超声在MRgFUS治疗子宫肌瘤中运用价值

目的:探讨超声在MRgFUS治疗子宫肌瘤中运用价值。方法:对56例子宫肌瘤患者,在MRgFUS治疗前及治疗后进行常规超声及超声造影检查,常规超声记录肌瘤数目、位置、大小、内部回声,CDFI血供情况,超声造影记录肌瘤的增强强度及无灌注造影体积。结果:56例子宫肌瘤患者中,常规超声共显示72个瘤体,CDFI显示有51个瘤体为0级血供(完全消融),16个瘤体为I级血供(大部分消融),5个瘤体为II级血供(部分消融)。CEUS显示37个消融率≥80%(完全消融), 22个消融率60%~80%(大部分消融),13个消融率<60%(部分消融)。CEUS与常规超声CDFI在评估子宫肌瘤的消融情况,两者比较,差异有统计学意义(P<0.05)。结论:超声在MRgFUS治疗子宫肌瘤中可一站式管理运用,全程动态监测肌瘤变化,为临床提供数据,及时调整诊疗方案。

Magnetic resonance-guided focused ultrasound for essential tremor:a prospective,single center,single-arm study

The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.

磁共振引导超声聚焦MRgFUS治疗子宫肌瘤的疗效和安全性

分析MRgFUS治疗患者(子宫肌瘤)的疗效和安全性。方法:选取本院2020年3月-11月期间收治的患者(子宫肌瘤)39例进行研究,患者均选择相同的治疗方式(MRgFUS),随后实施子宫肌瘤增强MRI扫描,对肌瘤NPV(无灌注体积)、完整性、安全性进行评价。结果:手术100%成功,治疗后当天患者的NPV百分比为术前SSS为(28.67±9.56),使用MRgFUS技术治疗6个月后SSS为(8.43±7.15),降幅为(20.34%),NPV百分比平均62.83%(23%-98%),1例患者(2.56%)在手术后出现不良反应(下腹部持续疼痛),其他患者均没有不良反应的出现,术后1d 和随访结束(术后6个月)差异显著(p<0.05).结论:临床中对子宫肌瘤患者使用MRgFUS技术进行治疗,实现了在门诊就能完成治疗,在手术过程中患者不会使用强效麻醉药物,不需要通过射线照射,术后只需要观察半个小时左右的时间即可,患者不用住院,没有各种饮食禁忌,术后第二天就能正常的工作和生活。和传统手术、腹腔镜等治疗方式相对比,MRgFUS技术的安全性更高、并发症更少、创伤更小、近期疗效更佳。

Magnetic resonance imaging-guided focused ultrasound thalamotomy launch with remote telemedicine international proctorship

Background: COVID-19 limitations have hindered the implementation of new technologies by preventing proctors from coming to the site.We share our first experience of magnetic resonance imaging(MRI)-guided focused ultrasound(MRgFUS)treatment with an international remote online proctorship,and develop and evaluate the methodology of remote MRgFUS proctorship.Methods: This single-center,nonrandomized controlled prospective study included 94 patients:27 with essential tremor(ET)and 67 with tremor-dominant Parkinson's disease(PD).The coming of proctors was impossible,so we arranged for the remote participation of proctors from the United Kingdom,Spain,and Israel.A total of 38 patients(40.4%)received telemedicine-proctored treatment(proctor group)and 56 received their treatment independently(solo group).We used the Clinical Rating Scale for Tremor(CRST)for ET patients and the Unified Parkinson's Disease Rating Scale(UPDRS)Part III for PD patients.Results: In patients with ET,success rates were 81.8%(proctor group)and 100%(solo group)(p=0.22).CRST reduction on the treated side was 71.43%[65.83%;80.56%](proctor group)versus 60.87%[53.99;79.58](solo group)(p=0.19).None of the patients showed worsening of tremors within 1 year.In patients with PD,the success rates were 92.6%(proctor group)and 100%(solo group)(p=0.08).The UPDRS Part III improvement was 30.1%(proctor group)versus 39.9%(solo group)(p=0.003).The 1-year recurrence rate was 40%(proctor group)and 17.5%(solo group)(p=0.04).No complications were observed at 6 months.Conclusions: We developed a feasible and safe methodology for telemedicine remote online-proctored MRgFUS treatment.No significant difference was observed between the solo and developed remote proctor protocols in terms of complication rate,effect,and long-term results;however,UPDRS Part III improvement was better in the PD solo group.This study demonstrated that the MRgFUS international proctorship can be performed successfully remotely.

Universal Software Architecture of Magnetic Resonance-Guided Focused Ultrasound Surgery System and Experimental Study

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is an emerging, non-invasive hyperthermia technology which can be used for the treatment of benign and malignant tumours, in conjunction with intracranial neurological diseases. To treat different indications, it is often necessary to design special focused ultrasound devices and treatment plans, which poses great challenges and results in substantial costs during software development. This article introduces a general software architecture that can be applied to three different focused ultrasound devices for the treatment of uterine fibroids, breast fibroids, and pain palliation of bone metastases, respectively, and can be integrated with GE Discovery or Signa MRI scanners and Xingaoyi BroadScan MRI scanners. Finally, the proposed software architecture was shown to possess desirable universality and safety through various tests and animal experimental studies.

Evaluation Value of Intravoxel Incoherent Motion Diffusion-Weighted Imaging on Early Efficacy of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation for Uterine Adenomyoma

To investigate the evaluation value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)on the early efficacy of magnetic resonance-guided high-intensity focused ultrasound(MRgFUS)ablation for uterine adenomyoma.The clinical and magnetic resonance imaging(MRI)data of 36 patients with uterine adenomyoma before and after MRgFUS treatment in our hospital from January 2018 to December 2018 were retrospectively analyzed.All the 36 patients underwent MRI examination one day before operation and immediately after operation using GE Discovery MR7503.0T MRI,including conventional sequences(T1WI,T2WI,and T2 fat suppression sequences)plain scan,IVIM-DWI sequences with 9 b values,and contrast enhanced-MRI sequences.The IVIM-DWI quantitative parameters(true diffusion coefficient D,perfusion related diffusion coefficient D*,and perfusion fraction f)of double-exponential model were obtained by using GE ADW 4.7 functool,a postprocessor.SPSS 24.0 software was used to analyze the difference in parameter between the ablation and non-ablation areas of uterine adenomyoma.DWI signal in the ablation area of uterine adenomyoma was increased,and manifested as heterogeneous diffuse high signal,with low central signal and high edge signal.Values of D,D*and f in the ablation area of uterine adenomyoma were significantly lower than those in the non-ablation area,and there was statistical difference between the two(P<0.05).The areas under receiver operating characteristic(ROC)curve of D,D*and f values in the ablation area of uterine adenomyoma were 0.854,0.898 and 0.924,respectively;the optimal thresholds for the diagnosis of ablation area of uterine adenomyoma were 0.81×10−3 mm2/s,4.99×10−3 mm2/s and 0.24,respectively;the diagnostic sensitivity was 80.6%,72.2%and 94.4%,respectively;and the specificity was 91.7%,97.2%and 94.4%,respectively.IVIM-DWI has a certain clinical value in the evaluation on early efficacy of MRgFUS ablation of uterine adenomyosis.