高强度聚焦超声消融离体人子宫腺肌病标本

目的探讨高强度聚焦超声(HIFU)消融离体人子宫腺肌病标本的有效性和临床可行性。方法对手术切除的新鲜人子宫腺肌病标本7件进行HIFU消融。照射完毕后超声测量照射区域的最大截面积。取材后将标本进行2,3,5-三苯基氯化四氮唑(TTC)染色,测量未着色区最大截面积,并将两种方法测量的结果进行比较。组织病理学检查观察照射区域及周围组织的细胞形态学改变。结果照射前子宫腺肌病标本病灶区域呈不均匀较低回声,照射后该区域回声明显增强。肉眼观察见照射区域周围组织未见明显改变,照射区域内组织呈灰黄色,质地变坚硬,TTC染色显示该区域内未着色,与周围组织边界清晰。声像图上高回声区最大截面积与TTC染色未着色区域最大截面积差异无统计学意义(P>0.05)。结论HIFU能有效形成消融灶,且对周围组织无损伤。     

MRI在高强度聚焦超声消融子宫肌瘤中的应用进展

高强度聚焦超声（HIFU）已广泛应用于子宫肌瘤治疗,疗效确切。MRI软组织分辨率高,在妇科实体肿瘤检测中优势明显。MR多参数成像技术在术前拟定治疗计划、术中实时监测、术后疗效评估中具有不可替代的作用。本文对MRI各参数在HIFU消融子宫肌瘤术前、术中及术后的应用进行综述。     

磁共振梯度双回波序列监控高强度聚焦超声治疗

目的 利用MR梯度双回波脉冲序列监控高强度聚焦超声(MRgHIFU)治疗,同时获取温度图和解剖图,提高治疗的准确性和安全性。方法 在第一、第二个回波上分别施加独立的相位编码梯度,一个回波获取高分辨率的解剖图,另一个回波获取快速的温度图。将温度图叠加在解剖图上治疗监控。通过牛肝离体加热和水膜移动实验加以验证。结果 牛肝离体实验表明,在最快1幅/秒温度图时仍然可以很好地测量和显示温度,优于传统的温度图显示方法。水模实验证明此法对检测运动的敏感度较好,有利于监控治疗的准确性和安全性。结论 利用MR梯度双回波脉冲序列可以在HIFU实验中更好地监控温度和检测运动。     

MRI评价子宫肌瘤高强度聚焦超声消融术后盆底筋膜改变

目的 探讨MRI评价子宫肌瘤高强度聚焦超声消融术（HIFU）后盆底筋膜改变的价值。方法 回顾性分析初次行HIFU治疗的283例子宫肌瘤患者的盆腔MRI及临床资料,观察盆腔筋膜水肿情况,记录HIFU治疗总能量、辐照时间。分析患者年龄、肌瘤情况（位置、类型、数量、体积）及HIFU治疗总能量、辐照时间与盆底筋膜改变的相关性。结果 共201例（201/283,71.02%）患者HIFU后盆腔筋膜出现水肿,59.71%（169/283）为1度和2度。不同肌瘤位置患者术后盆底筋膜水肿程度差异有统计学意义（χ²=27.50,P=0.007）。患者年龄、肌瘤情况（数目、体积）与盆腔筋膜水肿程度无相关性（P均> 0.05）;HIFU治疗总能量、辐照时间与盆腔筋膜水肿程度呈正相关（r_s=0.288、0.317,P均< 0.001）。结论 采用MRI可评价HIFU治疗子宫肌瘤引起的盆腔筋膜水肿,HIFU辐照时间、治疗总能量、子宫肌瘤位置是引起盆底筋膜水肿的主要影响因素。     

MR增强扫描评估HIFU治疗原发骨肉瘤的短期疗效

目的 评估MR平扫和增强扫描在高强度聚焦超声(HIFU)治疗原发骨肉瘤短期疗效随访中的价值。 方法 回顾性分析11例原发骨肉瘤患者HIFU治疗前后的MR平扫和增强图像,观察病灶HIFU治疗前后的信号变化和强化特点。 结果 HIFU治疗前11例原发骨肉瘤T1WI以低信号为主、T2WI以高信号为主的混杂信号,增强扫描呈不同程度强化。HIFU治疗后病灶T1WI信号增高,T2WI信号减低;8例治疗1个月后病灶未见强化,其周围区域见条带样强化,3~4个月后呈线样强化;1例治疗1个月后在病变骨干内见片状强化;1例治疗1个月后在病灶边缘出现结节样强化,再次HIFU治疗后强化消失,病灶周围见条带状强化;1例治疗后与治疗前强化形式相似,再次HIFU治疗后病灶未见强化,周围出现线样强化带。 结论 MR增强扫描能准确评估原发骨肉瘤HIFU治疗后的短期疗效;根据常规MR平扫的信号改变不能准确判断肿瘤完全坏死或残留。     

高强度聚焦超声消融治疗子宫肌瘤的临床研究

近年来,随着医学和工程技术的发展,子宫肌瘤的外科治疗除传统的子宫切除术、肌瘤剔除术以及子宫动脉栓塞术外,非侵入性的高强度聚焦超声消融技术也得到了越来越多的临床应用。本文旨在介绍高强度聚焦超声消融治疗子宫肌瘤的适应证与禁忌症、安全性与有效性、临床剂量学探讨、疗效相关因素分析。     

MRI温度图监控聚焦超声开放家兔血脑屏障的作用

目的探讨MRI温度图监控聚焦超声波开放家兔血脑屏障（BBB）的可行性及安全性。方法20只家兔分3组，分空白对照组、超声组和超声＋微泡组，分别在1．1MHz聚焦超声波，10W功率下照射不同时间，从6～20s不等。照射过程中应用MRIGRE序列实施实时监测焦点温度变化图，照射后进行MRIT2扫描和T1造影增强扫描，病理学检查。结果平均温度44．6℃到48．8℃之间、峰值温度45．9℃～51．6℃之间，可见BBB开放，而脑组织未见明显坏死，而在此温度之上，则有明显的脑组织坏死。结论MRI实时温度图可以预测聚焦超声开放家兔BBB过程中的脑组织改变，并监控其安全范围。     

肝癌高强度聚焦超声消融的增效方法

本文从肝癌高强度聚焦超声（HIFu）治疗的优势与不足出发,探讨肝癌HIFU增效剂的临床价值。通过改变肝癌组织声环境,增加靶区能量沉积,即肝癌组织内引入高声阻抗物质,改变肝癌组织声学特性及血供状态,引入微泡造影剂等,阐述HIFU增效剂的原理及应用。     

High intensity focused ultrasound in benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is an extremely common condition and represents a major health issue in terms of patient numbers and treatment cost. Traditionally, the choice of treatment has been between watchful waiting and surgery, however, the side effects of surgery lead to reluctance for treatment in many men, other than those with severe symptoms and complications. In the last 2 decades there has been a rapid expansion in the number of treatments being offered and the number of patients submitting to novel therapies. Medical management has evolved to achieve a central role in the management of BPH. Heat based treatments are also being investigated with considerable interest. Transrectal high intensity focused ultrasound (HIFU) is one such treatment, which allows radiation-free treatment, without the need for intra-urethral manipulation. Imaging can be performed during treatment and treatment results in symptomatic improvement, which is retained with medium-term follow-up. It involves a brief hospital stay and post-operative complications are few. The use of HIFU has also been extended to the treatment of renal, prostatic and bladder tumours and the results in these areas suggest further expansion of its role in urological practice.     

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。     

Characterization of extracorporeal ablation of normal and tumor-bearing liver tissue by high intensity focused ultrasound

Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in normal and tumor-bearing rabbit liver. HIFU was generated with a 1 MHz transducer and energy was provided by a 7.5 kW power amplifier. In vivo experiments were conducted on 74 New Zealand rabbits. Normal rabbits and rabbits bearing an intrahepatic VX2 tumor were used. In group 1, spatial peak temporal peak (SPTP) intensities ranging from 1470 to 5500 W cm⁻² and exposure times from 0.5 to 5 s were tested at a constant depth in the liver; in group 2, the output power was adjusted as a function of the target depth in order to keep constant the focal in situ intensity in the liver; in group 3 (liver tumors), the focal in situ intensity was 1365 W cm⁻² in eight rabbits and 500 W cm⁻² in nine. In groups 1, 2 and 3, rabbits were sacrificed 48 h after the treatment. Groups 4 and 5 were designated for analysis of the lesion in the normal liver 4 weeks after treatment at 1000 W cm⁻² and 3000 W cm⁻² SPTP intensities, respectively. In normal rabbits, the lesion volume increased with exposure time at constant intensity; there was a negative correlation between intensity and exposure time (group 1). When the output power was adjusted as a function of the path length, the lesion size was nearly constant (group 2). In VX2 rabbits, tumor destruction rates were significantly higher in rabbits treated at 500 W cm⁻² than in rabbits treated at 1365 W cm⁻² (p < 0.05; group 3). As in the normal liver, the lesion volume increased with the exposure time at constant intensity. HIFU lesions treated at 1000 W cm⁻² (SPTP) healed as thin fibrous scars, and no severe complication occurred (group 4); at 3000 W cm⁻² (SPTP), scars were larger and perforation of a neighboring organ was seen in 7 of 11 rabbits (group 5).     

Activated anti-tumor immunity in cancer patients after high intensity focused ultrasound ablation

T cell-mediated immune responses represent the main cellular antitumor immunity in cancer patients. Recent studies have shown that that both surgical procedure and radiation therapy could cause the functional suppression of lymphocyte-mediated cellular immunity. The purpose of current study is to evaluate whether high intensity focused ultrasound (HIFU) might change a systemic antitumor immunity, particularly T lymphocyte-mediated immunity in cancer patients. A total of 16 patients with solid malignancies were treated with HIFU. Among them, six patients had osteosarcoma (Enneking stage, II(B)4, III(B) 2), five had hepatocellular carcinoma (TNM stage, III 3, IV 2), and five had renal cell carcinoma (TNM stage, III 2, IV 3). Using flow cytometry technique, T lymphocyte and subset, B lymphocyte and natural killer cell (NK) in the peripheral blood were measured in these patients on the day before HIFU and 7 to 10 d after HIFU. The statistical significance of any observed difference is evaluated by Student's t-test. The results showed a significance increase in the population of CD4(+) lymphocytes (p < 0.01) and the ratio of CD4(+) /CD8(+) (p < 0.05) in the circulation of cancer patients after HIFU treatment. The abnormal levels of CD3(+) lymphocytes returned toward the normal range in two patients, CD4(+)/CD8(+) ratio in 3, CD19(+) lymphocytes in one and cytotoxic NK in one, respectively, in comparison to control values. It is concluded that HIFU could enhance a systemic antitumor cellular immunity in addition to local tumor destruction in patients with solid malignancies.     

高强度聚焦超声治疗肝细胞癌的MRI观察

目的:分析原发性肝细胞癌高强度聚焦超声(highintensityfocusedultrasound,HIFU)治疗后的早期MRI表现。方法:29例经病理诊断为肝细胞癌患者在HIFU治疗前、后行腹部轴位T1WI,轴位T2WI,冠状位SPIR,以及Gd-DTPA增强后T1WI轴位、FFE序列冠状位扫描。观察HIFU治疗前后肿瘤的大小及MRI信号改变。结果:HIFU治疗36个瘤灶,其中28个缩小(77.8%),5个增大(13.9%),3个无明显变化(8.3%);T1WI增强30个瘤灶(83.3%)出现无信号增强区,12个瘤灶无增强区周围见环状增强,7个强化环内见低信号环(T1WI、T2WI、SPIR)。治疗后T1WI19个(52.8%)信号强度增加,T2WI17个(47.2%)信号强度减弱。结论:HIFU治疗后,肝癌瘤灶内可出现多种MRI信号改变,MRI是HIFU治疗效果评估的一种无创而有效的影像学方法。     

高强度聚焦超声治疗恶性骨肿瘤后的MRI表现

目的(1)探讨高强度聚焦超声(HIFU)治疗恶性骨肿瘤前后的MRI变化特征;(2)探讨MRI作为HIFU治疗恶性骨肿瘤后的近期疗效评价手段.方法总结35例恶性骨肿瘤HIFU治疗前及治疗2周后的MRI变化,分析治疗前后平扫T1W1、T2WI及Gd-DTPA增强后T1WI各序列的信号变化特征.结果HIFU治疗后MRI检查,肿瘤治疗区T1、T2变短,增强后病灶不强化,治疗边界清楚,边缘锐利,周边可见线状的强化带.结论HIFU治疗前后MRI信号变化较明显,治疗后2周MRI检查,T1、T2较治疗前缩短,Gd-DTPA增强后不强化,且治疗区边界清楚,边缘呈线状强化,信号变为较均匀一致,MRI可作为HIFU治疗后的一种近期无创性的疗效评价手段.     

影响聚焦超声治疗子宫腺肌病消融率的相关因素初步分析

目的探讨影响高强度聚焦超声(HIFU)治疗子宫腺肌病病灶消融率的因素。方法回顾性分析2012年4月至2014年4月30例经HIFU治疗的子宫腺肌病患者的病灶消融率及其影响因素,根据患者年龄、子宫位置、病灶位置、病灶弥散程度、病灶的MRI信号强度等进行分组,术后1周内通过增强MRI进行病灶消融率评估。分析年龄、子宫位置、病灶位置、病灶弥散程度、病灶MRI信号强度等因素对消融率的影响。结果 HIFU治疗子宫腺肌病后显示子宫底病灶和后壁病灶的平均消融率均小于前壁病灶的平均消融率(P<0.05);超声治疗强度越大,平均消融率越大(P<0.05)。结论子宫腺肌症病灶位置和超声治疗强度对聚焦超声消融率有一定影响。     

Activation of tumor-infiltrating antigen presenting cells by high intensity focused ultrasound ablation of human breast cancer

Previous studies have shown that high intensity focused ultrasound (HIFU) ablation can trigger activation of host antitumor responses after direct tumor destruction. The goal of this study was to investigate the status and functions of tumor-infiltrating antigen presenting cells (APCs) after HIFU ablation of human breast cancer, and to explore the mechanisms regarding HIFU-enhanced antitumor response. Forty-eight women with biopsy-proven breast cancer were divided randomly into a control group (n = 25) and a HIFU group (n = 23). Patients in the control group received modified radical mastectomy, and those in the HIFU group underwent HIFU ablation of primary breast cancer, followed by modified radical mastectomy within 1-2 weeks. Using immunohistochemical analysis, tumor-infiltrating dendritic cells (DCs), macrophages, B lymphocytes and expression of HLA-DR and costimulatory molecules on DCs and macrophages were assessed in all patients. The results showed that APCs infiltrated along the margins of the ablated regions in all HIFU-treated tumors, and numbers of tumor-infiltrating DCs, macrophages and B lymphocytes increased significantly in the HIFU group. Compared with the values in the control group, the percentage of DCs and macrophages expressing HLA-DR, CD80 and CD86 was significantly greater in the HIFU group. There were statistically significant differences between numbers of S-100(+) HLA-DR(+), S-100(+) CD80(+), S-100(+) CD86(+), CD68(+) HLA-DR(+), CD68(+) CD80(+) and CD68(+) CD86(+) cells in the control and HIFU groups, respectively. It was concluded that HIFU ablation induces significant infiltration of APCs within the residual tumor debris in patients with breast cancer, and most of the tumor-infiltrating DCs and macrophages were activated after HIFU ablation.     

高强度聚焦超声治疗子宫肌瘤及影像学评价

高强度聚焦超声(HIFU)治疗子宫肌瘤正逐步推广,其疗效评价尚缺乏统一标准.影像学可提供更加客观确切的图像信息,是临床疗效评价的重要组成部分.本文概述子宫肌瘤HIFU治疗的研究现状,并重点介绍其主要的影像学评价方法及特征.     

MRI monitoring of the effect of tissue interfaces in the penetration of high intensity focused ultrasound in kidney in vivo

In this paper, we studied the effect of interfaces during the application of high intensity focused ultrasound (HIFU) ablation in rabbit kidney in vivo. In kidney ablation, mainly two types of interfaces are encountered: these are muscle-kidney and fat-kidney. It was observed that the intensity for which the probability of cavitation (POC) is one was decreased when HIFU penetrated through interfaces, meaning that an interface is a potential site of cavitation. We utilized the concept of scanning the area to be treated in two dimensions (rectangular grid) by applying low intensity ultrasound (diagnostic scan). When all the points of the grid show decrease of signal in T1-weighted fast spoiled gradient (FSPGR) which indicated heating, complete necrosis was observed in the targeted area during the application of HIFU (therapeutic scan). If ultrasound goes through an interface that includes air spaces, the diagnostic scan indicates spaces with poor ultrasound penetration and as a result, during the application of the therapeutic scan, some sites remain untreated. The muscle-kidney and fat-kidney interfaces cause reflection of ultrasound, which prevents the penetration of ultrasound. Microscopic bubbles in the interface may initiate cavitation, especially at high intensities. However, sometimes these types of interfaces do not include any bubbles and therefore the propagation of ultrasound is not inhibited.     

磁共振血氧水平依赖成像观察原发性肝细胞癌高强度聚焦超声治疗前后氧摄取变化特点

目的 通过观察原发性肝细胞癌(HCC)高强度聚焦超声(HIFU)治疗前后氧摄取变化特点,探讨BOLD MRI评估HIFU治疗原发性HCC疗效的潜在价值。方法 16例原发性HCC患者于HIFU治疗前及治疗后2周内接受常规MRI、BOLD MRI及动态增强扫描。BOLD MRI采用梯度回波序列。将BOLD图像数据传输至工作站,采用R2^*软件对图像进行后处理生成R2^*图及T2^*图。在病灶中心、周围正常肝组织以及背部肌肉设置ROI,测量R2^*值、T2^*值及信号强度(SI)。对3个ROI R2^*值、T2^*值及SI在HIFU治疗前后的差异进行比较。结果 与治疗前比较,HCC R2^*值在HIFU治疗后2周内明显升高 ,而T2^*值、SI值在HIFU治疗后2周内明显降低 。周围肝组织及背部肌肉R2^*值、T2^*值及SI值在HIFU治疗前后的无明显变化(P＞0.05)。结论 BOLD MRI在评价原发性肝细胞癌缺氧及HIFU疗效方面有一定潜力。     

高强度聚焦超声制备肿瘤抗原致敏树突状细胞

目的:探讨用高强度聚焦超声辐照肿瘤细胞制备肿瘤抗原致敏树突状细胞的可行性,为高强度聚焦超声开辟新的应用领域。方法:实验于2004-01/2005-04在泰安市中心医院中心实验室完成。①实验材料:BALB/C清洁级小鼠20只。CT-26肿瘤细胞为BALB/C小鼠来源的结肠癌细胞,由解放军第二军医大学免疫学研究所惠赠。②实验方法:应用白细胞介素4 粒细胞-巨噬细胞集落刺激因子联合诱导培养小鼠骨髓细胞。设立4组:高强度聚焦超声辐照组将CT-26细胞置于含10%小牛血清的RPMI1640培养液中,进入对数生长期后调整细胞浓度为5×109L-1,采用1000W/cm2×30s剂量辐照CT-26细胞,离心,取上清过滤除菌。冻融组将CT-26细胞调整浓度至5×109L-1,-80℃冷冻,35℃水浴复温,循环4次,裂解离心,取上清过滤除菌。单纯CT-26细胞组将CT-26细胞调整浓度至5×109L-1,细胞不经其他任何处理。空白对照组将树突状细胞与抗原按1∶10接种,培养4～6h。从小鼠脾脏制备脾细胞,分离纯化T细胞,调整浓度至2×109L-1,T细胞与上述4组负载的树突状细胞按20∶1接种,培养基中加入白细胞介素2,共孵育48h。③实验评估:对扩增培养的树突状细胞首先进行形态学观察,再采用流式细胞仪分析细胞表型。锥虫蓝染色观察高强度聚焦超声辐照后CT-26细胞拒染率和形态学变化。ELISA法检测各组致敏树突状细胞诱导T细胞分泌白细胞介素12及干扰素-γ的含量。结果:①骨髓源性树突状细胞形态及细胞表面表型分析:体外培养小鼠骨髓细胞6～8d,细胞表面出现较多毛刺样突起,拉长,为典型的树突状细胞特征。流式细胞仪检测树突状细胞表面分子CD80、CD86、H-2Kd及I-Ad呈高表达。②高强度聚焦超声辐照后细胞拒染率和形态学的变化:超声辐照剂量为1000W/cm2×30s时,无细胞存活,完全失去细胞形态,全部被撕裂成碎片。③致敏树突状细胞诱导T细胞分泌细胞因子情况:与空白对照组比较,高强度聚焦超声辐照组、冻融组、单纯CT-26细胞组分泌的白细胞介素12及干扰素-γ含量均明显升高(P均<0.05);且高强度聚焦超声辐照组、冻融组升高幅度大于单纯CT-26细胞组,但此两组比较差异无显著性意义(P>0.05)。结论:高强度聚焦超声能使肿瘤细胞灭活、破碎,其制备的肿瘤抗原可体外致敏树突状细胞,并使树突状细胞分泌白细胞介素12,诱导T细胞分泌干扰素-γ。