高强度聚焦超声治疗子宫肌瘤300例的临床疗效分析

目的：探讨高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗子宫肌瘤的临床疗效及其安全性。方法：回顾性分析我院2007年1月～2011年1月300例采用高强度聚焦超声治疗的子宫肌瘤患者的临床资料,比较分析治疗前后瘤体大小、病灶内部回声、临床症状改善情况、血流的变化及超声造影图像改变。结果：HIFU治疗后1、3、6及12个月,瘤体体积均较治疗前显著缩小（P〈0.05）,显效率80.33%（241例）,有效率19.33%（58例）,无效率0.33%（1例）,肌瘤所致的临床症状减轻或消失,瘤体内部回声增强,彩色血流均消失,超声造影瘤体内无灌注。治疗期间,患者出现治疗部位疼痛、骶尾部酸胀及肛门坠胀,治疗结束时症状消失;治疗过程中出现腿部疼痛、麻木症状,经过重新定位后症状消失,少数出现阴道少量流血,给予止血药;治疗后出现血尿,经大量喝水排尿后消失。结论：HIFU治疗子宫肌瘤是安全有效的,在妇科领域便于推广。     

高强度聚焦超声在药物控制释放的应用及进展

高强度聚焦超声能够以一种非侵入性的方式有效地穿透身体内部组织,聚焦在深层组织中一个很小的空间区域内,产生很强的声能,这些能量被组织吸收引起局部温度的升高。当温度到达热敏脂质体的相变温度时,磷脂烷基链构象的会发生改变,导致脂质体的通透性增强,从而能够促进药物的释放。因此,高强度聚焦超声可以被用作外源刺激控制体内特定位置热敏脂质体的药物释放。本文对高强度聚焦超声在药物控制释放领域的应用及进展进行综述。     

高强度聚焦超声可治疗区域的仿真研究

数值仿真不同治疗参数条件下高强度聚焦超声(high intensity focused ultrasound,HIFU)可治疗区域的变化,对HIFU治疗剂量的确定具有重要的指导意义。本文采用Westervelt方程的近似式,结合Pennes生物热传导方程,以离体猪肝组织为例,在考虑组织声学特性对HIFU焦域温度场影响的条件下,通过时域有限差分法(finite difference time domain,FDTD)对HIFU焦域温度场进行仿真研究。研究结果表明,照射时间越长,组织声学特性的影响就越明显;焦点处的最高温升相同时,可治疗区域的大小差异较小;声强越大,形成可治疗区域所需的时间也越短;当声强一定时,随着照射时间的增加,可治疗区域的长、短轴长度均呈非线性增加;在相同可治疗区域的长轴或短轴长度一定时,输入声强和照射时间呈负相关。     

高能聚焦超声在治疗晚期胰腺癌中的疗效分析

目的：通过对晚期胰腺癌患者行高强度聚焦超声治疗,观察其近期疗效,为晚期胰腺癌患者的临床治疗提供一种新的选择。方法：对15例晚期胰腺癌患者行高强度聚焦超声治疗,对比治疗前后的KPS评分,疼痛感受评分,CA199,三大常规,生化检查,B超观察肿瘤回声及血供,CT观察肿瘤大小改变。结果：HIFU治疗后,患者KPS评分升高,疼痛评分下降,肿瘤标志物下降,B超观察肿瘤回声,其中10例肿瘤回声增强,11例肿瘤血供减少或消失,CT示大部分患者治疗后肿瘤体积缩小或不变,治疗后三大常规、生化和电解质无明显改变。结论：运用高强度聚焦超声治疗晚期胰腺癌患者,在改善患者临床症状方面有明显疗效,并且能缩小肿瘤体积,减少或中断肿瘤血供,是一种很有发展前景的无创治疗方法。     

高强度聚焦超声在治疗肝癌中的研究进展

肝癌是我国常见的恶性肿瘤之一,手术切除是治疗肝癌的首选治疗方法,但是大多数患者发现时多数为中晚期,无法进行手术切除.高强度聚集超声(HIFU)是一种非侵袭性的治疗方法,在肝癌的治疗中发挥着举足轻重的作用.为此作者对HIFU治疗肝癌的原理、提高免疫力的作用及抑制肝癌侵袭和转移的作用进行阐述,为临床治疗该病提供参考.     

高强度聚焦超声在治疗肝癌中的研究进展

肝癌是我国常见的恶性肿瘤之一,手术切除是治疗肝癌的首选治疗方法,但是大多数患者发现时多数为中晚期,无法进行手术切除。高强度聚集超声(HIFU)是一种非侵袭性的治疗方法,在肝癌的治疗中发挥着举足轻重的作用。为此作者对HIFU治疗肝癌的原理、提高免疫力的作用及抑制肝癌侵袭和转移的作用进行阐述,为临床治疗该病提供参考。     

Modeling and Predicting Tissue Movement and Deformation for High Intensity Focused Ultrasound Therapy

PurposeIn ultrasound-guided High Intensity Focused Ultrasound (HIFU) therapy, the target tissue (such as a tumor) often moves and/or deforms in response to an external force. This problem creates difficulties in treating patients and can lead to the destruction of normal tissue. In order to solve this problem, we present a novel method to model and predict the movement and deformation of the target tissue during ultrasound-guided HIFU therapy.MethodsOur method computationally predicts the position of the target tissue under external force. This prediction allows appropriate adjustments in the focal region during the application of HIFU so that the treatment head is kept aligned with the diseased tissue through the course of therapy. To accomplish this goal, we utilize the cow tissue as the experimental target tissue to collect spatial sequences of ultrasound images using the HIFU equipment. A Geodesic Localized Chan-Vese (GLCV) model is developed to segment the target tissue images. A 3D target tissue model is built based on the segmented results. A versatile particle framework is constructed based on Smoothed Particle Hydrodynamics (SPH) to model the movement and deformation of the target tissue. Further, an iterative parameter estimation algorithm is utilized to determine the essential parameters of the versatile particle framework. Finally, the versatile particle framework with the determined parameters is used to estimate the movement and deformation of the target tissue.ResultsTo validate our method, we compare the predicted contours with the ground truth contours. We found that the lowest, highest and average Dice Similarity Coefficient (DSC) values between predicted and ground truth contours were, respectively, 0.9615, 0.9770 and 0.9697.ConclusionOur experimental result indicates that the proposed method can effectively predict the dynamic contours of the moving and deforming tissue during ultrasound-guided HIFU therapy.     

高强度聚焦超声肿瘤治疗焦域的仿真研究

数值仿真是预测高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗的温度分布、确定治疗剂量的有效方法之一。本研究采用Westervelt方程的近似式,并结合Pennes生物热传导方程,以猪肝肿瘤为例,在考虑肝组织声学特性对HIFU温度场影响的条件下,通过时域有限差分法仿真研究辐照时间和声强对肿瘤组织内可治疗焦域体积的影响。研究结果表明,一定声强条件下,肝组织声学特性对肿瘤内可治疗焦域的影响随着辐照时间的延长而凸显;可治疗焦域体积随时间增长或声强增大而非线性增加;相同辐照条件下,肿瘤组织内的可治疗焦域体积大于肝组织内的;当可治疗焦域体积一定时,辐照声强和辐照时间呈负相关;同时,等效热剂量判定的可治疗焦域大于温度阈值判定的可治疗焦域,且二者之差随声强而变化。     

Magnetic Resonance Imaging Assessment of Effective Ablated Volume following High Intensity Focused Ultrasound

Under magnetic resonance (MR) guidance, high intensity focused ultrasound (HIFU) is capable of precise and accurate delivery of thermal dose to tissues. Given the excellent soft tissue imaging capabilities of MRI, but the lack of data on the correlation of MRI findings to histology following HIFU, we sought to examine tumor response to HIFU ablation to determine whether there was a correlation between histological findings and common MR imaging protocols in the assessment of the extent of thermal damage. Female FVB mice (n = 34), bearing bilateral neu deletion tumors, were unilaterally insonated under MR guidance, with the contralateral tumor as a control. Between one and five spots (focal size 0.5 × 0.5 × 2.5 mm³) were insonated per tumor with each spot receiving approximately 74.2 J of acoustic energy over a period of 7 seconds. Animals were then imaged on a 7T MR scanner with several protocols. T1 weighted images (with and without gadolinium contrast) were collected in addition to a series of T2 weighted and diffusion weighted images (for later reconstruction into T2 and apparent diffusion coefficient maps), immediately following ablation and at 6, 24, and 48 hours post treatment. Animals were sacrificed at each time point and both insonated/treated and contralateral tumors removed and stained for NADH-diaphorase, caspase 3, or with hematoxylin and eosin (H&E). We found the area of non-enhancement on contrast enhanced T1 weighted imaging immediately post ablation correlated with the region of tissue receiving a thermal dose CEM43 ≥ 240 min. Moreover, while both tumor T2 and apparent diffusion coefficient values changed from pre-ablation values, contrast enhanced T1 weighted images appeared to be more senstive to changes in tissue viability following HIFU ablation.     

Transmural Ultrasound Imaging of Thermal Lesion and Action Potential Changes in Perfused Canine Cardiac Wedge Preparations by High Intensity Focused Ultrasound Ablation

Intra-procedural imaging is important for guiding cardiac arrhythmia ablation. It is difficult to obtain intra-procedural correlation of thermal lesion formation with action potential (AP) changes in the transmural plane during ablation. This study tested parametric ultrasound imaging for transmural imaging of lesion and AP changes in high intensity focused ultrasound (HIFU) ablation using coronary perfused canine ventricular wedge preparations (n = 13). The preparations were paced from epi/endocardial surfaces and subjected to HIFU application (3.5 MHz, 11 Hz pulse-repetition-frequency, 70% duty cycle, duration 4 s, 3500 W/cm²), during which simultaneous optical mapping (1 kframes/s) using di-4-ANEPPS and ultrasound imaging (30 MHz) of the same transmural surface of the wedge were performed. Spatiotemporally correlated AP measurements and ultrasound imaging allowed quantification of the reduction of AP amplitude (APA), shortening of AP duration at 50% repolarization, AP triangulation, decrease of optical AP rise, and change of conduction velocity along tissue depth direction within and surrounding HIFU lesions. The threshold of irreversible change in APA correlating to lesions was determined to be 43±1% with a receiver operating characteristic (ROC) area under curve (AUC) of 0.96±0.01 (n = 13). Ultrasound imaging parameters such as integrated backscatter, Rayleigh (α) and log-normal (σ) parameters, cumulative extrema of σ were tested, with the cumulative extrema of σ performing the best in detecting lesion (ROC AUC 0.89±0.01, n = 13) and change of APA (ROC AUC 0.79±0.03, n = 13). In conclusion, characteristic tissue and AP changes in HIFU ablation were identified and spatiotemporally correlated using optical mapping and ultrasound imaging. Parametric ultrasound imaging using cumulative extrema of σ can detect HIFU lesion and APA reduction.     

超声造影剂协同下的高强度聚焦超声对包虫原头蚴酶活性的影响

为探索高强度聚焦超声结合适宜比例的微泡造影剂对离体细粒棘球绦虫原头蚴酶活性的影响,实验分离包虫原头蚴,在原头蚴悬液中加入比例为1:80的微泡造影剂(含氟脂质体微泡),以声功率为50W的高强度聚焦超声波辐照30s,辐照后悬液涂片作酶组织化学染色,检测原头蚴三磷酸腺苷酶、葡萄糖-6-磷酸酶和琥珀酸脱氢酶的活性。结果显示,超声剂量相同时,微泡造影剂组的原头蚴三磷酸腺苷酶和琥珀酸脱氢酶活性明显低于单纯超声辐照组(P<0.05);葡萄糖-6-磷酸酶活性有一定降低;阴性对照组无酶反应物产生。高强度聚焦超声结合微泡造影剂能增强对离体原头蚴三磷酸腺苷酶和琥珀酸脱氢酶活性的抑制作用。