Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: results in gel phantoms.
Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: results in gel phantoms.
复制标题
使用 MRI 控制的经尿道超声治疗凝固人类前列腺体积：产生凝胶体模。
DOI：
10.1118/1.4730288
复制
发表时间：
2012
期刊：
影响因子：
3.8
通讯作者：
Chopra,Rajiv
中科院分区：
文献类型：
--
作者：
N'djin,WilliamApoutou;Burtnyk,Mathieu;Kobelevskiy,Ilya;Hadjis,Stefan;Bronskill,Michael;Chopra,Rajiv
目的最近在一项初步的人体研究中证实了磁共振成像（MRI）控制的经尿道超声治疗的可行性和安全性，在该研究中，在根治性前列腺切除术前治疗了一小部分前列腺组织。然而，将该技术转化为完全的临床应用需要在高达前列腺本身的体积中产生热凝固的能力。本研究的目的是调查所需的参数，以治疗一个完整的3D人类前列腺准确地与多元素经尿道喷头和多平面MR temperature control.MethodsThe方法是一个模拟（选择适当的参数），然后在组织模拟phanomaly实验确认相结合。使用从初步人体可行性研究中获得的6个人体前列腺模型（平均体积：36 cm 3）评价了10通道、MRI兼容的经尿道超声治疗系统。使用3 T下的真实的实时多平面MR温度测量来同时控制多达9个平面中的空间加热模式。治疗策略包括单频率（4.6或8.1 MHz）和双频率（4.6和14.4 MHz），以及10或20 W cm-2的最大声表面功率。将功率从10 W cm− 2增加到20 W cm− 2可将治疗时间缩短约50%，在1.8 ± 0.4 cm 3 min −1的凝固速率下，完成治疗需要26 ± 3 min。双频4.6/14.4 MHz治疗策略被证明是实现完整人类前列腺治疗的最有效配置，同时在小治疗半径下保持良好的治疗精度。双频方法减少了过度治疗接近前列腺底部和顶点，确认simulation.ConclusionsThis研究加强了MRI控制的经尿道超声治疗的能力，以治疗全前列腺体积在较短的治疗时间内具有良好的空间定位精度，并提供了关键参数，为下一个临床试验所需。
PurposeThe feasibility and safety of magnetic resonance imaging (MRI)‐controlled transurethral ultrasound therapy were demonstrated recently in a preliminary human study in which a small subvolume of prostate tissue was treated prior to radical prostatectomy. Translation of this technology to full clinical use, however, requires the capability to generate thermal coagulation in a volume up to that of the prostate gland itself. The aim of this study was to investigate the parameters required to treat a full 3D human prostate accurately with a multi‐element transurethral applicator and multiplanar MR temperature control.MethodsThe approach was a combination of simulations (to select appropriate parameters) followed by experimental confirmation in tissue‐mimicking phantoms. A ten‐channel, MRI‐compatible transurethral ultrasound therapy system was evaluated using six human prostate models (average volume: 36 cm3) obtained from the preliminary human feasibility study. Real‐time multiplanar MR thermometry at 3 T was used to control the spatial heating pattern in up to nine planes simultaneously. Treatment strategies incorporated both single (4.6 or 8.1 MHz) and dual (4.6 and 14.4 MHz) frequencies, as well as maximum acoustic surface powers of 10 or 20 W cm−2.ResultsTreatments at 4.6 MHz were capable of coagulating a volume equivalent to 97% of the prostate. Increasing power from 10 to 20 W cm−2reduced treatment times by approximately 50% with full treatments taking 26 ± 3 min at a coagulation rate of 1.8 ± 0.4 cm3min−1. A dual‐frequency 4.6/14.4 MHz treatment strategy was shown to be the most effective configuration for achieving full human prostate treatment while maintaining good treatment accuracy for small treatment radii. The dual‐frequency approach reduced overtreatment close to the prostate base and apex, confirming the simulations.ConclusionsThis study reinforces the capability of MRI‐controlled transurethral ultrasound therapy to treat full prostate volumes in a short treatment time with good spatial targeting accuracy and provides key parameters necessary for the next clinical trial.