超声造影Contrastenhanced ultrasound.docx
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超声造影Contrastenhancedultrasound
超声造影(Contrast-enhancedultrasound)
Preface
Reviewthehistoryofthedevelopmentofmedicalultrasound,weseethattheultrasoundrisein70s(real-timegrey-scaleultrasound)orBtypeultrasoundorgray-scaleultrasoundtomographytechnology,laidthefoundationofmodernultrasonicdiagnosis,pavingthewayfortheclinicalapplicationofultrasoundisverywide;colorDopplerimagingtechnologydevelopedinthe80s,themodernultrasonicimagingdiagnosisisverycharacteristicofnondestructiveexaminationandcardiovascularhemodynamicsandbloodflowofthebodyorgansandtissuestocreateanewfield;since90s,theemergenceofmanynewultrasoundtechnologyisoneofthemedicalultrasoundemergeinanendlessstream,themostinfluentialandcanfurtherimproveitsstatusinmodernimagingtechnology,thanultrasoundcontrastimaging.Thecontrast-enhancedultrasonography(contrastenhancedultrasound).Withthehelpofintravenouscontrastultrasoundandcontrastharmonicimagingtechnology,canclearlyshowthemicrobloodvesselsandtissueperfusion,increasetheimagecontrastresolution,greatlyimprovethesensitivityandspecificityofultrasounddetectedlesions.ThisisverysimilartotheenhancedCTscan.Nowadays,radiographynotonlyopensupthescopeofclinicalapplication,butalsoimprovesthediagnosticlevelofconventionalgreyscale/colorDopplerultrasonography,andhasagoodprospectintargetedtherapy.Inconclusion,CEUSisamajortechnologicalinnovationandresearchdirection,andisanewmilestoneinthedevelopmentofmedicalultrasound.
Theconceptofcontrast-enhancedultrasound
BarryB.Goldbergisapioneerintheresearchanddevelopmentofnewultrasoundcontrastagentsintheworld.Hehasshowngreatinterestintheresearchandapplicationofvariousultrasoundcontrastagents.Goldbergetalcomparedmicrobubblestoultrasoundcontrastagents(vascularcontrast,agents)orvascularenhancedultrasoundcontrastagents,whicharedifferentfromoralcontrastagents(oralagents)commonlyusedingastrointestinalimaging.Therefore,ultrasoundcontrasthas2kindsofangiographyagentsandoralorenemacontrastagents,andtheformerisalsocalledmicrobubblecontrastmedium.Forthepastmorethan10years,contrastenhancedultrasoundorvascularcontrastenhancedultrasoundhasbeenthemostrapidlydeveloped.Microbubbleultrasoundcontrastagentintheinitialresearchstage,thefirstgasismainlyusedforimagingofairandoxygen,then,istoCO2astherepresentativeofthemicrobubbleshellmembranecontrastagentintravenousinjectionandtranscatheterarterialinjectionofcontrast-enhancedultrasound.In90s,anewtypeofultrasoundcontrastagentcameintobeing.ThemembranecontrastagentcontainingmicrobubbleswasrepresentedbyLevovist(LiFa),AlbunexandEchvist,whichiscalledthefirstgenerationofnewcontrastagents.Sincethen,moreinertgascontainingSonoVue(SonoVue)andOptionsangiographyastherepresentativeoftheshellmembranetypeagent,alsoknownasthesecondgenerationofnewcontrastagent.Theaveragediameterofthenewcontrastmicrobubblesisabout3~5m,whichcansuccessfullypassthroughthepulmonarycirculation,andrealizethecontrastenhancementoftheleftventricle,themyocardium,andtheorgans,tissuesandlesionsofthewholebody.Thesafetyofmicrobubbleultrasoundcontrastagents:
alargenumberofexperimentalstudiesandmorethan10000casesofclinicalexperiencehaveprovedthatmicrobubblecontrastagentsaresafe.Accordingtoestimates,eachtimetheintravenousinjectionofultrasoundcontrastmicrobubblescontainingair/gasamountislessthan200L(0.2ml),anynodangerofairembolism;thecontrastagentlistedonlyinshellmembranewascomposedofacousticctose,thecontrastagentwithalbumin,phospholipidsorpolymer.Thatiseasyforhumanmetabolism,toxiceffectsonthehumanbodydoesnot.Therefore,itisanidealultrasoundcontrastagent.ThestudypointedoutthatthesecondgenerationofnewultrasoundcontrastagentwithhighmolecularweightandlowsolubilityandlowdispersionoffluorinecontaininginertgassuchasSF6,C3F8etc.,cansignificantlyextendthemicrobubblesinthehumanbodylife,increasethestabilityofmicrobubbles.
Principleofcontrast-enhancedultrasound
Studyofultrasoundcontrastagenthasexperiencedthreestages,namelythefirstgenerationofCO2freemicroshellmembranetypebubblecontrastagentastherepresentative,withAlbunexandLevovist(Levovist)astherepresentativeofthesecondgenerationofaircontainingmicrobubbleshellmembranemodelandcontrastagent,containinganinertgasmicrobubblecontrastagentssuchasSonoVue,Optison,Echogenetc..
Thebasicprincipleofthesecontrastagentsarebychangingthesoundattenuation,velocityandenhancedscattering,changethebasicroleofsonicandbetweenorganizations,namelytheabsorption,reflectionandrefraction,sothatthelocationoftheechosignalenhancement.Ultrasoundcontrastagentmicrobubblestoidealthroughsmalllung,heartandcapillarycirculation,sothattheperipheralintravenouscontrastcanbesimple,andcanstablymaintainitseffectinacousticimaging.Itisfoundthatlowsolubilityandlowdispersionofhighmoleculargas,suchasfluorinegas,canincreasethelifetimeofmicrobubblesinbloodandincreasestability.Withthedevelopmentofpolymerchemistry,someforeignscholarsusingbiodegradablepolymericmaterialstoreplacetheHumanAlbuminandothernaturalphospholipidsubstances,changingthecompositionofmicrobubbleshell,therebyavoidingtheproblemofacousticeffectcausedbythelimitationofthenatureofthematerialitselfisnotstable.Atpresentthedomesticandforeignresearchshowsthatpolymermicrobubbleultrasoundcontrastagentdevelopmentisthemostpromising,itcanchangethepolymerizationconditionstheacousticpropertiescanbedesignedfora"tailored"fortheimagingconditionofcontrastagent,maketheparticlesizedistributionismoreconcentrated,afterthesoundattenuationisweakandprolongedinvivotheremainingtimetobeusedindifferentphysiologicalandpathologicalconditionsandtargeteddrugdelivery.Withmicrobubblesespeciallyhalothanegasultrasoundcontrastagentwasdevelopedandusedinclinical,ultrasoundcontrastimagingtechnologyisinrapiddevelopment,fromthecolorDopplerimaging,intermittentharmonicgray-scaleultrasonography,contrast-enhancedultrasoundimagingqualityhasbeengreatlyimproved,theresolutionisobviouslyimproved,andgreatlyreducethetheartifacts,andcandisplayreal-timeperfusion.
Clinicalapplicationofcontrastenhancedultrasound
Thedevelopmentofultrasoundcontrastagentsandcontrast-enhancedultrasoundhaspromotedtheapplicationofcontrast-enhancedultrasoundinclinicaldiagnosisandtreatment.
1.contrastechocardiography(contrast,echocar-diography):
itisreportedthatroutineechocardiographyresultsintechnicaldifficultiesinsome10%to20%ofpatients.Microbubblecontrastechocardiographyisausefulmethodforimprovingendocardialfindingsandmakingcardiacfunctionmoreaccurate.Inaddition,itcanvisuallydisplaymyocardialperfusionandimprovethequantitativedeterminationofmyocardialviability,whichcanbesuccessfullyusedtodeterminemyocardialischemiaandnecrosis.
Theroomofultrasonographyinthediagnosisofseptaldefectsensitivitywas97%,higherthanthesamegroupofpatientswithcardiaccatheterizationsensitivity.Itcanalsobeusedforthediagnosisofprimarypulmonaryhypertension,
2.liverharmoniccontrastenhancedultrasonography:
Theeffectofliverultrasoundcontrast:
1.,improvethedetectionrateof2.,locationandqualitativechangesofthelesions,3.curativeeffectjudgment,4.portalveinbloodflowstudy.Contrastobservationcontents:
1.enhancedmode:
theoverallenhancedperipheralenhancedcentralenhanced(radial)enhanced2..Distributionafterthepeak:
homogeneous,cyclic,homogeneousenhancementofthe3.phase:
accordingtotheCTstagingcanbedividedintoarterialportalvenousphasedelay0-40S41-120S121-200S4.enhancedcontinuouslythetime.
Alargenumberofstudieshaveconfirmedthatharmonicultrasoundisthemostsuccessfulclinicalapplicationintheliver,andhasmadeabreakthroughintheapplicationoflivertumors,andcanbecomparedwithCTangiography.Firstofall,thesensitivityofsmalltumorswasimprovedsignificantly,especiallyfortumorslessthan1cm.Secondly,thespecificitywasenhancedsignificantly.
(1)livertumorsorlesionsofbenignandmalignantdifferentiation,includinghepatocellularcarcinoma(HCCandmetastasis),hemangioma,adenomaandfocalnodularhyperplasia(FNH)withnon-uniformdistributionoffattyliverandotheridentification;
(2)livercancerpreoperativeroutineliverultrasound,andfurtherdeterminethesizeandscopeofinvasiontumormetastasis,therearenosmallhiddenintrahepaticormultifocaltumors;(3)applicationinthediagnosisoflivertumors:
interventionalultrasoundcontrasthelpssmalltumorofliverinsuspiciousespeciallynodulebiopsypunctureecho;(4)theapplicationofinterventionaltherapyliverneoplasms:
inhepaticarteryembolizationchemotherapyaftercontrast-enhancedultrasound,butalsointheRF,microwaveablation,HIFUimmediatelyaftertreatmentofbedsideultrasoundangiography,determinetheablationeffectandthereisnoresidualtumortissue,todeterminefurthertreatment,improvethecurativeeffect.
Forwithoutfurthertreatmentinpatientswithlong-termfollow-up;(5)theapplicationofcontrast-enhancedultrasoundinlivercanceroperation:
itisreportedthatintraoperative