CN101500502B - 用于对射频组织消融进行最佳超声成像的基于图像的功率反馈 - Google Patents
用于对射频组织消融进行最佳超声成像的基于图像的功率反馈 Download PDFInfo
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Abstract
提供了用于监控和调节射频(RF)消融疗法以提高超声成像的质量的方法和系统。由实时超声成像提供反馈,并且响应于反馈信号改变RF功率以提高图像质量。
Description
本发明的技术领域是提供一种方法和系统,用于通过提供来自实时成像和控制RF功率的反馈,而对射频(RF)消融期间的超声图像进行优化。
RF消融是一种通常用于在治疗诸如肝转移或肝细胞癌的不同种类癌中破坏肿瘤的临床治疗程序。RF消融是一种有前途的对不能接受切除手术的癌症患者进行治疗的程序。RF消融的临床目的是用热的方式消融癌组织,而不伤害健康实质以确保治疗的副作用最小化。
RF消融是微创程序,其需要由外部介入成像模态进行导引和监控。当前,最常用于导引和监控RF消融的成像模态是超声和计算机断层摄影。由于超声扫描提供实时图像,几乎没有有害的辐射并且成本相对适中,因此该技术对于导引和监控介入程序而言具有大量现有和未使用的前途。超声的优点包括其的实时能力和成本因素,然而由于在RF治疗期间由加热强度产生的空化效应带来的负面影响,因此可能降低了超声图像质量。
在RF消融治疗期间,体温局部不同水平地增加以引起靶区的坏死,即细胞或组织死亡。通常经皮,将RF探针插入靶组织。通过在探针尖端产生的RF电流通路处的介电损耗产生热量。在加热期间,围绕探针尖端的组织的温度可能达到沸点(接近90-100℃),这引起空化效应,即,形成气泡囊。气泡的存在影响将成像声波通过介质的传播,并且破坏超声图像质量。当存在气泡时,对程序进行超声监控的有效性将易于被气囊远处信号的“阴影”或损失而降低。而且,气泡的产生还可以修改治疗自身的结果,因为空气是良好的绝缘体,因此可以防止组织内的热量扩散。因此,需要防止气泡形成,以改进RF消融程序在超声扫描器上的显像。
因此,本发明的目的是通过控制RF功率以最小化气泡形成而最优化超声图像,同时最大化RF消融疗法的功效。使用超声成像系统提供的超声数据作为反馈参数,RF消融治疗期间产生的RF功率得以限制,以便避免热量引起的空化效应。
本文提供的本发明的特征化实施例是一种用于监控和调节射频(RF)消融疗法以提高成像质量的方法,该方法包括:使用超声成像系统对靶区进行成像以提供治疗前图像用于校准,并且保持持续实时采集至少一幅附加图像;将RF探针插入靶区并且产生RF电流以加热RF探针尖端附近的靶区,并且根据持续实时采集而产生至少一幅手术中图像;以及比较治疗前图像和手术中图像以产生反馈信号,其中,将该反馈信号传送至RF功率发生器,并且响应于反馈信号改变RF功率,以提高手术中图像的质量。
在相关实施例中,该方法包括进一步响应于确定靶区中存在至少一个气泡的指数而比较治疗前图像和手术中图像。所述指数是从指示是否存在气泡的超声图像导出的。由于气泡通常表现为高回声囊,因此可以通过对若干超声特征进行检查做出决定。例如,反馈信号包括声学特征的变化。在相关实施例中,声学特征是下列中的至少一个:回声的变化、双重成像(duplex imaging)中多普勒谱的变化和非线性检测方案。此外,非线性检测方案包括谐波信号和/或次谐波信号。
在另一相关实施例中,比较治疗前图像和手术中图像还包括获得热电偶读数或阻抗读数。
本文提供的本发明的另一特征化实施例是一种系统,其包括:超声扫描器,所述超声扫描器采集靶区的治疗前图像用于校准,以及靶区的至少一幅附加图像;射频(RF)探针,使RF探针插入靶区;RF功率发生器;以及气泡检测器,使气泡检测器指示靶区中是否存在至少一个气泡并产生反馈信号,并且使得响应于该反馈信号而改变RF功率发生器。
在相关实施例中,气泡检测器还比较治疗前图像和至少一幅手术中图像。在替代实施例中,气泡检测器包括下列中至少之一:无源空化检测器、扩音器和听诊器。例如,气泡检测器确定回声的变化、双重成像中多普勒谱的变化和非线性检测方案。此外,非线性检测方案包括谐波信号和/或次谐波信号。
在相关实施例中,检测靶区中存在至少一个气泡启动闭环反馈系统中的至少一个事件。例如,该事件包括改变RF功率。例如,改变RF功率包括改变施加于RF探针的至少一个尖端的功率。此外,该事件包括RF功率发生器信号的暂时消失。
在替代或附加实施例中,通知用户检测到靶区中存在至少一个气泡,并且用户启动开环反馈系统中的至少一个事件。例如,该事件包括改变RF功率。此外,改变RF功率包括改变施加于RF探针的至少一个尖端的功率。此外,该事件包括RF功率发生器信号的暂时消失。
图1是示出了超声扫描器、RF探针或电极和RF功率发生器的图,其中超声扫描器向RF功率发生器提供反馈控制;
图2是示出了使用从超声信号接收到的反馈而调整RF功率的流程图。
用于对RF消融疗法进行介入导引的超声成像具有多种应用,其包括超声心动描记术、腹部和胸部成像以及肿瘤消融。图1中示出本发明的一个实施例。使用诸如超声扫描器或超声探针的超声成像系统以获得诸如器官、组织或肿瘤的靶区的超声图像。将由RF功率发生器提供动力的RF探针插入靶区。使用获自超声成像系统的超声图像可以导引RF探针的定位。超声成像系统还作为反馈控制机构,以将反馈信号传送至RF功率发生器,进而允许在开始形成气泡时减少或关闭给予RF探针的功率。
如图2中所示,RF探针的尖端插入诸如器官、组织或肿瘤的靶区,其中使用超声导引以确保正确地放置RF探针。用预设参数打开RF功率发生器,并且产生RF功率。RF功率发生器运行直到接到终止信号的提示。例如,如果RF功率发生器运行的时间量(t)大于最大时间量(tmax),则自动关闭RF功率发生器。如果尚未到达tmax,则继续采集超声图像。如果使用超声图像检测到气泡,则产生反馈信号,所述反馈信号例如减小或关闭RF功率。可以自动减小或关闭RF功率,或者用户可以响应于来自系统的警告或通知而手动调节RF功率。如果未检测到气泡,则获得诸如热电偶读数或阻抗读数的读数,并且基于所述热电偶或阻抗参数调节RF功率。
本发明的一个实施例包括一种超声成像系统,例如超声扫描器或超声探针。将超声探针置于患者身体上。超声成像系统通过超声耦合凝胶示出了感兴趣的器官或组织的图像。超声成像系统最初用于提供诸如器官、组织或肿瘤的靶区的治疗前图像,所述图像用于校准。由超声成像系统维持持续实时采集附加图像。
超声成像系统还可以用于导引RF探针插入诸如器官、组织或肿瘤的靶区。应当适当地控制将RF探针放置在最优位置、治疗时间和功率沉积。当选择RF探针的最优位置时要考虑许多因素。肿瘤相对于其他解剖结构的尺寸和位置尤其重要。在示例性情况下,被消融体积的直径通常限制在约2至约3cm;有时需要多次插入以治疗较大的肿瘤。这需要进行治疗计划以及允许导引针插入并显示被消融区域的程度的成像模态。
RF探针包括针部分,其插入诸如器官、组织或肿瘤的靶区。通常经皮,即通过皮肤插入RF探针。在治疗期间,在RF探针尖端处灌注辅助生理盐水。在打开RF功率发生器之前,在患者的另一体表面(例如大腿)上施加接地垫。
打开RF功率发生器,从而使得要在RF探针尖端附近的组织中由RF电流通过产生热量。RF电极位于RF探针尖端,并且允许要在靶区产生RF功率。从持续实时采集产生手术中图像。比较治疗前图像和手术中图像以产生反馈信号。将该反馈信号传送至RF功率发生器,并且响应于该反馈信号改变RF功率以提高手术中图像的质量。
超声成像系统装配有气泡检测器,所述气泡检测器允许要在RF消融程序中检测是否存在气泡,并且产生反馈信号。气泡检测器比较治疗前图像和手术中图像。气泡检测器还包括例如无源空化检测器、扩音器或听诊器或者与例如无源空化检测器、扩音器或听诊器相关。气泡检测器的检测方案可以基于所采集的散射超声波,并且还可以依赖于不同类型的声学特征,所述声学特征包括但不局限于回声的突然变化(例如,在图像中、或者RF探针尖端周围的感兴趣区域中)、双重成像中多普勒谱的变化或者针对微泡造影剂的非线性检测方案(例如检测强谐波和/或次谐波信号)。
治疗前图像和手术中图像的比较响应于确定靶区中存在气泡的指数而发生。从指示是否存在气泡的超声图像导出所述指数。由于气泡通常表现为高回声囊,因此可以通过对若干超声特征进行检查做出决定。如果未检测到气泡,则治疗前图像和手术中图像之间的比较提示获得热电偶读数或阻抗读数。
检测靶区中存在气泡启动闭环反馈系统中的事件。当所述指数高于特定阈值时,反馈信号自动发送至RF发生器。作为响应,将产生RF功率发生器信号的减小或暂时消失,或者调节给予RF探针的其他部分、尖端或尖头的功率。或者,用户可以启动开环反馈系统中改变RF功率。
系统产生的反馈避免增加加热,因而限制了沸腾。由于已知的是,在低于沸点的温度时触发细胞坏死,并且通过诸如化学疗法或生理盐水注射的辅助疗法还可以增加细胞对热治疗的敏感性,因此可以期望的是,即使在防止超声成像场中发生气泡时,应当不会减小已凝结体积的范围。
此外将显然的是,在不脱离权利要求及其等效内容的精神和范围的情况下,可以设计出本发明的其他和更多形式以及除上述特定的示例性实施例之外的实施例,因此旨在说明本发明的范围包括这些等效内容,并且说明书和权利要求书仅是示例性的,而不应被理解为进一步限定。
Claims (6)
1.一种超声成像系统,包括:
超声扫描器,其中,所述超声扫描器配置用于采集(i)靶区的治疗前图像用于校准,以及(ii)所述靶区的至少一幅附加的手术中图像以在射频消融治疗期间使用;
射频探针,其中,射频探针配置用于插入所述靶区并生成射频电流以加热所述射频探针尖端附近的所述靶区;
射频功率发生器,其配置用于为所述射频探针供电;以及
气泡检测器,其中,所述气泡检测器根据所述治疗前图像与所述至少一幅手术中图像的比较来指示所述靶区中是否存在至少一个气泡,其中,所述比较还包括响应于确定所述靶区中存在至少一个气泡的指数,并且响应于存在至少一个气泡的指示自动产生反馈信号,其中,响应于所述反馈信号而改变所述射频功率发生器以避免热量引起的空化效应并且提高在所述射频消融治疗期间的成像质量,其中,改变包括(i)改变到所述射频探针的至少一个尖端的功率或者(ii)射频功率发生器信号的暂时消失,并且其中,响应于未检测到气泡,所述气泡检测器配置用于提示获得热电偶读数或者阻抗读数,其中基于热电偶或阻抗参数调节射频功率。
2.根据权利要求1所述的超声成像系统,其中,所述气泡检测器还包括选自包括下列特征的组中的至少一个:无源空化检测器、扩音器和听诊器。
3.根据权利要求1所述的超声成像系统,其中,所述气泡检测器还确定回声的变化、双重成像中多普勒谱的变化和非线性检测方案。
4.根据权利要求3所述的超声成像系统,其中,所述非线性检测方案包括谐波信号和次谐波信号。
5.根据权利要求1所述的超声成像系统,其中,检测所述靶区中存在至少一个气泡启动闭环反馈系统中的至少一个事件。
6.根据权利要求1所述的超声成像系统,其中,通知用户检测到所述靶区中存在至少一个气泡,并且其中,所述用户启动开环反馈系统中的至少一个事件。
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PCT/IB2007/053047 WO2008017990A1 (en) | 2006-08-11 | 2007-08-02 | Image-based power feedback for optimal ultrasound imaging of radio frequency tissue ablation |
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ATE554716T1 (de) | 2012-05-15 |
EP2051649B1 (en) | 2012-04-25 |
JP2010500080A (ja) | 2010-01-07 |
US20100168571A1 (en) | 2010-07-01 |
TW200816961A (en) | 2008-04-16 |
RU2460489C2 (ru) | 2012-09-10 |
WO2008017990A1 (en) | 2008-02-14 |
EP2051649A1 (en) | 2009-04-29 |
RU2009108637A (ru) | 2010-09-20 |
JP5437068B2 (ja) | 2014-03-12 |
CN101500502A (zh) | 2009-08-05 |
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