Moonen Chrit T W, Kilroy Joseph P, Klibanov Alexander L
From the Focused Ultrasound Foundation, Charlottesville, VA (C.T.W.M., J.P.K.); and Cardiovascular Division (Department of Medicine) and Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA (A.L.K.).
Invest Radiol. 2025 Mar 1;60(3):205-219. doi: 10.1097/RLI.0000000000001116. Epub 2024 Aug 21.
Invasive open surgery used to be compulsory to access tumor mass to perform excision or resection. Development of minimally invasive laparoscopic procedures followed, as well as catheter-based approaches, such as stenting, endovascular surgery, chemoembolization, brachytherapy, which minimize side effects and reduce the risks to patients. Completely noninvasive procedures bring further benefits in terms of reducing risk, procedure time, recovery time, potential of infection, or other side effects. Focusing ultrasound waves from the outside of the body specifically at the disease site has proven to be a safe noninvasive approach to localized ablative hyperthermia, mechanical ablation, and targeted drug delivery. Focused ultrasound as a medical intervention was proposed decades ago, but it only became feasible to plan, guide, monitor, and control the treatment procedures with advanced radiological imaging capabilities. The purpose of this review is to describe the imaging capabilities and approaches to perform these tasks, with the emphasis on magnetic resonance imaging and ultrasound. Some procedures already are in clinical practice, with more at the clinical trial stage. Imaging is fully integrated in the workflow and includes the following: (1) planning, with definition of the target regions and adjacent organs at risk; (2) real-time treatment monitoring via thermometry imaging, cavitation feedback, and motion control, to assure targeting and safety to adjacent normal tissues; and (3) evaluation of treatment efficacy, via assessment of ablation and physiological parameters, such as blood supply. This review also focuses on sonosensitive microparticles and nanoparticles, such as microbubbles injected in the bloodstream. They enable ultrasound energy deposition down to the microvascular level, induce vascular inflammation and shutdown, accelerate clot dissolution, and perform targeted drug delivery interventions, including focal gene delivery. Especially exciting is the ability to perform noninvasive drug delivery via opening of the blood-brain barrier at the desired areas within the brain. Overall, focused ultrasound under image guidance is rapidly developing, to become a choice noninvasive interventional radiology tool to treat disease and cure patients.
过去，为了切除肿瘤块，侵入性开放手术是必须进行的。随后出现了微创腹腔镜手术以及基于导管的治疗方法，如支架置入、血管内手术、化疗栓塞、近距离放射治疗，这些方法可将副作用降至最低并降低患者风险。完全无创的手术在降低风险、手术时间、恢复时间、感染可能性或其他副作用方面带来了更多益处。将体外的聚焦超声波专门作用于疾病部位已被证明是一种安全的无创方法，可用于局部消融热疗、机械消融和靶向药物递送。聚焦超声作为一种医学干预手段在数十年前就已被提出，但只有借助先进的放射成像能力，才能够对治疗过程进行规划、引导、监测和控制。本综述的目的是描述执行这些任务的成像能力和方法，重点是磁共振成像和超声。一些手术已经应用于临床实践，更多的仍处于临床试验阶段。成像完全融入工作流程，包括以下内容：（1）规划，确定目标区域和相邻的危险器官；（2）通过温度成像、空化反馈和运动控制进行实时治疗监测，以确保对相邻正常组织的靶向性和安全性；（3）通过评估消融和生理参数（如血液供应）来评估治疗效果。本综述还关注了对超声敏感的微颗粒和纳米颗粒，如注入血液中的微泡。它们能够将超声能量沉积至微血管水平，引发血管炎症和闭塞，加速血栓溶解，并进行靶向药物递送干预，包括局部基因递送。特别令人兴奋的是能够在大脑内的期望区域通过打开血脑屏障进行无创药物递送。总体而言，图像引导下的聚焦超声正在迅速发展，有望成为治疗疾病和治愈患者的首选无创介入放射学工具。
