Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, UK.
Ultrasound Med Biol. 2020 Dec;46(12):3317-3326. doi: 10.1016/j.ultrasmedbio.2020.08.021. Epub 2020 Sep 19.
Diagnostic ultrasound is the gold standard for obstetric scanning and one of the most important imaging techniques for perinatal and neonatal monitoring and diagnosis. Ultrasound provides detailed real-time anatomic information, including blood flow measurements and tissue elasticity. The latter is provided through various techniques including shear wave elastography (SWE). SWE is increasingly used in many areas of medicine, especially in detection and diagnosis of breast, thyroid and prostate cancers and liver disease. More recently, SWE has found application in gynaecology and obstetrics. This method mimics manual palpation, revealing the elastic properties of soft biological tissues. Despite its rising potential and expanding clinical interest in its use in obstetrics and gynaecology (such as for assessment of cervical ripening or organ development and structure during pregnancy), its effects on and potential risks to the developing fetus remain unknown. Risks should be evaluated by regulatory bodies before recommendations are made on the use of SWE. Because ultrasound is known to produce thermal and mechanical effects, this study measured the temperature increase caused by B-mode, pulse Doppler (PD) and SWE, using an instrumented phantom with 11 embedded thermocouples. Experiments were performed with an Aixplorer diagnostic ultrasound system (Supersonic Imagine, Aix-en-Provence, France). As expected, the greatest heating was detected by the thermocouple closest to the surface in contact with the transducer (2.9°C for SWE, 1.2°C for PD, 0.7°C for B-mode after 380-s excitation). Both conduction from the transducer face and direct heating owing to ultrasound waves contribute to temperature increase in the phantom with SWE associated with a larger temperature increase than PD and B-mode. This article offers a methodological approach and reference data for future safety studies, as well as initial recommendations about SWE safety in obstetrics and gynaecology.
诊断超声是产科扫描的金标准，也是围产儿和新生儿监测和诊断的最重要影像学技术之一。超声提供详细的实时解剖信息，包括血流测量和组织弹性。后者通过各种技术提供，包括剪切波弹性成像（SWE）。SWE 在许多医学领域得到越来越多的应用，特别是在乳腺癌、甲状腺癌和前列腺癌以及肝病的检测和诊断中。最近，SWE 在妇科和产科中得到了应用。该方法模拟手动触诊，揭示了软生物组织的弹性特性。尽管其潜力不断上升，并且在妇产科中使用其的临床兴趣不断扩大（例如评估宫颈成熟度或妊娠期间器官发育和结构），但其对发育中胎儿的影响及其潜在风险仍然未知。在对 SWE 的使用提出建议之前，监管机构应评估风险。由于已知超声会产生热和机械效应，因此本研究使用带有 11 个嵌入式热电偶的仪器化体模测量了 B 模式、脉冲多普勒（PD）和 SWE 引起的温升。实验在 Aixplorer 诊断超声系统（Supersonic Imagine，法国艾克斯普罗旺斯）上进行。正如预期的那样，最靠近与换能器接触的表面的热电偶检测到的加热最大（SWE 为 2.9°C，PD 为 1.2°C，B 模式为 380 秒激发后为 0.7°C）。换能器面的传导和超声波直接加热都导致了体模中的温度升高，SWE 与 PD 和 B 模式相比，温度升高更大。本文提供了一种方法学方法和参考数据，用于未来的安全性研究，以及妇产科中 SWE 安全性的初步建议。
