采用组织破碎超声消融技术的影像引导非侵入式超声肝脏消融:活体猪模型中的可行性研究。

Image-guided non-invasive ultrasound liver ablation using histotripsy: feasibility study in an in vivo porcine model.

机构信息

Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.

出版信息

Ultrasound Med Biol. 2013 Aug;39(8):1398-409. doi: 10.1016/j.ultrasmedbio.2013.02.005. Epub 2013 May 15.

Abstract

Hepatocellular carcinoma (HCC), or liver cancer, is one of the fastest growing cancers in the United States. Current liver ablation methods are thermal based and share limitations resulting from the heat sink effect of blood flow through the highly vascular liver. In this study, we explore the feasibility of using histotripsy for non-invasive liver ablation in the treatment of liver cancer. Histotripsy is a non-thermal ablation method that fractionates soft tissue through the control of acoustic cavitation. Twelve histotripsy lesions ∼1 cm(3) were created in the livers of six pigs through an intact abdomen and chest in vivo. Histotripsy pulses of 10 cycles, 500-Hz pulse repetition frequency (PRF), and 14- to 17-MPa estimated in situ peak negative pressure were applied to the liver using a 1-MHz therapy transducer. Treatments were performed through 4-6 cm of overlying tissue, with 30%-50% of the ultrasound pathway covered by the rib cage. Complete fractionation of liver parenchyma was observed, with sharp boundaries after 16.7-min treatments. In addition, two larger volumes of 18 and 60 cm(3) were generated within 60 min in two additional pigs. As major vessels and gallbladder have higher mechanical strength and are more resistant to histotripsy, these remained intact while the liver surrounding these structures was completely fractionated. This work shows that histotripsy is capable of non-invasively fractionating liver tissue while preserving critical anatomic structures within the liver. Results suggest histotripsy has potential for the non-invasive ablation of liver tumors.

摘要

肝细胞癌(HCC),又称肝癌,是美国发病率增长最快的癌症之一。目前的肝脏消融方法是基于热的方法,由于血流通过高度血管化的肝脏而产生的热沉效应,这些方法存在局限性。在这项研究中,我们探索了使用组织微爆破进行非侵入性肝脏消融治疗肝癌的可行性。组织微爆破是一种通过控制声空化使软组织碎裂的非热消融方法。通过完整的腹部和胸部,在六头猪的肝脏中创建了 12 个约 1cm3 的组织微爆破病变。使用 1MHz 治疗换能器,将 10 个周期、500Hz 脉冲重复频率(PRF)和 14-17MPa 的估计原位峰负压力的组织微爆破脉冲施加到肝脏上。治疗通过 4-6cm 的上层组织进行,肋骨笼覆盖了 30%-50%的超声通路。观察到肝实质完全碎裂,治疗 16.7 分钟后边界清晰。此外,在另外两头猪中,在 60 分钟内生成了两个更大体积的 18 和 60cm3。由于大血管和胆囊具有更高的机械强度,并且更能抵抗组织微爆破,因此这些结构保持完整,而周围的肝组织完全碎裂。这项工作表明,组织微爆破能够非侵入性地碎裂肝组织,同时保留肝脏内的关键解剖结构。结果表明,组织微爆破具有用于非侵入性消融肝脏肿瘤的潜力。

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