超声造影Contrastenhanced ultrasound.docx

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