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

使用实时 3D 回波去相关成像监测和控制人类肝癌消融

基本信息

批准号：
9531604
负责人：
T Douglas Mast
金额：
$ 43.73万
依托单位：
UNIVERSITY OF CINCINNATI
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-10 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9531604
关键词：
Ablation Accounting Adverse effects Algorithms Blinded Cancer Patient Cattle Cell Death Cirrhosis Clinic Clinical Clinical Trials Computers Data Dimensions Disseminated Malignant Neoplasm Electrodes Environment Excision Family suidae Feedback Foundations Future Gender Gold Heating Histology Human Image Investigation Lead Liver Liver diseases Liver neoplasms Liver parenchyma Localized Malignant Neoplasm Magnetic Resonance Imaging Malignant Neoplasms Malignant neoplasm of liver Maps Metastatic Neoplasm to the Liver Methods Modality Monitor Morbidity - disease rate Motion Neoplasm Metastasis Operative Surgical Procedures Oryctolagus cuniculus Pathologic Patient Schedules Patients Performance Prediction of Response to Therapy Primary Neoplasm Primary carcinoma of the liver cells Procedures Public Health ROC Curve Radiofrequency Interstitial Ablation Recurrence Research Resected Risk Safety Specific qualifier value Specimen Testing Thermal Ablation Therapy Three-Dimensional Imaging Time Tissues Transducers Translating Translations Transplantation Ultrasonography Unresectable Validation X-Ray Computed Tomography cancer recurrence cancer therapy clinical practice common treatment contrast enhanced direct application follow-up imaging modality improved improved outcome in vivo innovation liver tumor ablation microwave ablation millisecond minimally invasive mortality novel novel strategies performance tests prevent radiofrequency real time monitoring standard of care success surgery outcome tumor tumor ablation

项目摘要

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.

项目概要/摘要肝癌，包括肝细胞癌（HCC）以及转移性肿瘤，是一个主要的公共卫生问题问题。对于无法切除的肝癌患者，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，热消融方法是受到不均匀和不一致的治疗的限制，导致不良副作用、局部癌症复发和生存率下降，严重限制了其临床应用。回波去相关成像是一种新颖的超声方法，通过映射来缓解这些问题热消融过程中组织加热引起的超声回波变化。迄今为止关于回声的研究去相关成像表明，该方法可以可靠地预测兔子体内消融诱导的细胞死亡和猪肝组织以及 VX2 肝癌。尽管回波去相关成像是一种极其热消融监测和控制的有前途的方法，其转化为临床实践将需要验证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类肝实质（例如，肝硬化）肝脏）。我们这项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脏肿瘤消融的可靠性。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。 RFA 将使用标准临床实施受控消融方法电极和临床射频发生器，以回声去相关作为治疗终点。测试临床回声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脏组织，3D 回波去相关图像将由开放期间记录的回波数据形成手术 RFA 和经皮 MWA 手术，然后与后续对比 MRI 和 CT 进行比较评估消融体积边缘以及局部复发的预测。通过 3D 控制热烧蚀回声去相关成像将首先在人类转移性肝癌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，以及活体猪肝。这然后，研究将在回波去相关控制射频消融治疗和切除试验中达到高潮肝肿瘤患者，展示了回声去相关成像的直接应用以改善临床肿瘤消融。因此，这项研究将证明肝脏的有效预测和实时控制的可行性人类肝癌和伴随患病肝组织的癌症消融。