Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Germany.
Acad Radiol. 2018 Jan;25(1):88-94. doi: 10.1016/j.acra.2017.07.011. Epub 2017 Aug 23.
Several minimally invasive thermal techniques have been developed for the treatment of benign thyroid nodules. A new technique for this indication is high-intensity focused ultrasound (HIFU). The aim of this study was to assess effectiveness in varying preablative nodule volumes and whether outcome patterns that were reported during studies with other thermal ablative procedures for thyroid nodule ablation would also apply to HIFU.
Over the last 2 years, 19 nodules in 15 patients (12 women) whose average age was 58.7 years (36-80) were treated with HIFU in an ambulatory setting. Patients with more than one nodule were treated in multiple sessions on the same day. The mean nodule volume was 2.56 mL (range 0.13-7.67 mL). The therapeutic ultrasound probe (Echopulse THC900888-H) used in this series functions with a frequency of 3 MHz, reaching temperatures of approximately 80°C-90°C and delivering an energy ranging from 87.6 to 320.3 J per sonication. To assess the effectiveness of thermal ablation, nodular volume was measured at baseline and at 3-month follow-up. The end point of the study was the volume reduction assessment after 3 months' follow-up. Therapeutic success was defined as volume reduction of more than 50% compared to baseline. This study was retrospectively analyzed using the Wilcoxon signed rank test and Kendall tau.
The median percentage volume reduction of all 19 nodules after 3 months was 58%. An inverse correlation between preablative nodular volume and percentage volume shrinking was found (tau = -0.46, P < .05). Therapeutic success was achieved in 10 out of 19 patients (53%).
HIFU of benign thyroid nodules can be carried out as an alternative therapy for nodules ≤3 mL if patients are refusing surgery or radioiodine therapy.
已有多种微创热技术被开发出来用于治疗良性甲状腺结节。高强度聚焦超声（HIFU）是一种用于该适应证的新技术。本研究旨在评估不同消融前结节体积的有效性，以及其他甲状腺结节消融热消融术研究中报告的结局模式是否也适用于 HIFU。
在过去的 2 年中，15 名患者（12 名女性）的 19 个结节在日间治疗环境中接受了 HIFU 治疗。有多结节的患者在同一天接受多次治疗。平均结节体积为 2.56ml（范围 0.13-7.67ml）。本研究中使用的治疗超声探头（Echopulse THC900888-H）工作频率为 3MHz，可达到约 80°C-90°C 的温度，并能传递 87.6-320.3J 的能量。为评估热消融的有效性，在基线和 3 个月随访时测量结节体积。本研究的终点是 3 个月随访时的体积减少评估。治疗成功定义为与基线相比体积减少超过 50%。本研究采用 Wilcoxon 符号秩检验和 Kendall tau 进行回顾性分析。
所有 19 个结节在 3 个月时的中位数体积减少百分比为 58%。消融前结节体积与体积缩小百分比之间存在负相关（tau=-0.46，P<.05）。19 例患者中有 10 例（53%）达到治疗成功。
如果患者拒绝手术或放射性碘治疗，HIFU 可作为治疗最大直径≤3ml 良性甲状腺结节的替代疗法。
