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

项目总结/摘要 肝癌，包括肝细胞癌（HCC）以及转移性肿瘤，是主要的公共卫生问题， 问题.对于不可切除的肝癌患者，热消融，包括射频消融（RFA） 和微波消融（MWA）是当前的临床护理标准;然而， 受不统一和不一致治疗的限制，导致不良副作用，局部癌症复发，以及 存活率降低，严重限制了它们的临床应用。 回波去相关成像是一种新的超声方法，通过映射来缓解这些问题 在热消融期间由组织加热引起的超声回波变化。关于echo的研究 去相关成像表明，该方法可靠地预测了兔体内消融诱导的细胞死亡 和猪肝组织以及VX 2肝癌。虽然回波去相关成像是一种非常复杂的方法， 有前途的方法，热消融监测和控制，其翻译到临床实践将需要 验证用于人类肝癌消融的实时3D消融监测和控制，包括不同的 肿瘤类型（HCC和转移性），以及正常和异常的人肝实质（例如，肝硬化 肝脏）。本研究的中心假设是，通过3D回波去相关进行实时监测和控制 成像将提高人类肝肿瘤消融的可靠性。 为了检验这一假设，我们将使用临床超声心动图实现3D实时回波去相关成像。 超声扫描仪和矩阵阵列换能器，然后验证3D回波去相关的应用 RFA和MWA成像。将使用标准临床消融方法对RFA实施受控消融 电极和临床射频发生器，回波去相关作为治疗终点。 测试临床回波去相关成像在人类原发性和转移性癌症中的性能 作为患病的肝组织，3D回波去相关图像将从开放期间记录的回波数据形成， 手术RFA和经皮MWA手术，然后与随访对比MRI和CT进行比较， 评估消融体积边缘和局部复发的预测。通过3D控制热消融 回波去相关成像将首先在人类转移性肝癌的切除标本中进行研究， 正常肝组织边缘和肝硬化人肝组织标本以及体内猪肝。的 这项研究将最终导致一项回声去相关控制射频消融术的治疗和切除试验， 肝肿瘤患者，展示了回波去相关成像的直接应用，以提高临床 肿瘤消融因此，本研究将显示有效预测和实时控制肝脏的可行性 在人肝癌和伴随的患病肝组织中的癌症消融。

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.