聚焦超声用于治疗皮肤和黏膜上皮内非瘤样病变的量效关系初步研究

目的 初步研究聚焦超声治疗临床应用中的辐照剂量与治疗效果的关系，寻求一种较好的治疗辐照方式，为广泛的临床应用奠定基础。 方法 对皮肤和黏膜上皮内非瘤样病变30例进行超声治疗，在治疗前及治疗后3个月分别进行外阴活检，通过观察在不同的治疗剂量下其症状、体征及组织结构在治疗前后的变化，确定治疗效果。 结果 超声治疗剂量、次数对临床疗效均有一定的影响。在同一超声功率与频率下，不同类型疾病的临床治疗效果无显著性差异（P〉0．05）。在同一超声功率与频率下，单位面积的超声治疗疗效与辐照时间和次数呈正相关。 结论 适当的超声治疗剂量和治疗方案会使皮肤和黏膜上皮内非瘤样病变的疗效更明显。     

Instantaneous Frequency-Based Ultrasonic Temperature Estimation During Focused Ultrasound Thermal Therapy

Focused ultrasound thermal therapy relies on temperature monitoring for treatment guidance and assurance of targeting and dose control. One potential approach is to monitor temperature change through ultrasonic-backscattered signal processing. The current approach involves the detection of echo time-shifts based on cross-correlation processing from segmented radiofrequency (RF) data. In this study, we propose a novel ultrasonic temperature-measurement approach that detects changes in instantaneous frequency along the imaging beam direction. Focused ultrasound was used as the heating source, and the 1-D beamformed RF signals provided from an ultrasound imager were used to verify the proposed algorithm for temperature change estimation. For comparison, a conventional cross-correlation technique was also evaluated. Heating experiments testing tissue-mimicking phantoms and ex vivo porcine muscles were conducted. The results showed that temperature can be well estimated by the proposed algorithm in the temperature range, where the relationship of sound speed versus temperature is linear. Compared with the cross-correlation–based algorithm, the proposed new algorithm yields a six-fold increase in computational efficiency, along with comparable contrast-detection ability and precision. This new algorithm may serve as an alternative method for implementing temperature estimation into a clinical ultrasound imager for thermal therapy guidance. (E-mail: kcju@isu.edu.tw)     

高强度聚焦超声治疗中晚期胰腺癌的临床研究

目的 初步评价高强度聚焦超声(HIFU)治疗胰腺癌的止痛作用和有效性.方法 29例不能手术的胰腺癌患者进行了HIFU治疗,通过症状、实验室检查和影像学变化等观察HIFU的治疗效果,同时比较全麻与镇静镇痛2种方式下HIFU治疗的剂量强度和效率的不同.结果 治疗后68.2%(15/22)患者血清肿瘤标志物(Ca19-9)下降,疼痛缓解有效率为69.2%(18/26),影像学显示HIFU辐照靶区内组织呈凝固性坏死表现,1年生存率为23.1%,中位生存期为8.5个月.而全麻与镇静镇痛2种方式下HIFU治疗的剂量强度是一致的(P>0.05),但镇静镇痛方式下治疗的效率均要高于全麻方式(P<0.05).结论 HIFU 治疗能够有效地消融胰腺肿瘤和缓解疼痛,HIFU治疗胰腺癌更适合使用镇静镇痛方式.     

聚焦超声治疗变应性鼻炎的临床观察

目的:观察临床聚焦超声治疗变应性鼻炎的疗效。方法:运用CZB型超声波治疗仪,对60例变应性鼻炎患者进行治疗。按照2004年制定的"变应性鼻炎的治疗原则和推荐方案",用记分法分别评定其疗效。结果:随访12个月进行疗效评价,其中显效率35.0%(21/60),有效率46.7%(28/60),无效率18.3%(11/60),总有效率为81.7%(49/60)。结论:采用聚焦超声治疗变应性鼻炎,具有操作简单、创伤小、安全性高、可重复等优点,近期效果显著。     

Inactivation of Planktonic Escherichia coli by Focused 2-MHz Ultrasound

This study was motivated by the desire to develop a non-invasive means to treat abscesses, and represents the first steps toward that goal. Non-thermal, high-intensity focused ultrasound (HIFU) was used to inactivate Escherichia coli (～1 × 10⁹ cells/mL) in suspension. Cells were treated in 96-well culture plate wells using 1.95-MHz ultrasound and incident focal acoustic pressures as high as 16 MPa peak positive and 9.9 MPa peak negative (free field measurements). The surviving fraction was assessed by coliform culture and the alamarBlue assay. No biologically significant heating was associated with ultrasound exposure. Bacterial inactivation kinetics were well described by a half-life model, with a half-time of 1.2 min. At the highest exposure levels, a 2log inactivation was typically achieved within 10 min. The free field-equivalent peak negative acoustic pressure threshold for inactivation was ～7 MPa. At the highest acoustic pressures used, inactivation efficacy was insensitive to reciprocal changes in pulse length and pulse repetition frequency at constant duty factor. Although treated volumes were very small, proof of principle was provided by these experiments.     

High-Intensity Focused Ultrasound Sonothrombolysis: The Use of Perfluorocarbon Droplets to Achieve Clot Lysis at Reduced Acoustic Power

The purpose of this study was to evaluate use of intravascular perfluorocarbon droplets to reduce the sonication power required to achieve clot lysis with high-intensity focused ultrasound. High-intensity focused ultrasound with droplets was initially applied to blood clots in an in vitro flow apparatus, and inertial cavitation thresholds were determined. An embolic model for ischemic stroke was used to illustrate the feasibility of this technique in vivo. Recanalization with intravascular droplets was achieved in vivo at 24 ± 5% of the sonication power without droplets. Recanalization occurred in 71% of rabbits that received 1-ms pulsed sonications during continuous intravascular droplet infusion (p = 0.041 vs controls). Preliminary experiments indicated that damage was confined to the ultrasonic focus, suggesting that tolerable treatments would be possible with a more tightly focused hemispheric array that allows the whole focus to be placed inside of the main arteries in the human brain.     

聚焦超声治疗外阴上皮内非瘤样病变的有效性研究

目的评价超声治疗外阴上皮内非瘤样病变的临床疗效。方法根据随机化数字表按2：1的比例，将经病理确诊的90例外阴上皮内非瘤样病变患者随机分为超声治疗组（60例）和光谱治疗对照组（30例），于治疗后6个月评价两组的近期疗效和复发率。结果超声治疗组临床治愈29例，显效25例，好转6例，复发5例；光谱治疗组临床治愈1例，显效6例，好转19例，无效4例，复发21例。超声治疗组疗效优秀于对照组（Z=6.191．P=0.000），且复发率更低（X^2=-37.02，P=0.000），差异均有统计学意义。结论超声是目前治疗外阴上皮内非瘤样病变的一种有效方法。     

Neurophysiologic Correlates of Sonication Treatment in Patients with Essential Tremor

Transcranial magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) is gaining attention as a potent substitute for surgical intervention in the treatment of neurologic disorders. To discern the neurophysiologic correlates of its therapeutic effects, we applied MRgHIFU to an intractable neurologic disorder, essential tremor, while measuring magnetoencephalogram mu rhythms from the motor cortex. Focused ultrasound sonication destroyed tissues by focusing a high-energy beam on the ventralis intermedius nucleus of the thalamus. The post-treatment effectiveness was also evaluated using the clinical rating scale for tremors. Thalamic MRgHIFU had substantial therapeutic effects on patients, based on MRgHIFU-mediated improvements in movement control and significant changes in brain mu rhythms. Ultrasonic thalamotomy may reduce hyper-excitable activity in the motor cortex, resulting in normalized behavioral activity after sonication treatment. Thus, non-invasive and spatially accurate MRgHIFU technology can serve as a potent therapeutic tool with broad clinical applications.     

Enhanced Numerical Method for the Design of 3-D-Printed Holographic Acoustic Lenses for Aberration Correction of Single-Element Transcranial Focused Ultrasound

The correction of transcranial focused ultrasound aberrations is a relevant issue for enhancing various non-invasive medical treatments. The emission through multi-element phased arrays has been the most widely accepted method to improve focusing in recent years; however, the number and size of transducers represent a bottleneck that limits the focusing accuracy of the technique. To overcome this limitation, a new disruptive technology, based on 3-D-printed acoustic lenses, has recently been proposed. As the submillimeter precision of the latest generation of 3-D printers has been proven to overcome the spatial limitations of phased arrays, a new challenge is to improve the accuracy of the numerical simulations required to design this type of ultrasound lens. In the study described here, we evaluated two improvements in the numerical model applied in previous works for the design of 3-D-printed lenses: (i) allowing the propagation of shear waves in the skull by means of its simulation as an isotropic solid and (ii) introduction of absorption into the set of equations that describes the dynamics of the wave in both fluid and solid media. The results obtained in the numerical simulations are evidence that the inclusion of both s-waves and absorption significantly improves focusing.     

两种麻醉方式用于聚焦超声治疗外阴白色病变171例疗效比较

目的比较两种麻醉方式用于聚焦超声治疗外阴白色病变的疗效。方法收治外阴白色病变171例，分为局麻组126例，骶麻纽45例，观察两组疗效。结果局麻组一次性治愈率68．25％（86／126），重复治疗率31.75％（40／126）。骶麻组一次性治愈率93．33％（42／45），重复治疗率6．67％（3／42），（P〈0．005）。结论持续骶管麻醉具有麻醉效果好，维持时间长，增强聚焦超声疗效，减少重复治疗率等优点，值得临床推广使用。     

Therapeutic Effects of Focused Ultrasound in 4014 Patients with Symptomatic Cervical Ectopy

This study aimed to explore the therapeutic effect of focused ultrasound (FU) therapy in patients with symptomatic cervical ectopy. 4677 patients with symptomatic cervical ectopy were enrolled and treated with FU. Three months after treatment, we analyzed the therapeutic effects and the adverse reactions in 4014 cases with complete records. All influential factors were also analyzed with logistic regression analysis. For the treatment of symptomatic cervical ectopy, the effective rate of FU was 99.8%, and the cure rate was 72.52%. Bleeding that either reached or exceeded normal menstrual volume occurred in 12 cases. Logistic regression analysis showed that the degree of illness, vaginal cleanliness, economic level, occupation, age and artificial abortion frequency were all influential factors. Focused ultrasound is a promising new therapeutic option for the treatment of symptomatic cervical ectopy. Additionally, it can be widely used for a variety of patients.     

高强度聚焦超声消融胰腺癌安全性及疗效研究

目的评估高强度聚焦超声（HIFU）消融胰腺肿瘤的安全性及疗效。方法应用Jc型体外HIFU肿瘤治疗系统治疗不能手术切除的胰腺癌，通过治疗前后的增强影像评估肿瘤的消融体积，探讨其与超声治疗参数之间的关系。结果20例HIFU治疗的胰腺癌有l6例获得治疗后的消融影像评估，肿瘤消融比率平均为（55．9±33．7）％，HIFU洽疗的最大声功率与肿瘤消融比率呈正相关（r=0．686，P=0．020），高声功率治疗组（最大声功率≥300W）获得的肿瘤消融比率[（68．5±26．1）％]显著大于低声功率治疗组（最大声功率≤280W）获得的消融比率[（32．5±31．8）％，P〈0．05]。15例治疗前显著疼痛的患者有12例治疗后疼痛缓解或显著减轻。本组1例高声功率HIFU治疗后发生了肠系膜上动脉闭塞。结论使用较高的声功率，体外HIFU治疗能够有效地消融胰腺肿瘤和缓解疼痛，作为晚期胰腺癌的减瘤治疗措施，其安全性和临床意义值得进一步研究。     

Histotripsy: The Next Generation of High-Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

This article reviews the most current methods and technological aspects of high-intensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.     

聚焦超声单次治疗7027例宫颈炎症相关疾病患者疗效及影响因素分析

目的评价聚焦超声在农村基层医院治疗宫颈炎症相关疾病的有效性、安全性和适用性。方法在重庆市9区县80家乡镇医院进行多中心临床研究,采用CZF型超声波治疗仪,对8 352例宫颈炎症相关疾病患者行聚焦超声单次治疗后随访3个月,根据4级计分法和疗效指数评价方法,分析和评价有完整记录的7 027例患者(轻度1 156例、中度5 312例、重度559例)的治疗效果、安全性和适用性,采用非条件logistic回归分析探讨疗效的影响因素。结果 7 027名患者中6 413例(91.26%)在5分钟内完成聚焦超声治疗。经3个月随访观察,总有效率为99.59%,5 012例(71.32%)治愈。656例(9.34%)治疗后有少-中量阴道出血,仅12例患者(占0.17%)的出血量与月经量相当,经压迫止血及对症抗炎治疗后血止。结论聚焦超声是治疗宫颈炎症相关疾病安全有效的新疗法,术后出血少,阴道排液时间短,适合在基层农村地区推广使用。     

Ultrasound insertion loss of rat parietal bone appears to be proportional to animal mass at submegahertz frequencies

Transcranial ultrasound therapy is an increasing area of research for noninvasive treatments in the brain including targeted drug delivery. Measurements of ultrasound transmission through rat parietal bone at five frequencies (0.268 MHz, 0.841 MHz, 1.409 MHz, 1.972 MHz and 2.53 MHz) were performed at 88 locations in 22 ex vivo rat skullcaps (Wistar) using a fiber-optic hydrophone system. At submegahertz frequencies, the skull insertion loss was found to be proportional to animal mass, while at higher frequencies this trend was lost. Maps of the transverse pressure profile of the transducer before and after skull insertion showed increased distortion effects at higher frequencies. Parietal bone thickness was measured and was found to increase with increasing body mass. Additional measurements were made through mouse and rabbit skulls at 2.53 MHz. At this frequency, aberration effects through mouse skull were negligible, while large distortions were observed through rat and rabbit skull. Preclinical transcranial ultrasound studies in rats may be improved by scaling applied powers according to body mass to produce more consistent in situ pressures.