高强聚焦超声(HIFU)无创外科─21世纪治疗肿瘤的新技术

本文从简要回顾超声治疗的发展历史开始,重要介绍了90年代初在国际上兴起的HIFU无创外科技术及我国在该领域中的成就。文章继而对HIFU“切除”肿瘤的机理,治疗质量及其发展前景做了讨论。     

HIFU治疗中换能器驱动电功率变化机制及规律*

高强度聚焦超声(HIFU)治疗中的驱动电功率对治疗效率起着非常关键的作用,驱动电功率控制的精准性势必会影响治疗的效率和安全性。前期研究表明：HIFU治疗过程中焦域瞬态物理特性的变化会导致换能器的负载阻抗发生变化,进而影响HIFU驱动电功率,但驱动电功率与焦域瞬态物理特性之间的影响关系及规律尚不明确。该文基于电压、电流传感器、空化检测探头和温度传感器等器件,构建了一种HIFU治疗中驱动电功率实时监测及焦域声空化、温度检测系统。基于该实验研究系统,以离体牛心组织作为HIFU辐照对象,分别研究了HIFU焦域温度变化、声空化及组织损伤与驱动电功率之间的变化关系及规律。研究结果表明：当焦域温度升高时,驱动电功率缓慢上升,驱动电功率与温度变化有良好的相关性;当空化产生时,驱动电功率出现明显的波动;当组织出现损伤时,驱动电功率呈陡然下降的变化。三种情景下,驱动电功率变化有明显区别,这有望为区分HIFU治疗过程中焦域处发生损伤和空化以及实时监测靶组织损伤程度提供一种新的解决方案。     

从临床角度浅谈体外高强度聚焦超声肿瘤治疗设备的研制

本文从临床角度探讨在体外高强度聚焦超声（HIFU）治疗机的研发中应该关注的问题，指出重视HIFU的生物学效应研究、充分理解HIFU治疗肿瘤的临床意义对HIFU治疗机的研发具有的指导价值，提出了HIFU治疗机主要部件性能的临床要点，以及开发专用治疗机等构想，强调医工结合在HIFU治疗机开发中的重要性。     

高强度聚焦超声经颅脑肿瘤治疗焦域的仿真研究*

为了研究脑组织和脑肿瘤组织在HIFU治疗时形成焦域的特性及坏死肿瘤组织、不同治疗剂量参数以及多次治疗时焦点间距和时间间隔对HIFU形成焦域的影响,本文以脑胶质瘤患者为例,利用患者头颅CT图像数据建立HIFU经颅治疗的仿真模型,基于Westervelt声波非线性传播方程和Pennes生物热传导方程进行HIFU经颅治疗的仿真研究。结果表明,脑组织和脑肿瘤组织内形成HIFU焦域的差异较小,坏死肿瘤组织对HIFU温度场分布有较小影响;辐照声强越大,焦点温升达到同一温度所用时间越短,焦域长短轴越短,颅骨处温升越低;当焦点间距在一定范围内时,第一次辐照形成的温度场分布对第二个焦点温升达到同一温度所需时间影响较大;两次辐照时间间隔对颅骨处温升和两次聚焦形成60?C以上温度分布影响较小。     

基于电阻抗层析成像的高强度聚焦超声温度监测技术

作为一种对正常组织无损伤且不易引起癌细胞转移的非入侵肿瘤治疗手段,高强度聚焦超声(HIFU)治疗过程中焦域的温度监测是实现剂量精准控制的关键.本文基于生物组织的温度-电阻抗的关系,将电阻抗层析成像(EIT)和HIFU治疗相结合,提出了一种利用组织焦平面的表面电压实现电阻抗重构的检测技术.建立了HIFU治疗和EIT综合系统模型,在考虑组织的声吸收条件下,对三维Helmholtz方程在柱坐标下的声场计算进行了二维简化,并引入Pennes生物热传导方程来计算HIFU焦域的声压和温升分布特性;引入生物组织的温度-电阻抗关系,基于麦克斯韦电磁场理论,建立了具有温度分布HIFU焦域的电流和电压计算模型,利用恒流注入的边界条件实现电场计算,获得焦平面的表面电压分布.在数值计算中,利用实验聚焦换能器参数,模拟了在固定声功率下组织焦域的声场和温度场分布,以及中心和偏心聚焦条件下不同治疗时刻的电导率分布;然后通过对称电极的循环电流注入,计算了组织模型焦平面内的电流密度和电势分布,获得了焦平面圆周分布的表面电极电压;进一步采用修正的牛顿-拉夫逊算法,利用32×32的表面电极电压实现了焦平面内电导率分布的重建.结果表明,基于温度-电阻抗关系的EIT电导率重建技术不但能准确定位HIFU焦域中心,还能恢复HIFU治疗中焦域的温度分布,证明了EIT用于HIFU治疗中温度监测的可行性,为其疗效评估和剂量控制提供了一种无创电阻抗测量和成像新方法.     

高强度聚焦超声螺旋扫描形成的组织损伤研究

为满足高强度聚焦超声(HIFU)治疗对组织损伤均匀性和高效性的需求,理论及实验研究了连续扫描模式下HIFU沿螺旋扫描路径形成的组织损伤。基于Khokhlov-Zabolotskaya-Kuznetsov方程和生物传热方程建立了声热耦合模型,数值模拟了螺旋路径栅格距离为3 mm和4 mm时不同扫描速度下HIFU辐照体模的温度场和组织损伤分布,并采用凝胶体模进行了实验验证。结果表明,采用连续螺旋模式可以使热扩散均匀化,产生分布均匀的热损伤;选择适当的栅格距离和扫描速度,发挥螺旋路径内外圈热扩散的相互影响,可以产生大范围的整体性的热损伤,同时提高治疗效率。本文工作对优化HIFU治疗效果具有指导意义。     

高强度聚焦超声在医学超声领域中的发展与应用

高强度聚焦超声(high intensity focused ultrasound,简称HIFU)作为一种非侵入性、无毒副作用、具有巨大潜力的治疗肿瘤的手段,近年来已经越来越受到国内外学者的广泛关注。HIFU技术能将超声能量聚焦到人体组织的肿瘤内,产生高温,使肿瘤组织温度迅速上升至65℃以上,而发生不可逆转的凝固性坏死,从而达到消融肿瘤组织的目的。目前中国的HIFU肿瘤治疗技术和临床居国际领先。文章对HIFU在医学超声领域中的发展历史、现状和前景进行了探讨。     

HIFU温度场可视化测量初探

本实验用蓖麻油模拟人体环境、热敏打印纸作为记录载体,测量高强度聚焦超声(HIFU)治疗系统焦点附近的温度分布情况。实验中热敏打印纸显影所指示的温度已经达到HIFU治疗所需要的温度,实验的结果对进一步研究HIFU温度场分布有借鉴作用。     

时间反转方法用于高强度聚焦超声的焦点偏移补偿

传统的高强度聚焦超声(HIFU)治疗中实际焦点和预设焦点容易出现偏移,为考察时间反转方法对HIFU治疗中焦点偏移的补偿效果,采用时域有限差分方法求解Westervelt方程,建立高强度聚焦声场数值模型。数值计算得到在人体软组织中进行HIFU治疗时,采用时间反转方法后焦点偏移距离最大仅为1.6 mm。脂肪层厚度及声源强度改变对时间反转聚焦精度影响不大,F数(焦点距离同换能器孔径的比值)降低时,焦点偏移减小。研究表明在人体软组织吸收系数和非线性系数范围内,时间反转方法可有效补偿焦点偏移,达到更好的聚焦效果。      

基于分数导数研究高强度聚焦超声的非线性声场

在高强度聚焦超声(high intensity focused ultrasound, HIFU) 的研究中, 生物组织的衰减和色散性质会对声能量的空间分布产生影响. 本文提出应用分数导数修正非线性Khokhlov-Zabolotskaya-Kuznetsov (KZK)方程, 研究生物组织中非线性HIFU声场. 对三种生物仿体的衰减和声速色散的理论实验研究表明分数导数应用的可行性, 在此基础上通过数值仿真分析研究了衰减及声速随频率的变化对HIFU焦域分布的影响. 研究结果表明, 在计算强非线性聚焦超声时, 由于高次谐波的强色散作用, 引入分数导数来解决生物组织特殊的衰减以及色散问题可进一步提高HIFU治疗的安全性. 关键词： 分数导数 声衰减 色散 高强度聚焦超声     

高强聚焦超声(HIFU)无创外科─21世纪治疗肿瘤的新技术

本文从简要回顾超声治疗的发展历史开始,重点介绍了９０年代初在国际上兴起的ＨＩＦＵ无创外科技术及我国在该领域中的成就．文章继而对ＨＩＦＵ“切除”肿瘤的机理,治疗质量及其及发展前景做了讨论．     

液体中高强度聚焦超声场及其测量

基于已知文献,文章介绍了液体中高强度聚焦超声场的基本性质,包括传播、频谱、吸收、聚焦、辐射力等特性,描述了它的物理图景和测量方法。     

Pulse compression technique for simultaneous HIFU surgery and ultrasonic imaging: a preliminary study

In an ultrasound image-guided High Intensity Focused Ultrasound (HIFU) surgery, reflected HIFU waves received by an imaging transducer should be suppressed for real-time simultaneous imaging and therapy. In this paper, we investigate the feasibility of pulse compression scheme combined with notch filtering in order to minimize these HIFU interference signals. A chirp signal modulated by the Dolph-Chebyshev window with 3-9 MHz frequency sweep range is used for B-mode imaging and 4 MHz continuous wave is used for HIFU. The second order infinite impulse response notch filters are employed to suppress reflected HIFU waves whose center frequencies are 4 MHz and 8 MHz. The prototype integrated HIFU/imaging transducer that composed of three rectangular elements with a spherically con-focused aperture was fabricated. The center element has the ability to transmit and receive 6 MHz imaging signals and two outer elements are only used for transmitting 4 MHz continuous HIFU wave. When the chirp signal and 4 MHz HIFU wave are simultaneously transmitted to the target, the reflected chirp signals mixed with 4 MHz and 8 MHz HIFU waves are detected by the imaging transducer. After the application of notch filtering with pulse compression process, HIFU interference waves in this mixed signal are significantly reduced while maintaining original imaging signal. In the single scanline test using a strong reflector, the amplitude of the reflected HIFU wave is reduced to −45 dB. In vitro test, with a sliced porcine muscle shows that the speckle pattern of the restored B-mode image is close to that of the original image. These preliminary results demonstrate the potential for the pulse compression scheme with notch filtering to achieve real-time ultrasound image-guided HIFU surgery.     

A novel method for estimating the focal size of two confocal high-intensity focused ultrasound transducers

Estimating the focal size and position of a high-intensity focused ultrasound (HIFU) transducer remains a challenge since traditional methods, such as hydrophone scanning or schlieren imaging, cannot tolerate high pressures, are directional, or provide low resolution. The difficulties increase when dealing with the complex beam pattern of a multielement HIFU transducer array, e.g., two transducers facing each other. In the present study we show a novel approach to the visualization of the HIFU focus by using shockwave-generated bubbles and a diagnostic B-mode scanner. Bubbles were generated and pushed by shock waves toward the HIFU beam, and were trapped in its pressure valleys. These trapped bubbles moved along the pressure valleys and thereby delineated the shape and size of the HIFU beam. The main and sidelobes of 1.1- and 3.5 MHz HIFU beams were clearly visible, and could be measured with a millimeter resolution. The combined foci could also be visualized by observing the generation of sustained inertial cavitation and enhanced scattering. The results of this study further demonstrate the possibility of reducing the inertial cavitation threshold by the local introduction of shock wave-generated bubbles, which might be useful when bubble generation and cavitation-related bioeffects are intended within a small region in vivo.     

高强度聚焦超声(HIFU)——一门多学科的研究课题

高强度聚焦超声(high intensity focused ultrasound,简称HIFU)已作为一种无创外科工具而应用于门诊治疗肿瘤。文章介绍了它的基本原理、有关的研究现状和存在的问题,以及对今后研究工作的建议。文章特别强调高强度聚焦超声是一门多学科的综合研究课题,需要各方面的科学工作者通力协作。     

Ultrasound line-by-line scanning method of spatial–temporal active cavitation mapping for high-intensity focused ultrasound

This paper presented an ultrasound line-by-line scanning method of spatial–temporal active cavitation mapping applicable in a liquid or liquid filled tissue cavities exposed by high-intensity focused ultrasound (HIFU). Scattered signals from cavitation bubbles were obtained in a scan line immediately after one HIFU exposure, and then there was a waiting time of 2 s long enough to make the liquid back to the original state. As this pattern extended, an image was built up by sequentially measuring a series of such lines. The acquisition of the beamformed radiofrequency (RF) signals for a scan line was synchronized with HIFU exposure. The duration of HIFU exposure, as well as the delay of the interrogating pulse relative to the moment while HIFU was turned off, could vary from microseconds to seconds. The feasibility of this method was demonstrated in tap-water and a tap-water filled cavity in the tissue-mimicking gelatin–agar phantom as capable of observing temporal evolutions of cavitation bubble cloud with temporal resolution of several microseconds, lateral and axial resolution of 0.50 mm and 0.29 mm respectively. The dissolution process of cavitation bubble cloud and spatial distribution affected by cavitation previously generated were also investigated. Although the application is limited by the requirement for a gassy fluid (e.g. tap water, etc.) that allows replenishment of nuclei between HIFU exposures, the technique may be a useful tool in spatial–temporal cavitation mapping for HIFU with high precision and resolution, providing a reference for clinical therapy.     

微泡对高强度聚焦超声焦域影响的研究

微泡对高强度聚焦超声(HIFU)治疗具有增效作用,而HIFU治疗中不同声学条件下微泡对HIFU治疗焦域的影响尚不清楚。本文基于声传播方程、Yang-Church气泡运动方程、生物热传导方程、时域有限差分法(FDTD)、龙格-库塔(RK)法数值仿真研究输入功率、激励频率和气泡初始半径对HIFU在含气泡体模中形成焦域的影响,并利用含Sono Vue造影剂的仿组织体模研究进行实验验证。结果表明,增大输入功率、气泡初始半径和升高激励频率均可增大焦域,随着输入功率的增大,焦域形状可能发生变化,而随着激励频率升高和气泡初始半径的增大,焦域会向远离换能器的方向移动。