空化效应与超声治疗仪

本文简要综述在超声作用下，液体中空化气泡快速闭合瞬间所产生的放电、发光、高温、高压、高能量密度、冲击波、微冲流、微聚变、高精度时钟等奇特的理化效应。这些效应构成了近年来迅速发展的超声治疗、超声手术、超声美容等的物理机制，也为设计、改进及合理应用这类超声治疗仪提供了科学依据     

Cardiovascular cavitation

This article reviews the role of cavitation in the therapeutic applications of ultrasound and laser surgery, and the cavitation effects in mechanical heart valves. Whenever laser pulses are used to ablate or disrupt tissue in a liquid environment, cavitation bubbles are produced which interact with the tissue. The interaction between cavitation bubbles and tissue during pulsed laser surgery may cause collateral damage to sensitive tissue structures in the vicinity of the laser focus, and it may also contribute in several ways to ablation and cutting. Cavitation is also one of the most exploited bioeffects of ultrasound for therapeutic advantage. In both cases, the violent implosion of cavitation bubbles can lead to the generation of shock waves, high-velocity liquid jets, free radical species, and strong shear forces that can damage the nearby tissue. Knowledge of these physical mechanisms is therefore of vital importance and would provide a framework wherein novel and improved surgical techniques can be developed.     

Non-Invasive Liver Ablation Using Histotripsy: Preclinical Safety Study in an In Vivo Porcine Model

This study investigates the safety profile for use of histotripsy, a non-invasive ultrasonic ablation method currently being developed for the treatment of liver cancer, for liver ablation in an in vivo porcine model. Histotripsy treatments were applied to the liver and hepatic veins of 22 porcine subjects, with half of the subjects receiving systemic heparinization. Vital signs (heart rate, blood pressure, temperature, electrocardiogram and SpO₂) were monitored throughout the procedure and for 1 h post-treatment. Blood was drawn at six points during the experiment to analyze blood gases, liver function and free hemoglobin levels. All treatments were guided and monitored by real-time ultrasound imaging. After treatment, the tissue was harvested for histological analysis. Results indicated that histotripsy generated well-defined lesions inside the liver and around the treated hepatic veins of all subjects in both treatment groups. Vital signs and blood analysis revealed that animals responded well to histotripsy, with all animals surviving the treatment. One animal in the non-heparinized group had a transient increase in pH and decreases in blood pressure, heart rate and PCO₂ during the 15-min vessel treatment, with these changes returning to baseline levels soon after the treatment. Overall, the results indicate that histotripsy can safely be performed on the liver without the need for systemic heparinization, even in regions containing large hepatic vessels, supporting its future use for the treatment of liver cancer.     

Mechanical and Biological Effects of Ultrasound: A Review of Present Knowledge

Ultrasound is widely used for medical diagnosis and increasingly for therapeutic purposes. An understanding of the bio-effects of sonography is important for clinicians and scientists working in the field because permanent damage to biological tissues can occur at high levels of exposure. Here the underlying principles of thermal mechanisms and the physical interactions of ultrasound with biological tissues are reviewed. Adverse health effects derived from cellular studies, animal studies and clinical reports are reviewed to provide insight into the in vitro and in vivo bio-effects of ultrasound.     

On the Closing Sounds of a Mechanical Heart Valve

In the 1994 Replacement Heart Valve Guidance of the U.S. Food and Drug Administration (FDA), in-vitro testing is required to evaluate the potential for cavitation damage of a mechanical heart valve (MHV). To fulfill this requirement, the stroboscopic high-speed imaging method is commonly used to visualize cavitation bubbles at the instant of valve closure. The procedure is expensive; it is also limited because not every cavitation event is detected, thus leaving the possibility of missing the whole cavitation process. As an alternative, some researchers have suggested an acoustic cavitation-detection method, based on the observation that cavitation noise has a broadband spectrum. In practice, however, it is difficult to differentiate between cavitation noise and the valve closing sound, which may also contain high-frequency components. In the present study, the frequency characteristics of the closing sound in air of a Björk-Shiley Convexo-Concave (BSCC) valve are investigated. The occluder closing speed is used as a control parameter, which is measured via a laser sweeping technique. It is found that for the BSCC valve tested, the distribution of the sound energy over its frequency domain changes at different valve closing speeds, but the cut-off frequency remains unchanged at 123.32± 6.12 kHz. The resonant frequencies of the occluder are also identified from the valve closing sound.     

Regurgitant flow field characteristics of the St. Jude bileaflet mechanical heart valve under physiologic pulsatile flow using particle image velocimetry

The regurgitant flow fields of clinically used mechanical heart valves have been traditionally studied in vitro using flow visualization, ultrasound techniques, and laser Doppler velocimetry under steady and pulsatile flow. Detailed investigation of the forward and regurgitant flow fields of these valves can elucidate a valve's propensity for blood element damage, thrombus formation, or cavitation. Advances in particle image velocimetry (PIV) have allowed its use in the study of the flow fields of prosthetic valves. Unlike other flow field diagnostic systems, recent work using PIV has been able to relate particular regurgitant flow field characteristics of the Bjork-Shiley Monostrut valve to a propensity for cavitation. In this study, the regurgitant flow field of the St. Jude Medical bileaflet mechanical heart valve was assessed using PIV under physiologic pulsatile flow conditions. Data collected at selected time points prior to and after valve closure demonstrated the typical regurgitant jet flow patterns associated with the St. Jude valve, and indicated the formation of a strong regurgitant jet, in the B-datum plane, along with twin vortices near the leaflets. Estimated ensemble-average viscous shear rates suggested little potential for hemolysis when the hinge jets collided. However, the vortex motion near the occluder tips potentially provides a low-pressure environment for cavitation.     

Cell detachment method using shock-wave-induced cavitation

The detachment of adherent HeLa cells from a substrate after the interaction with a shock wave is analyzed. Cavitation bubbles are formed in the trailing, negative pressure cycle following the shock front. We find that the regions of cell detachment are strongly correlated with spatial presence of cavitation bubbles. It is shown that the cavitation bubble collapse generates a transient high-speed flow along the substrate surface leading to rapid detachment of the cells. Flow trajectories are reconstructed from the video recordings using robust image-processing methods. From these trajectories, an estimate of the shear stress acting on the cells is obtained and the area of detachment is estimated with a kinetic model. Furthermore, it is suggested that the application of shock waves extends the known methods of cell detachment with the ability to control the process in space and time. (E-mail: c.d.ohl@tn.utwente.nl)     

A Comparison of Acoustic Cavitation Detection Thresholds Measured with Piezo-electric and Fiber-optic Hydrophone Sensors

A Fabry-Perot interferometer fiber-optic hydrophone (FOH) was investigated for use as an acoustic cavitation detector and compared with a piezo-ceramic passive cavitation detector (PCD). Both detectors were used to measure negative pressure thresholds for broadband emissions in 3% agar and ex vivo bovine liver simultaneously. FOH-detected half- and fourth-harmonic emissions were also studied. Three thresholds were defined and investigated: (i) onset of cavitation; (ii) 100% probability of cavitation; and (iii) a time-integrated threshold where broadband signals integrated over a 3-s exposure duration, averaged over 5–10 repeat exposures, become statistically significantly greater than noise. The statistical sensitiviy of FOH broadband detection was low compared with that of the PCD (0.43/0.31 in agar/liver). FOH-detected fourth-harmonic data agreed best with PCD broadband (sensitivity: 0.95/0.94, specificity: 0.89/0.76 in agar/liver). The FOH has potential as a cavitation detector, particularly in applications where space is limited or during magnetic resonance-guided studies.     

工作周期对脉冲高强度聚焦超声辐照离体牛肝的影响

目的探讨工作周期（即占空比）在脉冲高强度聚焦超声（HIFU）损伤组织的生物学效应中的作用。方法设置HIFU辐照参数使能量恒定,按不同工作周期与相应辐照时间分组,观察各辐照焦点温度、灰度以及组织学改变。结果HIFU辐照离体牛肝时,25%组、50%组、75%组和100%组最高温度大于85℃且有明显的凝固性坏死。1%组、5%组、15%组最高温度不高于56℃且无肉眼可见的坏死改变。15%组光镜下见细胞间裂隙增宽,肝细胞胞浆内见大小不等空泡。结论长工作周期易形成热凝固性坏死,而短工作周期则可能通过空化机械效应损伤组织。