs, as a unified method for determining the MR of the type of myoma node and a clarifying method for determining the localization, size and number of uterine fibroids. In accordance with the tasks set in the work, the effects of cavitation of the node were investigated by identifying the statistically significant influence of factors on the probability of manifestation of cavitation of the node. Based on the results of the study, a specialized predictive mathematical model was built, which allows, with an appropriate a priori probability, which is set by the doctor, to predict the cavitation event itself, depending on the type of node, its volume and duration of insonation, and to quantitatively calculate the optimal parameters of the operation. As a result of the studies presented in the work, the statistical model allows drawing conclusions about the characteristics of the treatment process.
Immediate outcome control was based on grayscale changes in real-time ultrasound imaging on the JC monitor. After the procedure, the regression of nodes was monitored using ultrasound and MRI with contrast enhancement 1, 3 and 6 months after HIFU ablation. The average value of the regression index at 6 months. local control, equal to -0.57, is considered in the work as a normative (critical) indicator of treatment success. For the practical application of the described algorithm for modeling the likelihood of a positive effect of treatment, the equation of the Cox proportional hazards model was considered. The formulas are implemented as a software product.
