MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery.
MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery.
复制标题
DOI：
10.1016/j.mric.2005.04.008
复制
发表时间：
2005-08-01
影响因子：
1.6
通讯作者：
Tempany, Clare
中科院分区：
文献类型：
--
作者：
Jolesz, Ferenc A;Hynynen, Kullervo;Tempany, Clare
MR引导FUS的历史表明需要将先进的治疗技术与先进的成像技术相结合。没有MR成像定位肿瘤边缘的能力，并且没有提供能量沉积的闭环控制的温度敏感成像，这种方法对于大多数临床应用是不充分的。鉴于这些局限性，高强度聚焦超声最初似乎具有狭窄的应用领域，并且无法与其他手术或消融方法竞争。如今，MR成像引导的FUS已成为执行探头递送热消融和微创手术的安全有效的手段。此外，它有可能取代使用电离辐射的治疗，如放射外科和近距离放射治疗。尽管将“高价”MR成像系统与复杂且昂贵的相控阵相结合的成本很高，但通过消除住院和麻醉以及减少并发症，这一支出将在很大程度上被抵消。实际上，对这一新兴技术的投资最终将有利于医疗保健提供系统，最重要的是，有利于患者。FUS系统为不需要侵入性方法的良性肿瘤（例如子宫肌瘤和乳腺纤维腺瘤）提供了一种安全、可重复的治疗方法。MR引导的FUS也可用于癌组织的减积。它已经作为乳腺癌治疗进行了测试;其在脑，肝和前列腺中的其他恶性肿瘤的应用正在开发中。MR引导的FUS提供了传统手术的一种有吸引力的替代方案，因为它结合了术中MR成像，这提供了比外科医生直接可视化病变更精确的目标定义。MR引导FUS无疑是当今图像引导治疗领域中最有前途的介入性MR成像方法。它不仅适用于肿瘤的热凝固治疗，也适用于侵入性手术或放射可能不是治疗选择的其他几种医疗情况。使用FUS治疗血管畸形或脑功能障碍也令人兴奋。它独特地适用于使用靶向药物递送方法和基因治疗的图像引导治疗。这项技术的进一步发展无疑将改善能量沉积并减少治疗时间。在不久的将来，FUS将为传统手术和放射治疗提供一种可行的替代方案;从长远来看，它还可以实现一系列有针对性的治疗方法，旨在根除或阻止迄今为止难以治愈的疾病，如某些脑恶性肿瘤和癫痫。
The history of MR-guided FUS demonstrates the need for merging advanced therapy technology with advanced imaging. Without the ability of MR imaging to localize the tumor margins and without the temperature-sensitive imaging that provides the closed-loop control of energy deposition, this method is inadequate for most clinical applications. Given these limitations,high-intensity focused ultrasound initially appeared to have a narrow application area and was not able to compete with other surgical or ablation methods. Today, MR imaging-guided FUS has become a safe and effective means of performing probe-delivered thermal ablations and minimally invasive surgery. Moreover, it has the potential to replace treatments that use ionizing radiation such as radiosurgery and brachytherapy. Although the cost of integrating"big ticket" MR imaging systems with complex and expensive phased arrays is high, this expenditure will largely be offset by eliminating hospitalization and anesthesia and by reducing complications. In effect, an investment in this emerging technology will ultimately redound to the benefit of the health care delivery system and, most important, to the patient. The FUS system provides a safe, repeatable treatment approach for benign tumors (eg, uterine fibroid and breast fibroadenoma) that do not require an aggressive approach. MR-guided FUS can also be used for debulking cancerous tissue. It has already been tested as a breast cancer treatment; its application for other malignancies in the brain, liver, and prostate is under development. MR-guided FUS offers an attractive alternative to conventional surgery because it incorporates intraoperative MR imaging, which provides far more precise target definition than is possible with the surgeon's direct visualization of the lesion. MR-guided FUS is undeniably the most promising interventional MR imaging method in the field of image-guided therapy today. It is applicable not only in the thermal coagulative treatment of tumors but also in several other medical situations for which invasive surgery or radiation may not be treatment options. The use of FUS for treating vascular malformation or functional disorders of the brain is also exciting. It is uniquely applicable for image-guided therapy using targeted drug delivery methods and gene therapy. Further advances in this technology will no doubt improve energy deposition and reduce treatment times. In the near future, FUS will offer a viable alternative to conventional surgery and radiation therapy; in the longer-term, it may also enable a host of targeted treatment methods aimed at eradicating or arresting heretofore intractable diseases such as certain brain malignancies and forms of epilepsy.