高强度聚焦超声治疗子宫肌瘤二维超声图像与坏死程度比较

目的 总结分析超声在HIFU治疗子宫肌瘤术中监控和治疗后的声像图特点,使超声在术中监控及评价疗效方面更加客观、准确.方法 对超声图像进行数字化处理,并把超声图像与MRI图像进行比较分析,比较不同坏死程度的肌瘤间超声图像的差异.结果 术中肌瘤灰度值增加明显表明治疗有效,而以团块状灰度增加更具特征性;完全坏死的肌瘤术后灰度值增加明显.结论 在术中,超声可以实时显示肌瘤的变化,并可通过这些改变反馈调整和控制辐照剂量.术后,超声也可以比较准确地评价疗效.     

灰度相关函数应用于HIFU监控的离体研究

目的探讨在高强度聚焦超声(HIFU)辐照过程中,超声图像与HIFU辐照产生凝固性坏死的关系,以提高监控超声对HIFU凝固性坏死的判断灵敏度。方法在相同声强、辐照时间、辐照深度情况下,HIFU定点辐照离体牛肝,观测靶区辐照前及辐照结束后即刻、1、2、3、4、5 min的声像图变化和灰度值变化,并进行靶区声像图相关函数运算,用支撑矢量机(support vector machine,SVM)筛选参数并得到决策超平面。结果超声图像相关系数可以评价HIFU凝固性坏死情况,其灵敏度高于用灰度评价(χ~2=18.716,P0.05)。结论声像图相关系数判断HIFU辐照的靶组织有无凝固性坏死优于灰度评价。     

高强度聚焦超声治疗子宫肌瘤二维超声疗效评价指标

目的 利用二维超声图像对HIFU治疗子宫肌瘤进行监控和疗效评价,探索建立二维超声半定量疗效评价的指标.方法 采用超声作为术中监控及疗效评价的影像学手段,把超声图像特点与MRI图像进行较分析,并根据不同声像图的子宫肌瘤对疗效的影响因素分析以及术中、术后超声变化情况,初步拟定二维超声疗效评分表对其进行评分与疗效等级结合,比较不同疗效等级间分值的差异并拟定治疗有效的分值.结果 有效和无效病例之间的分值有差异,分值≥22分可视为治疗有效.结论 通过评分表,超声可以较客观地评价疗效.     

子宫肌瘤高强度聚焦超声治疗术后二维超声表现

目的 探讨评价高强度聚焦超声（HIFU）治疗子宫肌瘤疗效的超声指标.方法 分析HIFU术后子宫超声图像特点,利用灰度处理软件对图像进行数字化处理.对比术前、术后子宫及肌瘤的体积、缩小率、肌瘤灰度值,以及内部均匀度的变化,寻找可用于评价HIFU疗效的客观指标.结果 HIFU治疗前后,子宫及肌瘤的体积均有较大变化（P〈0.05）,肌瘤灰度值变化除术后6个月与术前无差异外,余差异均有统计学意义（P〈0.05）,肌瘤内部均匀度的变化在术后1、3个月与术前比较差异无统计学意义（P〉0.05）.结论 超声是评价HIFU治疗子宫肌瘤疗效最方便,具有较高临床应用价值的影像学检查方法,其声像图反映的子宫及肌瘤体积缩小、肌瘤内部灰度值的变化可以作为疗效评价的指标.     

造影条件下声像图纹理分析评价HIFU消融兔VX2乳腺肿瘤的价值

目的 探讨高强度聚焦超声(HIFU)治疗过程中,纹理分析监控声像图对肿瘤凝固性坏死的判断,提高超声监控的灵敏度.方法 60只新西兰大白兔,左乳腺为造影剂组,右乳腺为非造影剂组.HIFU辐照在体兔VX2乳腺肿瘤,辐照强度80 W,辐照时间3s.采集辐照前后声像图,通过小波变换提取4个纹理参数作为纹理分析方法1;另提取Tamura纹理参数作为纹理分析方法2.运用支撑适量机(support vector machine,SVM)建立决策平面分析样本.结果 纹理分析方法运用于凝固性坏死的判断,造影和非造影条件下灵敏度和准确性均优于灰度评价,其差异有统计学意义(P＜0.05),2种纹理分析方法之间没有显著性差异.结论 纹理分析对凝固性坏死的判断,灵敏度和准确性较灰度评价更高.     

基于超声图像处理的HIFU所致组织损伤自动检测方法:实验研究

目的 探讨基于超声图像处理的HIFU所致组织损伤的自动检测方法。方法 针对HIFU辐照后新鲜离体猪肉声像图中的ROI,通过搜索灰度极大区域自动定位图像中的所有亮斑,结合数学形态学、连通域标记和Canny边缘检测算法提取测试对象的边缘轮廓;根据亮斑中心至边缘轮廓的欧式距离去除边缘附近的亮斑噪声,获取HIFU损伤候选区;而后提取候选区特征参数,并结合支持向量机（SVM）识别HIFU损伤。结果 最大灰度值和矩形度两个特征参数的识别率分别为86.25%和93.33%。选用识别率更高的矩形度,可正确识别单处、多处HIFU损伤或无HIFU损伤的图像。结论 采用此法可直接分析HIFU辐照后超声声像图而自动检测HIFU损伤,无需依靠图像配准技术,可减少手动定位带来的误差。     

高强度聚焦超声消融(HIFU)治疗有症状子宫肌瘤后的妊娠结局

【摘要】目的：分析实时超声引导下高强度聚焦超声消融（Ultrasound guided high intensity focused ultrasound, USgHIFU）治疗有症状子宫肌瘤后的妊娠结局。方法：回顾性分析2011年12月至2015年12月在我院接受HIFU消融的827例有症状子宫肌瘤患者中消融后自然妊娠的35例患者的病史资料和妊娠结局。结果：35例患者共39个肌瘤均顺利接受HIFU消融;患者发生不同程度的不良反应,均属于SIR A-B类,无SIR C-F类发生。治疗后自然妊娠的患者共35例(35人次),平均受孕时间为HIFU消融后(18.3±5.6)个月;其中非计划妊娠者11例:人工流产7例, 药物流产4例;计划妊娠24例:自然流产2例,顺产10例,剖宫产12例(11例社会因素),胎儿生长发育良好,无严重产时并发症及合并症;1例患者孕34+5周因胎盘早剥行剖宫产,新生儿窒息,经救治母儿预后良好。结论：HIFU治疗后可以正常受孕和分娩,自然妊娠的时间选择一般在治疗后12-24个月内。     

Tamura纹理分析在声像图监控HIFU消融兔VX2乳腺肿瘤中的应用

目的探讨Tamura纹理参数对声像图监控高强度聚焦超声(HIFU)辐照下靶组织凝固性坏死情况的评价效果。方法根据HIFU辐照兔VX2乳腺肿瘤的辐照强度,将120只新西兰白兔随机分为90W、120W、150W组,每组40只,辐照时间均为3s。采集辐照前和辐照后即刻的声像图,提取Tamura纹理参数中的方向度、粗糙度和对比度;通过支撑适量机筛选,获得决策超平面,并对结果进行分析。结果 Tamura判断凝固性坏死的敏感度为89.71%(61/68),特异度为69.23%(36/52),准确率为80.83%(97/120);灰度判断凝固性坏死的敏感度为57.35%(39/68),特异度为63.46%(33/52),准确率为60.00%(72/120),前者的敏感度和准确率均明显高于后者(P均<0.001)。90 W组中,Tamura判断凝固性坏死的准确率为77.50%(31/40),高于灰度(20/40,50.00%,P=0.011);120 W组中,Tamura判断凝固性坏死的准确率为80.00%(32/40),高于灰度(22/40,55.00%,P=0.017)。结论声像图Tamura纹理分析判断凝固性坏死是可行的,且较之灰度具有一定优越性。     

高强度聚焦超声所致组织坏死形式实验研究

目的：了解不同强度、不同发射方式高强度聚焦超声(high itenmty focused ultrasound，UIFU)所致组织坏死形式。方法：分别以活体猪肾和新鲜离体肾癌标本为靶目标，采用FEP-BY01型高能聚焦超声肿瘤热疗机，以不同强度、不同发射方式进行辐照，辐照后即刻对靶区组织细胞进行病理学检查和细胞台盼兰染色。结果：HIFU所致组织细胞即刻死亡有4种表现形式，即凝固性坏死、融解性坏死、裂解坏死和变性死亡，死亡形式与焦点声强和发射时间及发射方式有关。结论：临床上应尽量追求变性死亡和凝固性坏死，避免裂解坏死和融解性坏死。     

超声介入联合高强度聚焦超声治疗瘢痕妊娠

目的 观察超声介入联合高强度聚焦超声(HIFU)治疗瘢痕妊娠的效果.方法 纳入130例瘢痕妊娠患者,随机分为HIFU组、联合组,每组65例,HIFU组予HIFU治疗,联合组予超声介入MTX联合HIFU治疗.对比治疗前后组间包块大小、视觉模拟评分法(VAS)评分、实验室检查结果、超声参数及妊娠结局等差异.绘制受试者工作特...     

超声弹性成像对高强度聚焦超声肿瘤治疗的疗效评价

高强度聚焦超声(HIFU)是一种非侵入性肿瘤治疗技术,具有良好疗效。超声弹性成像能够得到关于组织弹性的信息,以评价HIFU肿瘤治疗的疗效。本文就静压弹性成像、谐波运动成像和声辐射力脉冲成像的特点以及用于HIFU肿瘤治疗疗效评价的研究概况做一综述。     

Effects of ultrasonic exposure parameters on myocardial lesions induced by high-intensity focused ultrasound.

OBJECTIVE: This study evaluated variables relevant to creating myocardial lesions using high-intensity focused ultrasound (HIFU). Without an effective means of tracking heart motion, lesion formation in the moving ventricle can be accomplished by intermittent delivery of HIFU energy synchronized by electrocardiographic triggering. In anticipation of future clinical applications, multiple lesions were created by brief HIFU pulses in calf myocardial tissue ex vivo. METHODS: Experiments used f-number 1.1 spherical cap HIFU transducers operating near 5 MHz with in situ spatial average intensities of 13 and 7.4 kW/cm2 at corresponding depths of 10 and 25 mm in the tissue. The distance from the HIFU transducer to the tissue surface was measured with a 7.5-MHz A-mode transducer coaxial and confocal with the HIFU transducer. After exposures, fresh, unstained tissue was dissected to measure visible lesion length and width. Lesion dimensions were plotted as functions of pulse parameters, cardiac structure, tissue temperature, and focal depth. RESULTS: Lesion size in ex vivo tissue depended strongly on the total exposure time but did not depend strongly on pulse duration. Lesion width depended strongly on the pulse-to-pulse interval, and lesion width and length depended strongly on the initial tissue temperature. CONCLUSIONS: High-intensity focused ultrasound creates well-demarcated lesions in ex vivo cardiac muscle without damaging intervening or distal tissue. These initial studies suggest that HIFU offers an effective, noninvasive method for ablating myocardial tissues to treat several important cardiac diseases.     

高强度聚焦超声治疗子宫肌瘤临床并发症分析

目的分析高强度聚焦超声治疗子宫肌瘤的不良反应及并发症,为其预后和防治提供依据。方法60例接受HIFU治疗的子宫肌瘤患者,观察HIFU治疗术中、术后的局部并发症及全身反应。结果术后不良反应为腹部疼痛31例,皮肤损伤15例,阴道流血4例,骶尾部疼痛不适9例,其程度不重,对机体的影响轻微。结论HIFU治疗子宫肌瘤具有一定的局部并发症,分析并发症的成因对HIFU治疗适应证选择及并发症的防治有一定意义。     

声通道上的肋骨对高强度聚焦超声在羊肝内形成凝固性坏死的影响

目的从有效性、安全性和剂量学的角度探讨声通道上的肋骨对高强度聚焦超声（HIFU）损伤山羊肝的影响。方法HIFU分别辐照声通道上有肋骨（对照组）和声通道上肋骨被手术切除（实验组）的羊肝。辐照结束后2d处死动物，观察靶区凝固性坏死形成情况，测量凝固性坏死的体积并计算能效因子（energy efficiency factor，EEF）。结果实验组的凝固性坏死形成率明显高于对照组，EEF远远小于对照组。结论声通道上的肋骨明显影响凝固性坏死的形成率和EEF，提高HIFU治疗受肋骨阻挡的肝癌的治疗效率非常重要。     

Treatment of small hepatocellular carcinomas with US-guided high-intensity focused ultrasound

High-intensity focused ultrasound (HIFU) is a noninvasive method that can cause complete coagulation necrosis without requiring the insertion of any instruments. The purpose of this study was to evaluate the safety and efficacy of HIFU treatment for small liver cancers without performing transcatheter arterial chemoembolization (TACE) or rib resection. HIFU ablation was performed without rib resection or the aid of TACE or percutaneous ethanol injection (PEI) in 12 patients with hepatocelullar carcinoma. The HIFU system (Chongqing Haifu Tech, Chongqing, China) was used under ultrasound guidance. All 12 patients completed the treatment without experiencing any adverse events. Complete coagulation was achieved by applying the sonications from the intercostal space when the tumor was located in the right lobe. After treatment, serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels were significantly higher than the baseline values; these levels recovered within 1 week. C-reactive protein (CRP) levels increased 1 week after treatment but decreased within 1 month. An epidural anesthetic provided sufficient pain suppression during the procedure. Edema of the subcutaneous tissue was detected in five cases, but the edema disappeared within 1 month. None of the patients developed acute hepatic failure, liver abscess or renal dysfunction. In conclusion, HIFU is effective for the treatment of patients with small liver cancer.     

基于质子共振频率MR温度成像监控高强度聚焦超声治疗

高强度聚焦超声（HIFU）作为一种热消融疗法,在治疗过程中需有良好的监控和实时精确的测温技术以保证治疗的安全性和有效性。MR温度成像通过具有温度敏感的参数进行测温,如弛豫时间、质子共振频率（PRF）、扩散系数、磁化矢量转移等,无创且无辐射,并可实时三维成像。其中,由于质子共振频率（PRF）对温度具有良好的线性度,且与组织类型不相关。基于PRF的MR温度成像成为中高场强（≥1T）系统应用的首选,在低场强系统中也有应用。本文对PRF MR温度成像的基本原理及其在监控HIFU治疗方面的研究进展进行综述。     

Resection of abdominal solid organs using high-intensity focused ultrasound

Our objective was to evaluate high-intensity focused ultrasound (HIFU) for minimizing blood loss during surgery by hemodynamically isolating large portions of solid organs before their resection. A high-power HIFU device (in situ intensity of 9000 W/cm(2), frequency of 3.3 MHz) was used to produce a wall of cautery for sealing of blood vessels along the resection line in surgically exposed solid organs (liver lobes, spleen and kidneys) of eight adult pigs. Following HIFU application, the distal portion of the organ was excised using a scalpel. If any blood vessels were still bleeding, additional HIFU application was used to stop the bleeding. The resection was achieved in 6.0 +/- 1.5 min (liver), 3.6 +/- 1.1 min (spleen) and 2.8 +/- 0.6 min (kidneys) of HIFU treatment time, with no occurrence of bleeding for up to 4 h (until sacrifice). The coagulated region at the resection line had average width of 3 cm and extended through the whole thickness of the organ (up to 4 cm). Blood vessels of up to 1 cm in size were occluded. This method holds promise for future clinical applications in resection of solid tumors and hemorrhage control from high-grade organ injuries.     

高强度聚焦超声治疗功血的初步研究

功能失调性子宫出血简称功血,是一种常见的妇科疾病,其传统的治疗方法主要有性激素治疗、宫内节育器植入、诊断性刮宫及手术治疗。高强度聚焦超声可以靶向消融子宫内膜且有止血作用,在功血治疗方面具有很好的应用前景。     

The effect of the scanning pathway in high-intensity focused ultrasound therapy on lesion production

Because tumors are much larger in size compared with the beam width of high-intensity focused ultrasound (HIFU), raster scanning throughout the entire target is conventionally performed for HIFU thermal ablation. Thermal diffusion affects the temperature elevation and the consequent lesion formation. As a result, the lesion will grow continuously over the course of HIFU therapy. The purpose of this study was to investigate the influence of scanning pathways on the overall thermal lesion. Two new scanning pathways, spiral scanning from the center to the outside and spiral scanning from the outside to the center, were proposed with the same HIFU parameters (power and exposure time) for each treatment spot. The lesions produced in the gel phantom and bovine liver were compared with those using raster scanning. Although more uniform lesions can be achieved using the new scanning pathways, the produced lesion areas (27.5 ± 12.3 mm² and 65.2 ± 9.6 mm², respectively) in the gel phantom are significantly smaller (p < 0.05) than those using raster scanning (92.9 ± 11.8 mm²). Furthermore, the lesion patterns in the gel phantom and bovine liver were similar to the simulations using temperature and thermal dose-threshold models, respectively. Thermal diffusion, the scanning pathway and the biophysical aspects of the target all play important roles in HIFU lesion production. By selecting the appropriate scanning pathway and varying the parameters as ablation progresses, HIFU therapy can achieve uniform lesions while minimizing the total delivered energy and treatment time.