新型超声诊疗一体机VINNO70的空化调控功能及声学测量

目的 对新型超声诊疗一体机VINNO 70的空化调控功能,以及对超声频率、脉冲宽度、脉冲重复频率及机械指数等声学参数进行测量,以及VFlash超声治疗模式下的声场分布及自适应可变焦域技术。方法 利用薄膜水听器法测量各项参数的实测值,验证其与仪器显示值的一致性。其中,重点测量在距换能器表面2cm和5cm位置感兴趣区（ROI）内的峰值负压值,然后计算对应的机械指数（MI）,并与MI仪器显示值对比。结果 超声线阵探头X4-12L与凸阵探头S1-8C在超声频率、脉冲宽度、脉冲重复频率参数的实测值与仪器显示值完全一致。峰值负压值的声场分布显示,自适应可变焦域区具有明显的超声弱聚焦性能,ROI内微泡击破明显。但是MI实测值与仪器显示值有较大差距（58%-267%）,而且频率与测量距离等均可以影响MI值。结论 VINNO 70超声仪准确调控多个空化相关参数,自适应可变焦域技术可以明显靶向击破ROI区内的微泡。MI实测值与显示值差别较大,因此,实施治疗时应该以实测值为准。     

医学超声微泡造影剂空化效应的研究进展

近年来,随着新型超声微泡造影剂的研究和应用,超声微泡介导靶向治疗可增强基因转染效率,提高特定组织的基因表达水平和药物浓度,是一种安全、简便、高效的靶向性基因转染及药物治疗的新方法。本文就超声空化效应和超声微泡的治疗机制和应用做一简要综述。     

微泡双重击破效应对裸鼠HepG2肿瘤微血管的损伤作用

目的 研究微泡双重击破效应对裸鼠HepG2移植肿瘤微血管的损伤作用以及对血流灌注的阻断作用.方法 28只皮下荷人类肝癌HepG2肿瘤的裸鼠随机分为3组,超声微泡组经静脉推注脂质微泡0.1 ml并联合空化治疗仪辐照肿瘤3 min,单纯超声组以等量生理盐水代替微泡,单纯微泡组推注微泡时进行超声假照.各组肿瘤治疗前后行超声造影检查,分析肿瘤造影的峰值强度及曲线下面积,最后获取肿瘤标本行光镜观察.结果 超声微泡组肿瘤造影的峰值强度百分比由(26.9±10.9)％下降至(8.2±5.8)％,曲线下面积由1210.4±823.1下降至291.6±255.2,差异有统计学意义(P＜0.05);但两对照组肿瘤治疗前后造影峰值强度及曲线下面积变化均无显著差异.病理观察发现超声微泡组肿瘤血管内皮细胞肿胀、血管断裂,组织间隙内出血、水肿.结论 微泡双重击破效应可造成裸鼠HepG2肿瘤微血管物理损伤和血流灌注显著下降.     

超声微泡造影剂在疾病诊断与治疗中的研究进展

超声微泡造影剂在疾病诊断与治疗中的作用日渐明显.超声微泡造影剂可用于对心脏、肝脏、肿瘤等的声学造影诊断,具有靶向性的超声微泡造影剂对组织、血栓及肿瘤的靶向显影应用前景广阔.目前的研究表明,超声微泡造影剂在治疗中也显示出巨大潜力,可作为一种有效的基因或药物运载工具.而低功率超声辐射微泡治疗肿瘤研究亦有望取得突破性进展.     

超声破坏靶向VEGFR2微泡治疗皮下结肠癌移植瘤的实验研究

目的 探讨靶向VEGFR2微泡结合超声辐照治疗结肠癌的效果.方法 将17只VEFGR2高表达的结肠癌皮下种植瘤Balb/C裸鼠模型分为三组:A组5只,为对照组,仅接受超声造影检查和假照;B组6只,空白脂质微泡结合超声辐照;C组6只,载靶向VEGFR2单抗的脂质微泡结合超声辐照,所有模型均用红色荧光蛋白标记.空化治疗前和空化后1周分别行超声造影和荧光摄片检查,测量肿块大小、荧光面积、荧光强度及血管密度,并进行比较.结果 治疗前裸鼠肿瘤长径、荧光面积、荧光强度及血管密度在各组间比较差异无统计学意义(P＞0.05);A组假照后肿瘤长径、荧光面积、荧光强度及血管密度均比假照前增加,差异有统计学意义(P＜0.05);B组辐照后荧光强度及血管密度均较空化前减小,差异有统计学意义(P＜0.05),而肿瘤长径和荧光面积差异不显著(P＞0.05);C组辐照后肿瘤长径、荧光面积、荧光强度及血管密度与辐照前比较均明显减小,差异有统计学意义(P＜0.01);治疗后A、B、C三组各参数两两比较差异有统计学意义(P＜0.05).结论 靶向VEGFR2脂质微泡能增强超声空化对结肠癌的治疗效果.     

超声微泡携基因治疗肝脏疾病应用进展

超声靶向微泡破坏技术通过空化效应有效促进外源基因在目的组织中的转染,可通过抑制细胞某些基因的表达或抑制其信号通路而进行基因治疗,使基因治疗各类肝脏疾病逐渐成为可能。本文主要就超声微泡携基因在肝脏疾病中的应用进展进行综述。     

携Sialyl Lewis~X和抗小鼠P-选择素单抗靶向超声微泡评价心肌缺血再灌注损伤对比研究

目的探讨携Sialyl Lewis~X靶向超声微泡结合对比超声分子成像评价心肌缺血再灌注损伤可行性并与携抗小鼠P-选择素单抗靶向超声微泡对比分析。方法采用"亲和素-生物素"桥接法构建携Sialyl Lewis~X和抗小鼠P选择素单抗靶向超声微泡(MB_(slex)、MBp),并应用平行板流动腔技术在体外模拟的生理血流条件下评价MBp和MB_(slex)与小鼠P-选择素Fc段的靶向黏附效能。然后,20只心肌缺血再灌注(IR)小鼠随机经静脉注入MB_(slex)和MBp,分别于注入5min后行心肌对比超声心动图(MCE)检查,测量心肌缺血区和非缺血区的声强度(VI)。结果平行板流动腔实验显示:在第6分钟时,MB_(slex)与小鼠P-选择素Fc段结合数目为MBp的1.7倍。对比超声图像显示MB_(slex)组和MBp组缺血区心肌均见显著造影增强,声强度(VI)值分别为(23.52±1.08)U、(25.98±6.23)U,两者相比无显著差异(P0.05)。但无论是MBp组还是MB_(slex)组的缺血区心肌VI值均明显高于非缺血区心肌VI值[(6.53±0.95)U,(7.13±0.91)U,(P0.05)]。结论 MB_(slex)对炎症组织靶向检出能力与MBp相似,它和对比超声结合可有效评价心肌缺血再灌注损伤。     

L-S靶向超声造影微泡的制备及声学性质的实验研究

目的探讨将淋巴细胞选择素(Lymph-Selectin,L-S)链接到脂质超声造影微泡膜表面的可行性,并体外验证其声学性质,为淋巴结特异靶向超声造影制备靶向微泡。方法采用静电吸附法将L-S链接到普通脂质超声微泡膜表面制备成L-S靶向超声造影微泡,荧光免疫染色实验验证L-S与脂质微泡膜的结合;流式细胞仪检测不同浓度L-S与微泡的结合率;超声体外验证L-S靶向微泡声学性质。结果 L-S靶向微泡的免疫荧光染色实验为阳性;L-S抗体浓度为5、15、35 μg/ml时L-S与脂质微泡的平均结合率分别为(9.88±1.49)%、(29.59±2.23)%、(86.66±4.71)%,两两比较均有统计学意义(P0.01);体外声学造影实验中,普通微泡组(UCM)和L S靶向微泡组(TUCM)平均灰度值分别为:(75.77±7.08)dB和(73.72±8.19)dB(P0.05)。结论采用静电吸附法可将L-S链接到脂质超声微泡膜表面制备成L-S靶向超声微泡,其结合率与加入的L-S抗体浓度有关。L-S的链接不会破坏靶向微泡的声学特性。     

超声击破微泡促进膀胱黏膜对盐酸多柔比星的摄取

目的探讨超声击破微泡效应促进膀胱黏膜上皮细胞摄取化疗药物盐酸多柔比星的可行性。方法 8只健康新西兰大白兔,经膀胱导尿管注入盐酸多柔比星和脂质微泡,同时高机械指数诊断超声体外辐照击破微泡;使用荧光显微镜观察兔辐照部位及对照部位膀胱黏膜药物自发荧光,并使用NIH Image J图像处理软件对荧光图像进行荧光强度分析比较。结果荧光显微镜下可观察到盐酸多柔比星自发红色荧光,聚集于黏膜层内,实验侧及对照侧黏膜下层和肌层内均未发现明显红色荧光聚集;荧光强度分析显示,实验侧黏膜层荧光强度值高于对照侧(P﹤0.05),实验侧黏膜层化疗药物摄入量高于对照侧。结论超声击破微泡效应可有效促进膀胱黏膜对化疗药物盐酸多柔比星的摄取,该方法简单易行,可在一定程度上提高膀胱癌灌注化疗效果。     

比较两种制备载紫杉醇超声微泡的方法

目的 比较能被超声击破的两种载紫杉醇超声微泡的制备方法,并评价其理化性质以及超声散射强度.方法 用单纯紫杉醇法Ⅰ号和三醋酸甘油酯溶解法Ⅱ号分别制备载紫杉醇脂质超声微气泡,测定其包封率、载药量、粒径大小、分布和Zeta电位、pH值,并行超声击破试验及兔VX2皮下肿瘤显像试验. 结果两种微泡显像无明显差异,可被低能量超声击破,但Ⅱ号(加入三醋酸甘油酯)脂质微泡较Ⅰ号(常规冷冻干燥法制备)载药微泡粒径显著减小[(1.07±0.38)μm vs(2.79±0.41)μm,P<0.01],表面电位增高[(19.10±0.32)mV vs (-5.90±0.21)mV,P<0.01],包封率和载药量显著增高[(95.00±1.22)% vs (36.10±4.74)%,P<0.01;(5.60±0.11)% vs (0.50±0.04)%, P<0.01]. 结论 三醋酸甘油酯溶解法制备的Ⅱ号微泡在局部药物释放中具有更大的应用价值.     

On the usefulness of the mechanical index displayed on clinical ultrasound scanners for predicting contrast microbubble destruction.

OBJECTIVE: The purpose of this study was to evaluate the mechanical index (MI) displayed on clinical ultrasound scanners as a predictor of exposure conditions related to the destruction of sonographic microbubble contrast agents. METHODS: Sonazoid (GE Healthcare, Oslo, Norway) and Optison (GE Healthcare, Princeton, NJ) microbubbles were injected into a tissue-mimicking flow phantom. Gray scale imaging was performed with 4 different scanners and 3 different transducers (3.5 MHz curved linear, 2.5 MHz convex, and 7.5 MHz linear array), and the MI displayed by the scanner was varied from 0.2 to 1.5 by changing the system output power. All other scanning parameters were kept constant. Downstream changes in echogenicity were monitored with a PowerVision 7000 scanner (Toshiba America Medical Systems, Tustin, CA) as an indirect measure of bubble destruction. Video intensity changes within the flow tube were determined as a function of MI for the different scanner/transducer combinations, and the best linear fit was determined. RESULTS: At a displayed MI of 0.7, different scanner/transducer combinations exhibited a range in video intensity from +16% to -3% of baseline for Sonazoid and from +8% to -71% for Optison. At an MI of 0.3, reductions in video intensity of up to 32% were produced. These results indicate a wide range in bubble destruction at identical MI values. Likewise, regression analysis found no linear fits for all scanner/transducer combinations (r2 < 0.046). CONCLUSIONS: The MI displayed on clinical ultrasound scanners does not predict the degree of microbubble destruction and should not be used by itself to define exposure conditions for destruction of microbubble contrast agents.     

Microbubble responses to a similar mechanical index with different real-time perfusion imaging techniques

The purpose of this study was to determine differences in contrast enhancement and microbubble destruction rates with current commercially available low-mechanical index (MI) real-time perfusion imaging modalities. A tissue-mimicking phantom was developed that had vessels at 3 cm (near field) and 9 cm (far field) from a real-time transducer. Perfluorocarbon-exposed sonicated dextrose albumin microbubbles (PESDA) were injected proximal to a mixing chamber, and then passed through these vessels while the region was insonified with either pulses of alternating polarity with pulse inversion Doppler (PID) or pulses of alternating amplitude by power modulation (PM) at MIs of 0.1, 0.2 and 0.3. Effluent microbubble concentration, contrast intensity and the slope of digital contrast intensity vs. time were measured. Our results demonstrated that microbubble destruction already occurs with PID at an MI of 0.1. Contrast intensity seen with PID was less than with PM. Therefore, differences in contrast enhancement and microbubble destruction rates occur at a similar MI setting when using different real-time pulse sequence schemes.     

Ultrasound-Targeted Microbubble Destruction Accelerates Angiogenesis and Ameliorates Left Ventricular Dysfunction after Myocardial Infarction in Mice

Failure of coronary recanalization within 12 h or no flow in the myocardium after percutaneous coronary intervention is associated with high mortality from myocardial infarction, and insufficient angiogenesis in the border zone results in the expansion of infarct area. In this study, we examined the effects of ultrasound-targeted microbubble destruction (UTMD) on angiogenesis and left ventricular dysfunction in a mouse model of myocardial infarction. Fifty-four mice with MI were treated with no UTMD, ultrasound (US) alone or UTMD four times (days 1, 3, 5 and 7), and another 18 mice underwent sham operation and therapy. Therapeutic US was generated with a linear transducer connected to a commercial diagnostic US system (VINNO70). UTMD was performed with the VINNO70 at a peak negative pressure of 0.8 MPa and lipid microbubbles. Transthoracic echocardiography was performed on the first and seventh days. The results indicated that UTMD decreased the infarct size ratio from 78.1 ± 5.3% (untreated) to 43.3 ± 6.4%, accelerated angiogenesis and ameliorated left ventricular dysfunction. The ejection fraction increased from 25.05 ± 8.52% (untreated) to 42.83 ± 9.44% (UTMD). Compared with that in other groups, expression of vascular endothelial growth factor and endothelial nitric oxide synthase and release of nitric oxide were significantly upregulated after UTMD treatment, indicating angiogenesis. Therefore, UTMD is a potential physical approach in the treatment of myocardial infarction.     

Differences in definity and optison microbubble destruction rates at a similar mechanical index with different real-time perfusion systems.

The purpose of this study was to determine microbubble responses to different pulse sequence schemes that exist on low mechanical index (MI) real-time perfusion imaging systems using either intravenous albumin-coated (Optison) or lipid-encapsulated (Definity) microbubbles. A tissue-mimicking phantom was created that permitted insonation of microbubbles at 3 cm (near field) and 9 cm (far field) from the diagnostic transducer face. Differences in effluent microbubble concentration were measured after they passed through vessels being insonified with pulse sequence schemes that transmitted alternating polarity (pulse inversion Doppler), alternating amplitude (power modulation), or both (contrast pulse sequencing) at a similar MI, frame rate, and transmit frequency. Normalized contrast signal intensity within a recirculating chamber was also measured in the near and far field. Pulse inversion Doppler produced less initial normalized contrast signal intensity and greater destruction rates than amplitude varying pulse sequence schemes like power modulation or contrast pulse sequencing at both the 0.1- and 0.2-MI settings. These differences indicate that the same MI setting on different real-time perfusion imaging techniques will produce different microbubble responses.     

Safety of Image-Guided Treatment of the Liver with Ultrasound and Microbubbles in an in Vivo Porcine Model

Ultrasound and microbubbles are useful for both diagnostic imaging and targeted drug delivery, making them ideal conduits for theranostic interventions. Recent reports have indicated the preclinical success of microbubble cavitation for enhancement of chemotherapy in abdominal tumors; however, there have been limited studies and variable efficacy in clinical implementation of this technique. This is likely because in contrast to the high pressures and long cycle lengths seen in successful preclinical work, current clinical implementation of microbubble cavitation for drug delivery generally involves low acoustic pressures and short cycle lengths to fit within clinical guidelines. To translate the preclinical parameter space to clinical adoption, a relevant safety study in a healthy large animal is required. Therefore, the purpose of this work was to evaluate the safety of ultrasound cavitation treatment (USCTx) in a healthy porcine model using a modified Philips EPIQ with S5-1 as the focused source. We performed USCTx on eight healthy pigs and monitored health over the course of 1 wk. We then performed an acute study of USCTx to evaluate immediate tissue damage. Contrast-enhanced ultrasound exams were performed before and after each treatment to investigate perfusion changes within the treated areas, and blood and urine were evaluated for liver damage biomarkers. We illustrate, through quantitative analysis of contrast-enhanced ultrasound data, blood and urine analyses and histology, that this technique and the parameter space considered are safe within the time frame evaluated. With its safety confirmed using a clinical-grade ultrasound scanner and contrast agent, USCTx could be easily translated into clinical trials for improvement of chemotherapy delivery. This represents the first safety study assessing the bio-effects of microbubble cavitation from relevant ultrasound parameters in a large animal model.     

超声微泡造影剂对心肌组织的生物学效应及介导VEGF基因转染大鼠心肌的实验研究

目的 探讨超声微泡造影剂对心肌组织的生物学效应及其介导VEGF基因转染大鼠心肌的有效性。方法 18只健康雄性Wistar大鼠，取3只采用超声波在鼠胸壁破坏微泡造影剂，观察对心肌组织显微结构的影响。将另15只急性心肌梗死3天后的雄性Wistar大鼠分为3组，每组5只。第一组采用超声破坏微泡造影剂的方式，将pcDzVEGFm基因转染大鼠心肌至造影剂不再显影(约6min)；第二组尾静脉输入同等剂量携pcD。VEGF。基因的造影剂；第三组为对照。2周后，取缺血心肌组织行VEGF免疫组织化学染色，观察心肌组织血管内皮生长因子(VEGF)蛋白表达情况。结果超声波破坏微泡造影剂能使心肌组织充血，产生大量空泡，并有部分心肌细胞坏死。采用超声微泡造影剂介导的VEGF基因转染，能明显增强大鼠心肌组织VEGF蛋白的表达。结论 超声微泡造影剂能明显增强对组织的空化效应，其介导的VEGF基因治疗是一种无创、新型、高效的基因转移方法。     

Loss of Echogenicity and Onset of Cavitation from Echogenic Liposomes: Pulse Repetition Frequency Independence

Echogenic liposomes (ELIP) are being developed for the early detection and treatment of atherosclerotic lesions. An 80% loss of echogenicity of ELIP has been found to be concomitant with the onset of stable and inertial cavitation. The ultrasound pressure amplitude at which this occurs is weakly dependent on pulse duration. It has been reported that the rapid fragmentation threshold of ELIP (based on changes in echogenicity) is dependent on the insonation pulse repetition frequency (PRF). The study described here evaluates the relationship between loss of echogenicity and cavitation emissions from ELIP insonified by duplex Doppler pulses at four PRFs (1.25, 2.5, 5 and 8.33 kHz). Loss of echogenicity was evaluated on B-mode images of ELIP. Cavitation emissions from ELIP were recorded passively on a focused single-element transducer and a linear array. Emissions recorded by the linear array were beamformed, and the spatial widths of stable and inertial cavitation emissions were compared with the calibrated azimuthal beamwidth of the Doppler pulse exceeding the stable and inertial cavitation thresholds. The inertial cavitation thresholds had a very weak dependence on PRF, and stable cavitation thresholds were independent of PRF. The spatial widths of the cavitation emissions recorded by the passive cavitation imaging system agreed with the calibrated Doppler beamwidths. The results also indicate that 64%–79% loss of echogenicity can be used to classify the presence or absence of cavitation emissions with greater than 80% accuracy.     

Intravascular inertial cavitation activity detection and quantification in vivo with Optison

Inertial cavitation (IC) is an important mechanism by which ultrasound (US)-induced bioeffects can be produced. It has been reported that US-induced in vitro mechanical bioeffects with the presence of ultrasound contrast agents (UCAs) are highly correlated with quantified IC "dose" (ICD: cumulated root-mean-squared broadband noise amplitude in the frequency domain). The ICD has also been used to quantify IC activity in ex vivo perfused rabbit ear vessels. The in vivo experiments reported here using a rabbit ear vessel model were designed to: (1) detect and quantify IC activity in vivo within the constrained environment of rabbit auricular veins with the presence of Optison and (2) measure the temporal evolution of microbubble IC activity and the ICD generated during insonation treatment, as a function of acoustic parameters. Preselected regions-of-interest (ROI) in the rabbit ear vein were exposed to pulsed focused US (1.17 MHz, 1 Hz PRF). Experimental acoustic variables included peak rarefaction pressure amplitude ([PRPA]: 1.1, 3.0, 6.5 or 9.0 MPa) and pulse length (20, 100, 500 or 1000 cycles). ICD was quantified based on passive cavitation detection (PCD) measurements. The results show that: (1) after Optison injection, the time to onset of measurable microbubble IC activity was relatively consistent, approximately 20 s; (2) after reaching its peak value, the IC activity decayed exponentially and the half-life decay coefficient (t(1/2)) increased with increasing PRPA and pulse length; and (3) the normalized ICD generated by pulsed US exposure increased significantly with increasing PRPA and pulse length.     

The disappearance of ultrasound contrast bubbles: observations of bubble dissolution and cavitation nucleation

The destruction process of biSphere and Optison ultrasound (US) contrast microbubbles were studied at 1.1 MHz. High-amplitude tone bursts caused shell disruption and/or fragmentation of the microbubbles, leading to dissolution of the freed gas. The bubble destruction and subsequent dissolution process was imaged with a high pulse-repetition frequency (PRF) 10-cycle, 5-MHz bistatic transducer configuration. Three types of dissolution profiles were measured: In one case, biSphere microbubbles showed evidence of dissolution through resonance, during which a temporary increase in the scattering amplitude was observed. In another case, both biSphere and Optison microbubbles showed evidence of fragmentation, during which the scattering amplitude decreased rapidly. Finally, in some cases, we observed the impulsive growth and subsequent rapid decay of signals that appear to be due to cavitation nucleation. Simulations of bubble dissolution curves show good agreement with experiments.