Monitoring and control of human liver cancer ablation using real-time, 3D echo decorrelation imaging

项目摘要/摘要 肝癌，包括肝细胞癌和转移性肿瘤，是一种主要的公共卫生问题 有问题。对于不能切除的肝癌患者，热消融，包括射频消融(RFA) 和微波消融(MWA)，是目前的临床护理标准；然而，热消融方法是 受限于不统一和不一致的治疗，导致不良副作用、局部癌症复发和 存活率下降，严重限制了它们的临床应用。 回声去相关成像是一种新的超声方法，它通过映射来缓解这些问题 热消融过程中组织加热引起的超声回声变化。关于回声的最新研究 去相关成像显示，这种方法可以可靠地预测兔体内消融诱导的细胞死亡。 和猪肝组织以及VX2肝癌。尽管回波去相关成像是一种非常 有希望的热消融监测和控制方法，将其转化为临床实践将需要 人肝癌消融的实时、3D消融监测和控制的有效性，包括不同的 肿瘤类型(肝癌和转移性)，以及正常和异常的人肝实质(例如，肝硬变) 肝脏)。我们这项研究的中心假设是通过3D回波去相关来实时监测和控制 成像将提高人肝肿瘤消融的可靠性。 为了验证这一假设，我们将实施3D，实时回声去相关成像使用临床 超声扫描仪和阵列式换能器，验证了三维回波去相关的应用 成像到RFA和MWA。射频消融将采用标准的临床方法进行控制消融。 电极和临床射频发生器，回声去相关作为治疗终点。 同时测试临床回声去相关成像在人的原发和转移癌中的表现 作为病变的肝组织，3D回波解相关图像将由打开过程中记录的回波数据形成 手术RFA和经皮MWA手术，并与随访对比MRI和CT进行比较 评估消融体积范围和局部复发的预测。用三维技术控制热烧蚀 回声去相关成像将首先在切除的人转移性肝癌标本中进行研究。 正常肝组织边缘和肝硬变人肝组织标本，以及活体猪肝标本。这个 这项研究随后将在回声去相关控制射频消融术的治疗和切除试验中达到高潮。 肝肿瘤患者，展示了回声去相关成像在改善临床中的直接应用 肿瘤消融。因此，本研究将为肝脏的有效预测和实时控制提供可行性 人肝癌及其伴发病变肝组织的肿瘤消融术。

Project Summary/Abstract Liver cancer, including hepatocellular carcinoma (HCC) as well as metastatic tumors, is a major public health problem. For patients with unresectable liver cancer, thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), is the current clinical standard of care; however, thermal ablation methods are limited by non-uniform and inconsistent treatment, leading to adverse side effects, local cancer recurrence, and decreased survival, severely limiting their clinical utility. Echo decorrelation imaging is a novel ultrasound approach that mitigates these problems by mapping ultrasound echo changes caused by tissue heating during thermal ablation. Research to date on echo decorrelation imaging has shown that this method reliably predicts ablation-induced cell death in vivo for rabbit and porcine liver tissue as well as VX2 liver cancer. Although echo decorrelation imaging is an extremely promising approach to thermal ablation monitoring and control, its translation to clinical practice will require validation of real-time, 3D ablation monitoring and control for human liver cancer ablation, including different tumor types (HCC and metastatic), as well as normal and abnormal human liver parenchyma (e.g., cirrhotic liver). Our central hypothesis for this study is that real-time monitoring and control by 3D echo decorrelation imaging will improve reliability of human liver tumor ablation. To test this hypothesis, we will implement 3D, real-time echo decorrelation imaging using a clinical ultrasound scanner and matrix array transducers, then validate the application of 3D echo decorrelation imaging to RFA and MWA. Methods for controlled ablation will be implemented for RFA using standard clinical electrodes and a clinical radiofrequency generator, with echo decorrelation serving as a treatment end point. To test the performance of clinical echo decorrelation imaging in human primary and metastatic cancer as well as diseased liver tissue, 3D echo decorrelation images will be formed from echo data recorded during open surgical RFA and percutaneous MWA procedures, then compared with follow-up contrast MRI and CT to assess prediction of ablated volume margins as well as local recurrence. Control of thermal ablation by 3D echo decorrelation imaging will first be studied in resected specimens of human metastatic liver cancer with normal liver tissue margins and specimens of cirrhotic human liver tissue, as well as in vivo swine liver. The study will then culminate in a treat-and-resect trial of echo decorrelation-controlled radiofrequency ablation in liver tumor patients, demonstrating the direct application of echo decorrelation imaging to improving clinical tumor ablation. This research will thus show feasibility for both effective prediction and real-time control of liver cancer ablation in human liver cancer and concomitant diseased liver tissue.