Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia.
Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia.
复制标题
用于磁共振引导良性前列腺增生超声消融的施药器。
DOI：
10.1097/rli.0b013e31827fe91e
复制
发表时间：
2013
影响因子：
6.7
通讯作者：
Diederich,Chris
中科院分区：
文献类型：
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作者：
Sommer,Graham;Pauly,KimButts;Holbrook,Andrew;Plata,Juan;Daniel,Bruce;Bouley,Donna;Gill,Harcharan;Prakash,Punit;Salgaonkar,Vasant;Jones,Peter;Diederich,Chris
本研究的目的是在磁共振成像（MRI）引导下，包括磁共振热成像（MRTI）引导下，在犬模型中评估设计用于在体消融人类良性前列腺增生（BPH）的施源器，确定MRI技术可视化前列腺消融变化的能力，并评估在这些研究中切除的前列腺组织的急性和长期组织学表现。使用包含具有双120扇区的管状换能器阵列的兼容的经尿道装置在体内消融犬前列腺组织，其区域类似于人BPH的区域（扩大的过渡区域）。磁共振热成像用于监测消融在3-T环境中，消融后MRI进行，以确定消融区域的可见性。在急性研究中消融了3只犬的前列腺，在消融后31天处死前对2只动物进行了重新扫描。急性和慢性外观的消融前列腺组织进行了组织学评价，并与MRTI和postablation MRI scanns.ResultsIt是可能的消融区域类似的大小，以扩大过渡区在人类前列腺增生症在6至18分钟。急性消融区域显示中心“热固定”区域被更明显的坏死区域包围，组织结构完全破坏。31天后，消融区域表现出消融组织的完全明显吸收，形成含有液体的囊性区域。固有的冷却的尿道使用该技术导致在所有cases.ConclusionsProstatic消融区域的大小和形状对应于人类BPH是可能的，使用适当的经尿道喷头使用MRTI，消融的组织可以清楚地描绘在对比增强的磁共振图像。准确监测前列腺组织加热的能力，消融区域在1个月内的明显吸收，以及固有的尿道保存表明，所描述的磁共振引导技术非常有希望用于有症状的人类BPH的体内消融。
ObjectivesThe aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.Materials and MethodsAn MRI-compatible transurethral device incorporating a tubular transducer array with dual 120 sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.ResultsIt was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central “heat-fixed” region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.ConclusionsProstatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance–guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.