van Breugel Johanna M M, Nijenhuis Robbert J, Ries Mario G, Toorop Raechel J, Vonken Evert-Jan P A, Wijlemans Joost W, van den Bosch Maurice A A J
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
J Ther Ultrasound. 2015 Dec 30;3:23. doi: 10.1186/s40349-015-0042-7. eCollection 2015.
Therapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.
Volumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62-80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.
Radiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.
In conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.
有症状的血管畸形的首选治疗方法包括手术、硬化疗法或栓塞术。然而，这些技术具有侵入性，可能会引发并发症，且需要住院治疗。我们介绍一种新型非侵入性技术，即磁共振引导高强度聚焦超声（MR-HIFU）消融术，用于治疗一名患者的血管畸形。该技术通过皮肤将高强度声波作用于身体，完全无创。MRI引导是HIFU治疗的新特点，用于精确描绘和定位病变，并在组织消融过程中进行准确的实时温度监测。MR-HIFU是治疗子宫肌瘤的成熟方法，目前正在对骨肿瘤、乳腺癌、前列腺癌和肝癌等进行研究。血管畸形的MR-HIFU治疗尚未成为研究课题。
对一名18岁男性患者下肢的血管畸形进行了容积性MR-HIFU消融。使用200W的功率，在4×4×8mm的声束范围内对目标病变进行超声处理，使病变部位温度达到62 - 80°C，持续时间小于20秒。在1个月的随访中，患者报告疼痛持续减轻，运动功能正常。3个月的随访成像显示病灶成功破坏，肿瘤体积缩小超过30%。13个月后，在剧烈运动数小时后疼痛评分降至<2，日常活动时疼痛评分为0。
射频消融和冷冻消融是微创技术，已用于低流量血管畸形的治疗，但结果不一致。此外，这两种技术都需要插入探头，存在伤口感染和住院的风险。由于MR-HIFU是真正无创的，这些风险可忽略不计。
总之，我们首次报告了在临床患者中使用MR-HIFU成功无创治疗血管畸形的案例，包括长期随访数据。患者报告治疗后长达13个月疼痛持续减轻。
