高强度聚焦超声治疗子宫肌瘤的临床研究

目的探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的安全性和有效性。方法选择180例,年龄在30-50岁之间已生育的、具有手术适应症的子宫肌瘤患者作为治疗对象。应用HIFUNIT9000型超声聚焦肿瘤消融肌瘤实施脉冲式释放高强度超声治疗。比较治疗前后患者的临床症状、Hb含量和肌瘤体积的变化。结果180例患者局部皮肤Ⅰ度烧伤者6例,未见其他严重并发症。术后3个月92.9%的月经量增多患者和96.4%的伴有尿频症状的患者恢复正常。贫血患者治疗后3月,总体血红蛋白含量明显增加。173例患者肌瘤缩小明显而不需要其他治疗手段,仅有7例因未见瘤体明显缩小或增大而进行手术治疗。结论HIFU是治疗子宫肌瘤安全、有效的方法。     

Noninvasive measurement of local thermal diffusivity using backscattered ultrasound and focused ultrasound heating

Previously, noninvasive methods of estimating local tissue thermal and acoustic properties using backscattered ultrasound have been proposed in the literature. In this article, a noninvasive method of estimating local thermal diffusivity in situ during focused ultrasound heating using beamformed acoustic backscatter data and applying novel signal processing techniques is developed. A high intensity focused ultrasound (HIFU) transducer operating at subablative intensities is employed to create a brief local temperature rise of no more than 10 degrees C. Beamformed radio-frequency (RF) data are collected during heating and cooling using a clinical ultrasound scanner. Measurements of the time-varying "acoustic strain", that is, spatiotemporal variations in the RF echo shifts induced by the temperature related sound speed changes, are related to a solution of the heat transfer equation to estimate the thermal diffusivity in the heated zone. Numerical simulations and experiments performed in vitro in tissue mimicking phantoms and excised turkey breast muscle tissue demonstrate agreement between the ultrasound derived thermal diffusivity estimates and independent estimates made by a traditional hot-wire technique. The new noninvasive ultrasonic method has potential applications in thermal therapy planning and monitoring, physiological monitoring and as a means of noninvasive tissue characterization. (E-mail: ajay.anand@philips.com).     

Effects of high-intensity focused ultrasound on the intervertebral disc: a potential therapy for disc herniations

PURPOSE: To determine the potential application of high-intensity focused ultrasound for the minimally invasive treatment of herniated intervertebral discs by developing a probe that produces sufficiently high temperature locally to shrink collagen fibers (65-75 degrees Celsius). MATERIALS AND METHODS: A 5-mm ultrasound probe was produced with a geometric focal length of 15 mm. The probe produced 2.5 W of acoustic power and was operated at a frequency of 4.1 MHz. Measurements of temperature increase were performed in discs from bovine tails. In vivo experiments were performed to assess histologic changes in the disc as well as in nerve root and muscle. RESULTS: Sufficient temperature increase to produce collagen shrinkage was observed close to the focus of the ultrasound. Temperature measurements in vertebral end plates showed a temperature increase of only 4 degrees Celsius after 60-second exposure of the disc. In vivo experiments revealed histologic changes in the disc consistent with collagen shrinkage, with no adverse effects seen in surrounding tissues. CONCLUSIONS: The experiments demonstrated the feasibility of high-intensity focused ultrasound in the treatment of contained herniated discs. This technique has several advantages over other thermal treatment modalities.     

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。     

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.     

高强度聚焦超声治疗输卵管妊娠临床应用研究

目的 探讨高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗输卵管妊娠的可行性与临床疗效。方法 根据病史、体征并结合超声、血清β-人绒毛膜促性腺激素（β-hCG）临床检查结果诊断的输卵管妊娠患者16例，并排除输卵管孕部破裂或流产，无明显腹腔出血，无紧急手术指征。在超声定位下对输卵管孕部予以HIFU照射治疗。治疗第3、5、7、14、21天复查血清β-hCG，术后随访3-6个月。结果 16例患者接受HIFU治疗19次。随访14例中12例患者临床治愈：治疗前患者血清β-hCG为739-4600U/L，均在治疗20d内达正常水平（〈10U/L）；其中3例第1次复查β-hCG稍升高或不降，患者症状体征无明显变化，进行第2次HIFU治疗后效果满意。2例HIFU治疗失败，治疗前血清β-hCG分别高达7200U/L、9000U/L，HIFU治疗后血清β-hCG持续升高，并出现内出血症状，转手术治疗。2例失访。随访中，超声复查发现，包块存留但明显缩小；1例患者HIFU治疗3个月后再次发生同侧输卵管妊娠，手术切除。结论 HIFU治疗输卵管妊娠取得了较好的临床效果。仍有一些问题有待于进一步探讨，如治疗前血清β-hCG水平与HIFU疗效关系，HIFU治疗参数的个体化设置和调整能否提高疗效，HIFU治疗后输卵管粘连、包块与冉发的关系等。     

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.     

Evaluation of physician experience in achieving non-perfused volume ratio of high-intensity focused ultrasound ablation for uterine fibroids: a multicentre study

ObjectiveTo evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training.MethodsThis prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician’s level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated.ResultsA total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve.ConclusionsNPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.     

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 ultrasonic appearance of pathology in the male breast.

The ultrasonic appearance of pathological conditions in the male breast is similar to that encountered in the female breast. With grey scale echography, characteristic features associated with a particular condition can be recognized and an estimation made of the extent of the pathological involvement.     

经腹超声评价高强度超声聚焦刀治疗子宫肌瘤的应用研究

目的探讨高强度超声聚焦刀在子宫肌瘤治疗前后超声声像图发生的变化。方法共收集63例经HIFU治疗的患者,比较治疗前后超声声像图的变化情况。结果经过超声检查发现子宫肌瘤经过HIFU治疗后,子宫肌瘤体积和瘤体内血流情况有明显减小和减少。结论经腹超声检查在子宫肌瘤HIFU治疗中,是对治疗效果一种有价值的辅助评价方法。     

DCE-MRI对评价高强度聚焦超声刀治疗子宫肌瘤早期疗效的价值

目的回顾性分析子宫肌瘤在高强度聚焦超声消融后DCE-MRI的特征。材料与方法对33例子宫肌瘤患者进行高强度聚焦超声消融术,所有患者在术前1周内及术后1周行DCE-MRI检查,然后对同一肌瘤边缘的强化模式进行分析,判断是否完全消融。结果高强度聚焦超声消融33例子宫肌瘤,其中25例术后DCE-MRI表现为中央低信号无强化的消融区,并有窄边强化,经术后6个月复查,未见复发肿瘤组织,证实完全消融;8例消融区边缘有结节或有不规则增厚边缘强化,5例经病理学确认有残留存活肿瘤组织,3例6个月后复查表现为增大。结论子宫肌瘤被完全消融的DCE-MRI征象为中央无强化低信号区,伴狭窄强化边缘,而边缘有结节强化或有不规则增厚边缘强化,则考虑肿瘤只被部分消融。     

Monitoring imaging of lesions induced by high intensity focused ultrasound based on differential ultrasonic attenuation and integrated backscatter estimation

We investigated the feasibility of two monitoring imaging methods to visualize and evaluate the high intensity focused ultrasound (HIFU) induced lesions in vitro during and after their formation, which were based on differential ultrasonic parameter estimation. Firstly, ultrasonic attenuation slope of tissue sample was estimated based on the spectral analysis of ultrasound RF backscattered signals. The differential attenuation slope maps were acquired, which were interpreted as the differences between the pretreatment image and those obtained in different stages during HIFU therapy. Secondly, ultrasonic integrated backscatter (IBS), defined as the frequency average of the backscatter transfer function over the useful bandwidth, was proposed quantitatively to evaluate the extent of lesions with the same RF signals as the first method. Differential IBS maps were also acquired to visualize temporal evolution of lesion formation. It was found in pig liver in vitro that more precise definition of the treated area was obtained from the differential IBS images than from differential attenuation slope images. Dramatic increase in both attenuation and IBS value was observed during the therapy, which may be related to dramatic enhancement of cavitation due to boiling and accompanying tissue damage. Two methods to obtain one differential image were compared and the cumulative differential image was found to be able to eliminate noises and artifacts to some extent, which was the cumulation of a series of differential images acquired from the differences between the temporally adjacent RF data frames. Moreover, we presented a bidirectional color code for identification of the artifacts due to tissue movements caused by HIFU radiation force. We conclude that cumulative differential IBS images have the potential to monitor the formation of HIFU-induced lesions.     

载Fe3O4高分子微球联合高强度聚焦超声损伤兔乳腺移植瘤的实验研究

目的 探讨自制载氧化铁高分子微球(Fe3O4/PLGA)联合高强度聚焦超声(HIFU)对兔VX2乳腺癌消融效果的影响.方法 双乳化法制备载Fe3O4的高分子微球.建立兔VX2乳腺癌模型32只,于肿瘤接种后14d,随机分为4组,第1组实验兔给予单纯HIFU辐照;第2、3、4组在HIFU辐照前,距肿瘤中心约3 mm处,经肿瘤3、6、9、12点钟方向,分别注入生理盐水、PLGA、Fe3O4/PLGA共0.5 ml,局部按摩1 min后行HIFU定点辐照,辐照声功率150 W,辐照时间5 s.HIFU辐照结束后,观测靶区凝固性坏死体积,采集标本行HE染色,增殖细胞核抗原(PCNA)检测及透射电镜观察.结果 Fe3O4/PLGA微球联合HIFU辐照明显增加肿瘤组织凝固性坏死体积(P＜0.05),降低肿瘤PCNA阳性表达率(P＜0.05).光镜下观察坏死区与周围组织分界清楚,电镜下癌细胞结构欠清晰,可见Fe颗粒沉积于胞浆.结论 自制Fe3O4/PLGA能有效增强HIFU消融兔乳腺VX2肿瘤的生物学效应.     

高强度聚焦超声体外辐照兔股动脉后的病理学观察

目的 探讨高强度聚焦超声(HIFU)体外辐照兔股动脉后血管的破坏情况。方法HIFU的工作频率为0．8MHz，焦距135mm，焦点平均强度为8000w／cm^2。30只兔随机分为三组，采用弹力纤维维多利亚蓝和丽春红S组织化学染色方法，观察HIFU辐照兔股动脉后即日、3d和7d的病理学变化。结果HIFU辐照后，各实验组均可见兔股动脉血管内皮细胞脱落、消失，管腔有微小血栓形成；平滑肌细胞出现核固缩，细胞排列紊乱；血管弹力纤维出现崩溃和断裂等现象。结论HIFU体外辐照可以造成兔股动脉血管损伤，并导致血流动力学改变。     

Transcatheter arterial chemoembolization in combination with high-intensity focused ultrasound for unresectable hepatocellular carcinoma: a systematic review and meta-analysis of the chinese literature

To evaluate the therapeutic effects of transcatheter arterial chemoembolization (TACE) in combination with high-intensity focused ultrasound (HIFU) for unresectable hepatocellular carcinoma (UHCC), we performed a systematic review and meta-analysis by searching the database. In nine controlled trials with a total of 736 patients, the effect of TACE plus HIFU (group A) was compared with TACE alone (group B) in treating UHCC. Outcomes mainly included tumor response and survival. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each relationship from raw study data using the fixed-effect model or the random effect model. We found that group A significantly improved the tumor response and 0.5-, 1-, 2-, and 3-year survival of patients. In conclusion, combined therapy was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before combined therapy can be recommended routinely.     

射频消融组织的B超图像纹理分析

目的分析射频消融组织的B超图像纹理表现,探讨利用B超图像纹理实现射频消融疗效监测的可行性。方法实验研究射频消融治疗前后离体猪肉治疗区域B超图像的纹理特征,对组织凝固坏死和非凝固区域的图像纹理特征进行统计分析。结果消融过程中组织凝固坏死和非凝固区域的B超图像纹理特征有显著差异;灰度均值、对比度等多个纹理特征具有区分猪肉组织是否发生凝固坏死的能力。结论B超图像的纹理特征能有效反映组织的消融效果。     

Novel tissue mimicking materials for high frequency breast ultrasound phantoms

The development and acoustical characterisation of a range of novel agar-based tissue mimicking material (TMMs) for use in clinically relevant, quality assurance (QA) and anthropomorphic breast phantoms are presented. The novel agar-based TMMs described in this study are based on a comprehensive, systematic variation of the ingredients in the International Electrotechnical Commission (IEC) TMM. A novel, solid fat-mimicking material was also developed and acoustically characterised. Acoustical characterisation was carried out using an in-house scanning acoustic macroscope at low (7.5 MHz) and high frequencies (20 MHz), using the pulse-echo insertion technique. The speeds of sound range from 1490 to 1570 m. s⁻¹, attenuation coefficients range from 0.1 to 0.9 dB. cm^?1. MHz⁻¹ and relative backscatter ranges from 0 to -20 dB. It was determined that tissues can be mimicked in terms of independently controllable speeds of sound and attenuation coefficients. These properties make these novel TMMs suitable for use in clinically relevant QA and anthropomorphic phantoms and would potentially be useful for other high frequency applications such as intravascular and small animal imaging. (E-mail: Louise.cannon@dit.ie)     

高强度聚焦超声体外治疗肝肿瘤的剂量学研究

目的 探讨高强度聚焦超声（ＨＦＵ）破坏肝肿瘤剂量与效应的关系。为ＨＩＦＵ体外治疗肝肿瘤的临床剂量学提供参考数据,方法 在换能器聚焦参数和工作为的前提下,观察并测定不同的输出功率、单次脉冲时间和治疗总时间致离体牛肝组织和活体猪肝脏靶区内组织凝固性坏死灶的大小。结果 肝组织内凝固性坏死灶的大小是可变的,且可能与ＨＩＦＵ治疗剂量和活体组织的生物学特性有关系。结论 肝脏靶区出现凝固性坏死是聚焦超声束作用于     

输卵管妊娠高强度聚焦超声治疗后输卵管通畅性的超声晶氧造影研究

目的 应用超声晶氧造影的方法观察高强度聚焦超声（HIFU）治疗输卵管妊娠后输卵管的通畅性，对其预后做出评价。方法 用1％的晶氧造影剂对33例（HIFU）治疗后的输卵管妊娠患者进行B—flow模式超声监控下输卵管造影，观察患侧输卵管的通畅性。结果 33例输卵管妊娠患者，经（HIFU）治疗后患侧输卵管通畅25例（76％），6例通而不畅（18％），2例阻塞（6％，其中1例附件区可见包块）。结论 超声晶氧造影发现，（HIFU）治疗后输卵管的通畅性较好。此造影方式是一种评价（HIFU）治疗输卵管妊娠后输卵管通畅情况的较佳方式。