Abstract
Ultrasound can penetrate deep into tissues and interact with human tissue via thermal and mechanical mechanisms. The ability to focus an ultrasound beam and its energy onto millimeter-size targets was a significant milestone in the development of therapeutic applications of focused ultrasound. Focused ultrasound can be used as a non-invasive thermal ablation technique for tumor treatment and is being developed as an option to standard oncologic therapies. High-intensity focused ultrasound has now been used for clinical treatment of a variety of solid malignant tumors, including those in the pancreas, liver, kidney, bone, prostate, and breast, as well as uterine fibroids and soft-tissue sarcomas. Magnetic resonance imaging and Ultrasound imaging can be combined with high intensity focused ultrasound to provide real-time imaging during ablation. Magnetic resonance guided focused ultrasound represents a novel non-invasive method of treatment that may play an important role as an alternative to open neurosurgical procedures for treatment of a number of brain disorders. This paper briefly reviews the underlying principles of HIFU and presents current applications, outcomes, and complications after treatment. Recent applications of Focused ultrasound for tumor treatment, drug delivery, vessel occlusion, histotripsy, movement disorders, and vascular, oncologic, and psychiatric applications are reviewed, along with clinical challenges and potential future clinical applications of HIFU.
Highlights
In clinical practice, a variety of different energies have been used for thermal ablation of tissues, including radiofrequency currents, microwaves, laser, thermal conductor sources, and ultrasound
The exposure time for catheter-based ultrasound devices is typically 10–30 minutes and the procedure is more invasive compared to external HIFU; this method has better energy localization [16]
HIFU has been investigated for treating different brain disorders including movement disorders [79,80], Parkinson’s disease (PD) and Alzheimer’s disease (AD) [81], depression/anxiety and pain syndromes-186 [82,83] [84], epilepsy, thrombolysis/intracerebral hemorrhage (188,189) [82,85,86,87], and cerebrospinal fluid (CSF) diversion [88]
Summary
A variety of different energies have been used for thermal ablation of tissues, including radiofrequency currents, microwaves, laser, thermal conductor sources, and ultrasound. Using ultrasound for heating tissues was one of its early clinical applications [2]. It was first recognized when high intensity ultrasound waves used to navigate submarines during World War II, were found to heat up and kill fishes [3]. COhthoenrgtqyipnegs HofAtIrFaUnsTMduCcoerms pinacnlyu,dCehpohnagsqedinagr,rCahyitnraa)n.Tsdhuecmerescwhahnicichalcommopvreimseemntuolftitphlee tpriasntosdnutrcaenr sddeutecremrsintheasttahree paorrsaitniognedofonthtehefotcraulnpcaotiendt, swuirtfhaceeleocftraosnpihcesrtiecearlinbogwolf (tFhieguurletr2abso) uonr da flbeaat mtraanlslodwucinerg/ffuinlley cpoonpturolaltoedf tphheafsoecdalasrpraoyt l(oFciagtuioren.2c) (e.g., Model-JC HIFU system, Chongqing HAIFUTM Company, Chongqing, China).The mechanical movement of the transducer determines the position of the focal point, with electronic steering of the ultrasound beam allowing fine control of the focal spot location. IIttpprroovviiddeesstthheebbeenneeffiitt ooffvveerriiffyyiinnggtthheeaaccoouussttiiccwwiinnddoowwwwiitthhssoonnooggrraapphhyyiinnrreeaallttiimmee,,wwhhiicchhmmeeaannsstthhaattiifftthheettaarrggeettrreeggiioonn iiss nnoott vviissuuaalliizzeedd bbyy uullttrraassoouunndd iimmaaggiinnggbbeeffoorree aanndd dduurriinngg HHIIFFUUtthheerraappyy,, tthheenn iitt iiss uunnlliikkeellyy tthhaatt HHIIFFUUtthheerraappyywwiillllbbeeeeffffeeccttiivvee iinn tthhaatt ssppeecciiffiicc rreeggiioonn. TThheeaabbllaatteeddttaarrggeettrreeggiioonniiss nnoott vviissuuaalliizzeeddoonn ssttaannddaarrdd BB--mmooddeeimimagaegseusnulenssletshse tghaes bguabsblbeus bpbroledsucperdodwuitcheidn twheitfhoicnaltzhoenefoacpapleazronase haypppereeacrhoaisc hsyppotesreinchtohiecimspaogtes [i9n].thUeSgimFUagSeis[9g]o.oUdSfgoFr UprSe-ipsrgooceoddufroarl pporsei-tpiornocinegduorfatlhepotasritgieotntiunmg oorf, bthuet ntaortgfeotr tiunmtrao-rp, rbouctendoutrafol revinatlruaa-tpioroncoedf uthrearlaepveaulutiactbioonunofdtahreiersap[9e]u. tic boundaries [9]
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