金属植入物附近组织碎裂术的安全性与有效性：体模与猪模型研究
本研究在66个琼脂体模和4只健康猪中评估组织碎裂术在治疗束路径或治疗区内存在金属时的安全性与有效性。结果显示，实验组与对照组的治疗能量、治疗尺寸及Dice系数均无显著差异，且未观察到靶外损伤；组织学显示治疗区完整。结论认为在该小样本急性猪研究中，组织碎裂术在金属植入物附近是安全有效的。
要点
- 治疗束路径中有血管内弹簧圈或治疗区内有金属基准标记时，组织碎裂术未导致靶外损伤。
- 金属存在与否不影响治疗能量、治疗尺寸及Dice系数。
- 组织学证实治疗区完全，表现为无细胞碎屑及周围肝细胞过渡带。
关键影像表现/征象
- 组织学显示弹簧圈下方和金属基准标记上方的治疗区均完整，表现为无细胞碎屑，周围为具有固缩核的肝细胞和萎缩肝窦板的过渡带。
- 未观察到靶外损伤。
诊断标准与关键数值
- 体模实验中，实验组与对照组的治疗能量水平、直径和Dice系数均无显著差异；体内治疗直径也无显著差异。
临床应用与阅片要点
- 在组织碎裂术治疗规划时，若治疗路径或治疗区内存在金属植入物（如血管内弹簧圈或基准标记），可参考本研究结果认为不影响治疗安全性和有效性。
- 治疗过程中应通过影像学监测确保无靶外损伤。
局限性
- 研究样本量小（4只猪），且为急性实验，结论需进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: This work evaluated the safety and efficacy of histotripsy treatments with metal in the therapeutic beam path or directly in the treatment zone.
METHODS: Histotripsy treatments were performed on 66 agar phantoms with metal nearfield, adjacent to and within the treatment zone. Two endovascular coil sizes, a surgical clip and three gold fiducials were tested. The energy required to treat, treatment size and Dice coefficient were compared with control treatments without metal. In vivo histotripsy treatments were performed on four healthy swine (two treatments per animal). Treatments were performed centered on a metallic fiducial (n = 3) or deep to the endovascular coils (n = 3), as well as without metal in the beam path (control, n = 2). The control treatments were performed in independent areas of the liver. Imaging and gross necropsy were used to assess safety. Additionally, imaging and histology were used to assess efficacy.
RESULTS: The phantom treatment energy levels, diameters and Dice coefficients, as well as in vivo treatment diameters, failed to show any significant differences between the experimental and control groups. No off-target damage was observed. Histologically, the treatment zones beneath a coil and over a metal fiducial were both complete, with acellular debris surrounded by a transition zone of hepatocytes with pyknotic nuclei and atrophic sinusoidal plates.
CONCLUSION: Histotripsy with endovascular coils in the ultrasound beam path or with a metal fiducial directly in the treatment zone was safe and effective in this small, acute in vivo swine study.
引用
- Falk KL, Wagner MG, Hennen C, et al. Safety and Efficacy of Histotripsy Treatments Near Implanted Metallic Fiducials and Endovascular Coils in Phantoms and in an In Vivo Swine Model. Ultrasound Med Biol. 2026. PMID: 42185184. doi:10.1016/j.ultrasmedbio.2026.04.025
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。