Method for monitoring ablation progress by Doppler ultrasound
阅读说明:本技术 用多普勒超声监测消融进展的方法 (Method for monitoring ablation progress by Doppler ultrasound ) 是由 陈驾宇 于 2018-04-30 设计创作,主要内容包括:本发明公开了用于治疗组织的系统和方法。靶组织被消融。在所述消融期间生成所述靶组织的实时图像。从所述实时图像确定所述靶组织的实时血液灌注水平,并将所述血液灌注水平与所述靶组织的初始血液灌注水平进行比较。所述比较提供了所述消融的进展的度量,并且当所述实时血液灌注相对于所述初始血液灌注水平降至阈值水平以下时,停止消融。(Systems and methods for treating tissue are disclosed. The target tissue is ablated. Generating a real-time image of the target tissue during the ablation. Determining a real-time blood perfusion level of the target tissue from the real-time image and comparing the blood perfusion level to an initial blood perfusion level of the target tissue. The comparison provides a measure of the progress of the ablation, and ablation is stopped when the real-time blood perfusion falls below a threshold level relative to the initial blood perfusion level.)
1. A method of treating a target tissue, the method comprising:
ablating the target tissue;
generating a real-time image of the target tissue during the ablation, the image showing blood perfusion of the target tissue as the target tissue is ablated; and
displaying the image showing blood perfusion of the target tissue, thereby indicating to a user a progress of the ablation.
2. The method of claim 1, further comprising determining a real-time blood perfusion level of the target tissue and determining whether the real-time blood perfusion level is below a threshold amount.
3. The method of claim 2, further comprising determining an initial blood perfusion level of the target tissue.
4. The method of claim 3, wherein the initial blood perfusion level comprises an initial Doppler ultrasound signal within the target tissue.
5. The method of claim 3, wherein the threshold amount is 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion level of the target tissue.
6. The method of claim 3, wherein the real-time blood perfusion level comprises a real-time Doppler ultrasound signal within the target tissue.
7. The method of claim 2, further comprising instructing the user to stop the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount.
8. The method of claim 2, further comprising stopping the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount.
9. The method of claim 1, further comprising fixing a position of an imaging source relative to the target tissue.
10. The method of claim 9, wherein the real-time image of the target tissue is generated during the ablation, wherein the position of the imaging source is fixed relative to the target tissue.
11. The method of claim 10, wherein the target tissue is ablated with an ablation element.
12. The method of claim 11, wherein the imaging source is fixedly coupled to the ablation element.
13. The method of claim 11, wherein the imaging source is removably coupled to the ablation element.
14. The method of claim 1, wherein generating the real-time image of the target tissue comprises generating at least one ultrasound image of the target tissue.
15. The method of claim 14, wherein the at least one ultrasound image comprises one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a doppler ultrasound image.
16. The method of claim 15, wherein the at least one ultrasound image comprises a B-mode ultrasound image and a doppler ultrasound image overlaid on each other.
17. The method of claim 1, wherein the target tissue is ablated with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, light energy, laser energy, X-ray energy, or microwave energy.
18. The method of claim 1, wherein ablating the target tissue comprises extending at least one ablation element to the target tissue.
19. The method of claim 18, wherein the at least one ablation element comprises one or more of at least one needle or at least one rake tine.
20. The method of claim 1, wherein the target tissue comprises a myoma, a uterine fibroid, a myoma tissue, a tumor, tissue hyperplasia, or unwanted scar tissue.
21. A method of treating a target tissue, the method comprising:
ablating the target tissue;
monitoring the progress of the ablation of the target tissue by viewing real-time images of the target tissue to monitor blood perfusion of the target tissue.
22. The method of claim 21, wherein monitoring the progress of the ablation of the target tissue by viewing the real-time image of the target tissue to monitor blood perfusion of the target tissue comprises determining an initial blood perfusion level of the target tissue, determining a real-time blood perfusion level of the target tissue, and comparing the initial blood perfusion level and the real-time blood perfusion level of the target tissue.
23. The method of claim 22, wherein comparing the initial blood perfusion level and a real-time blood perfusion level of the target tissue comprises determining whether the real-time blood perfusion level of the target tissue is below the initial blood perfusion level by a threshold amount.
24. The method of claim 23, further comprising stopping the ablation of the target tissue once the blood perfusion of the target tissue is below the threshold amount.
25. The method of claim 23, wherein the threshold amount is 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion amount of the target tissue.
26. The method of claim 22, wherein the initial blood perfusion level comprises an initial doppler ultrasound signal within the target tissue.
27. The method of claim 22, wherein the real-time blood perfusion level comprises a real-time doppler ultrasound signal within the target tissue.
28. The method of claim 21, further comprising fixing a position of an imaging source relative to the target tissue.
29. The method of claim 28, wherein the real-time image of the target tissue is generated during the ablation, wherein the position of the imaging source is fixed relative to the target tissue.
30. The method of claim 29, wherein the target tissue is ablated with an ablation element.
31. The method of claim 30, wherein the imaging source is fixedly coupled to the ablation element.
32. The method of claim 30, wherein the imaging source is removably coupled to the ablation element.
33. The method of claim 21, wherein the real-time image of the target tissue comprises at least one ultrasound image of the target tissue.
34. The method of claim 33, wherein the at least one ultrasound image comprises one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a doppler ultrasound image.
35. The method of claim 34, wherein the at least one ultrasound image comprises a B-mode ultrasound image and a doppler ultrasound image overlaid on one another.
36. The method of claim 21, wherein the target tissue is ablated with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, light energy, laser energy, X-ray energy, or microwave energy.
37. The method of claim 21, wherein ablating the target tissue comprises extending at least one ablation element to the target tissue.
38. The method of claim 37, wherein the at least one ablation element comprises one or more of at least one needle or at least one rake tine.
39. The method of claim 21, wherein the target tissue comprises a myoma, a uterine fibroid, a myoma tissue, a tumor, tissue hyperplasia, or unwanted scar tissue.
40. The method of claim 21, further comprising introducing a contrast agent to the target tissue prior to the ablating.
41. A system for treating a target tissue, the system comprising:
a treatment probe comprising a handle, a probe body, an imaging source coupled to the probe body, and an ablation element coupled to the probe body and configured to ablate the target tissue;
a real-time display coupled to the therapy probe; and
a controller coupled to the imaging source and the real-time display of the treatment probe, the controller comprising a computer-readable non-transitory storage medium including (i) instructions for the imaging source to generate a real-time image of the target tissue during ablation of the target tissue, and (ii) instructions for the real-time display to display the real-time image showing blood perfusion of the target tissue, thereby indicating a progress of the ablation to a user.
42. The system of claim 41, wherein the ablation element comprises a needle structure extendable from the treatment probe to the target tissue.
43. The system of claim 42, wherein the ablation element further comprises a plurality of needles extendable from the needle structure to the target tissue.
44. The system according to claim 43, wherein the computer-readable non-transitory storage medium further comprises instructions for the real-time display to display a representation of the position of one or more of the needle structure or plurality of tines on the real-time image.
45. The system of claim 41, wherein the computer-readable non-transitory storage medium further comprises instructions for determining a real-time blood perfusion level of the target tissue and determining whether the real-time blood perfusion level is below a threshold amount.
46. The system of claim 45, wherein the computer-readable non-transitory storage medium further comprises instructions for determining an initial blood perfusion level of the target tissue.
47. The system of claim 46, wherein the threshold amount is 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion amount of the target tissue.
48. The system of claim 46, wherein the initial blood perfusion level comprises an initial Doppler ultrasound signal within the target tissue.
49. The system of claim 45, wherein the real-time blood perfusion level comprises a real-time Doppler ultrasound signal within the target tissue.
50. The system of claim 45, wherein the computer-readable non-transitory storage medium further comprises instructions for instructing the user to stop the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount.
51. The system of claim 45, wherein the computer-readable non-transitory storage medium further comprises instructions for stopping the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount.
52. The system of claim 41, wherein a position of the imaging source during the ablation of the target tissue is configured to be fixed relative to the target tissue.
53. The system of claim 52, wherein the real-time image of the target tissue is generated during the ablation, wherein the position of the imaging source is fixed relative to the target tissue.
54. The system of claim 41, wherein the imaging source is configured to be in a fixed position relative to the ablation element.
55. The system of claim 41, wherein the imaging source is configured to be movable relative to the ablation element.
56. The system of claim 41, wherein the real-time image of the target tissue comprises at least one ultrasound image of the target tissue.
57. The system of claim 56, wherein the at least one ultrasound image comprises one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a Doppler ultrasound image.
58. The system of claim 57, wherein the at least one ultrasound image comprises a B-mode ultrasound image and a Doppler ultrasound image overlaid on one another.
59. The system of claim 41, wherein the ablation element is configured to ablate the target tissue with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, optical energy, laser energy, X-ray energy, or microwave energy.
60. The system of claim 41, wherein the target tissue comprises a myoma, a uterine fibroid, a myoma tissue, a tumor, tissue hyperplasia, or unwanted scar tissue.
1. Field of the invention
The present invention relates generally to medical methods and devices. More particularly, the present invention relates to a method and system for displaying images of tissue to be treated in real time so that treatment can be controlled.
Current medical treatments for organs and tissues within a patient's body often use needles or other elongate bodies to deliver energy, therapeutic agents, and the like. Typically, these methods use ultrasound imaging to view and identify treatment targets before, during, and/or after.
Of particular interest to the present invention are the recently proposed treatments for uterine fibroids that rely on transvaginal or laparoscopic positioning of a treatment probe or device within the uterus of a patient. A radiofrequency or other energy or therapeutic delivery needle is deployed from the device near or directly into the fibroid, and delivers energy and/or therapeutic substances for ablating or treating the fibroid. To facilitate positioning of the fibroid and placement of the needle within the fibroid, the treatment device includes an ultrasound imaging array having an adjustable field of view, typically in a forward or lateral direction relative to an axial shaft carrying the needle. A needle is advanced from the shaft and across the field of view such that the needle can be visualized and guided into tissue and target sarcomas.
While effective and highly beneficial to patients, such needle ablation and treatment protocols face several challenges. Although the position of the needle may be observed on an ultrasound or other visual image, it may be difficult to predict the treatment zone resulting from energy or other therapeutic delivery. One of the reasons may be that energy propagation within tissue may depend primarily on the tissue structure and the distribution of blood vessels acting as "heat sinks". Due to the distribution of blood vessels, the size of the coagulation introduced by RF ablation may vary from tumor to tumor. Current coagulation size and safety margins are generally based on static size predictions that may affect the efficacy or even safety of treatment. The physician's experience may help determine the appropriate ablation endpoint, but it is desirable to reduce the need to make decisions and guesses.
Tissue heating or cooling may be affected by adjacent vasculature as the blood vessels can dissipate thermal energy and cause changes in the calculated coagulation size. Thus, the magnitude of thermal ablation and the effectiveness of cytotoxicity may decrease with the proximity and size of adjacent vessels. An increase in the local recurrence rate of tumors adjacent to large vessels (>3mm) may demonstrate a significant effect of dissipating heat energy. Approximately one-third of the ablations may present a deformation of the vessel periphery. The degree of heat dissipation may be significantly related to the size of the blood vessel. Several studies also examined the effect of modulating liver perfusion and found that ablation size increased with decreasing blood flow. Developing better methods to estimate or monitor ablation size would benefit the effectiveness and safety of treatment.
For these reasons, it is desirable to provide improved systems and methods for deploying energy delivery and other needles within an ultrasound or other imaging field of view in an energy delivery or other treatment regimen. It would be particularly useful to provide the treating physician with information that helps determine the real-time progress of ablation. It is also desirable to provide feedback to the physician to assist in accurately predicting the treatment area. Such information should allow the physician to terminate the ablation plan at the appropriate time when the desired target tissue has been completely ablated or nearly completely ablated while reducing accidental ablation of non-target tissue, if necessary. Furthermore, it is desirable to provide feedback to the physician to allow the physician to assess a safety margin so as not to damage sensitive tissue structures. All such feedback or other information is preferably provided visually on an ultrasound or other imaging screen so that the physician can start, pause, and stop the treatment. At least some of these objects will be attained by the invention described hereinafter.
Background
Disclosure of Invention
The present disclosure provides systems and methods for treating tissue structures. In particular, systems and methods for ablating tissue structures and monitoring ablation are provided. A real-time image of a target tissue structure, such as a uterine fibroid, may be displayed. The real-time images may also show blood flow and/or perfusion within the target tissue structure. For example, the real-time images may include doppler ultrasound images and/or contrast enhanced ultrasound imaging (CEUS) to show blood perfusion. The image showing blood perfusion may be overlaid with an image showing the morphology and/or density of the target tissue structure. As the target tissue is ablated, the blood perfusion of the target tissue may decrease and/or the size of the reduced blood perfusion area may increase. By displaying real-time images of the target tissue showing tissue morphology and blood perfusion during ablation to the physician or user, the physician or user can track the progress of the treatment. For example, once the target subject's blood perfusion is reduced by a threshold amount compared to its initial blood perfusion level, and/or once the size of the reduced blood perfusion region reaches a threshold size, the user may stop ablation to ensure complete or near complete ablation of the target tissue structure, and to minimize undesired ablation of non-target subjects. Furthermore, the effectiveness and safety of the treatment can be ensured by displaying real-time images of the target tissue, which may allow for real-time monitoring of the movement of the perfusion boundary, the effective margin of ablation.
Aspects of the present disclosure provide exemplary methods of treating a target tissue. The target tissue can be ablated. Real-time images of the target tissue may be generated during the ablation. The image may show blood perfusion of the target tissue as the target tissue is ablated. An image showing blood perfusion of the target tissue may be displayed, indicating to a user the progress of the ablation.
A real-time blood perfusion level of the target tissue may be determined, and it may be determined whether the real-time blood perfusion level is below a threshold amount. An initial blood perfusion level of the target tissue may be determined, and the threshold amount may be 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion level of the target tissue. A user may be instructed or instructed to stop the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount. Alternatively or in combination, the ablation of the target tissue may be stopped (e.g., automatically stopped) in response to the real-time blood perfusion level being below the threshold amount. The initial blood perfusion level may comprise an initial doppler ultrasound signal within the target tissue, and the real-time blood perfusion level may comprise a real-time doppler ultrasound signal within the target tissue.
The position of the imaging source may be fixed relative to the target tissue. The real-time image of the target tissue may be generated during the ablation, wherein a position of the imaging source is fixed relative to the target tissue. The target tissue can be ablated with an ablation element. The imaging source may be fixedly coupled to the ablation element. Alternatively or in combination, the imaging source may be removably coupled to the ablation element.
The real-time image of the target tissue may be generated by generating at least one ultrasound image of the target tissue. The at least one ultrasound image may include one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a doppler ultrasound image. The at least one ultrasound image may include a B-mode ultrasound image and a doppler ultrasound image overlapped with each other. Common anatomical markers in the two images can be identified and mapped to each other to generate an overlapping image. In some cases, a contrast agent may be introduced to the target tissue prior to the ablation to provide a more enhanced ultrasound image.
The target tissue may be ablated with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, optical energy, laser energy, X-ray energy, or microwave energy. The target tissue may be ablated by extending at least one ablation element to the target tissue. The at least one ablation element may comprise one or more of at least one needle or at least one tine. The target tissue may include fibroids, uterine fibroids, fibroid tissue, tumors, tissue hyperplasia, or unwanted scar tissue.
Aspects of the present disclosure provide additional methods of treating the target tissue. The target tissue can be ablated. Monitoring the progress of the ablation of the target tissue by viewing real-time images of the target tissue to monitor blood perfusion of the target tissue.
Monitoring the progress of the ablation of the target tissue by viewing the real-time image of the target tissue to monitor blood perfusion of the target tissue, including that an initial blood perfusion level of the target tissue can be determined, a real-time blood perfusion level of the target tissue can be determined, and the initial blood perfusion level and the real-time blood perfusion level of the target tissue can be compared. To compare an initial blood perfusion level and a real-time blood perfusion level of the target tissue, it may be determined whether the real-time blood perfusion level of the target tissue is below the initial blood perfusion level by a threshold amount. Stopping the ablation of the target tissue once the blood perfusion of the target tissue is below the threshold amount. The threshold amount may be 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion amount of the target tissue. The initial blood perfusion level may comprise an initial doppler ultrasound signal within the target tissue. The real-time blood perfusion level may comprise a real-time doppler ultrasound signal within the target tissue.
The position of the imaging source may be fixed relative to the target tissue. The real-time image of the target tissue may be generated during the ablation, with the position of the imaging source fixed relative to the target tissue. The target tissue can be ablated with an ablation element. The imaging source may be fixedly coupled to the ablation element. Alternatively or in combination, the imaging source may be removably coupled to the ablation element.
The real-time image of the target tissue may include at least one ultrasound image of the target tissue. The at least one ultrasound image may include one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a doppler ultrasound image. The at least one ultrasound image may include a B-mode ultrasound image and a doppler ultrasound image overlapped with each other. Common anatomical markers in the two images can be identified and mapped to each other to generate an overlapping image. In some cases, a contrast agent may be introduced to the target tissue prior to the ablation to provide a more enhanced ultrasound image.
The target tissue may be ablated with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, optical energy, laser energy, X-ray energy, or microwave energy. The target tissue may be ablated by extending at least one ablation element to the target tissue. The at least one ablation element may comprise one or more of at least one needle or at least one tine. The target tissue may include fibroids, uterine fibroids, fibroid tissue, tumors, tissue hyperplasia, or unwanted scar tissue.
Aspects of the present disclosure also provide a system for treating a target tissue. The treatment system may include a treatment probe, a real-time display, and a controller. The treatment probe can include a handle, a probe body, an imaging source coupled to the probe body, and an ablation element coupled to the probe body and configured to ablate the target tissue. The real-time display may be coupled to the therapy probe. The controller may be coupled to the imaging source and the real-time display of the treatment probe. The controller may include a computer-readable non-transitory storage medium comprising: (i) instructions for the imaging source to generate a real-time image of the target tissue during ablation of the target tissue, and (ii) instructions for the real-time display to display a real-time image showing blood perfusion of the target tissue, thereby indicating to a user a progress of the ablation.
The ablation element may include a needle structure extendable from the treatment probe to the target tissue. The ablation element may further include a plurality of needles extendable from the needle structure to the target tissue. The computer-readable non-transitory storage medium may further include instructions for a real-time display to display a representation of the position of one or more of the needle structure or plurality of tines on the real-time image.
The computer-readable non-transitory storage medium may further include instructions for determining a real-time blood perfusion level of the target tissue and determining whether the real-time blood perfusion level is below a threshold amount. The computer-readable non-transitory storage medium may further include instructions for determining an initial blood perfusion level of the target tissue. The threshold amount may be 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion amount of the target tissue. The computer-readable non-transitory storage medium may further include instructions for instructing the user to stop the ablation of the target tissue in response to the real-time blood perfusion level being below the threshold amount. The initial blood perfusion level may comprise an initial doppler ultrasound signal within the target tissue. The real-time blood perfusion level may comprise a real-time doppler ultrasound signal within the target tissue.
The position of the imaging source may be fixed relative to the target tissue. The real-time image of the target tissue may be generated during the ablation, wherein a position of the imaging source is fixed relative to the target tissue. The target tissue can be ablated with an ablation element. The imaging source may be fixedly coupled to the ablation element. Alternatively or in combination, the imaging source may be removably coupled to the ablation element.
The real-time image of the target tissue may include at least one ultrasound image of the target tissue. The at least one ultrasound image may include one or more of a contrast-enhanced ultrasound image, a B-mode ultrasound image, or a doppler ultrasound image. The at least one ultrasound image may include a B-mode ultrasound image and a doppler ultrasound image overlapped with each other. Common anatomical markers in the two images can be identified and mapped to each other to generate an overlapping image. In some cases, a contrast agent may be introduced to the target tissue prior to the ablation to provide a more enhanced ultrasound image.
The target tissue may be ablated with one or more of RF energy, thermal energy, cryogenic energy, ultrasound energy, HIFU energy, optical energy, laser energy, X-ray energy, or microwave energy. The target tissue may be ablated by extending at least one ablation element to the target tissue. The at least one ablation element may comprise one or more of at least one needle or at least one tine. The target tissue may include fibroids, uterine fibroids, fibroid tissue, tumors, tissue hyperplasia, or unwanted scar tissue.
Is incorporated by reference
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
Drawings
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
fig. 1 is a schematic diagram of a system of the present disclosure including a system controller, an image display, and a treatment probe having a deployable needle structure and an imaging sensor.
Fig. 2 is a perspective view of a treatment probe of the present disclosure.
FIG. 3 is a view of the treatment probe of FIG. 2 showing the imaging assembly separated from the needle assembly with portions removed and portions enlarged.
FIG. 3A illustrates the distal end of the needle assembly connected to the distal end of the imaging assembly.
Fig. 4 illustrates a schematic view of a treatment probe of the present disclosure.
Fig. 5 illustrates a distal portion of a treatment probe introduced into the uterine cavity to image fibroids in the myoma of the uterine musculature.
Fig. 6A, 7A, 8A, 9A, 10A, and 11A illustrate "screenshots" of the real-time image display as the treatment and safety boundaries are adjusted and the ablation elements of the treatment probe are advanced into the target tissue, in accordance with the principles of the present disclosure.
Fig. 6B, 7B, 8B, 9B, 10B, and 11B illustrate manipulation of the handle, which corresponds to repositioning of the projection images of the treatment boundary and safety boundary on the real-time images of fig. 6A, 7A, 8A, 9A, 10A, and 11A, respectively.
Figure 12 illustrates a system diagram in which a B-mode ultrasound data stream (showing tissue morphology) is combined with a doppler-mode ultrasound data stream to generate a real-time image in accordance with the present disclosure.
Fig. 13 illustrates a flow chart of a method of treating tissue according to the present disclosure.
Fig. 14A, 14B, 14C, and 14D illustrate a plurality of real-time images of a target tissue structure as ablated in accordance with the present disclosure.
Detailed Description
As shown in FIG. 1, a
Referring now to fig. 2 and 3, the
The
The
The
In use, as will be described in more detail below, the
Fig. 4 shows a schematic view of the
The physician can adjust the
One particular advantage of the method and system is that the physician can manipulate the treatment/safety margin on the target anatomy paper by moving the treatment margin/safety margin relative to (or within) the real-time image caused by manipulating (pressing forward/backward, pressing left/right) the
Referring now to fig. 5, the
Once the fibroid is located on
However, as shown in fig. 7A, the size of the treatment boundary TB may not be sufficient to treat the fibroid because the boundary does not extend throughout the image of the fibroid. Thus, as shown in fig. 8B, it may be necessary to enlarge the treatment boundary TB by manipulating the
While the
After the
With the
Fig. 12 shows a diagram of a tissue treatment system 1200. The user US may operate the
Fig. 13 illustrates a
In step 1301, a target tissue structure, such as target myoma F, can be located.
In step 1306, a real-time representation of the target tissue structure may be displayed as described herein. In some embodiments, contrast agents may be introduced to the target tissue to enhance the images of structural and morphological features of the target tissue so that they may be better tracked during ablation. In some embodiments, the characteristics of doppler ultrasound images indicative of blood perfusion may also be enhanced. Potentially suitable contrast agents may include some commercially available contrast agents, such as
Andand so on.In step 1311, one or more ablation elements (e.g.,
In step 1316, an initial blood perfusion level of the target tissue may be determined, such as by observing and/or quantifying a doppler ultrasound image that may be taken by
In step 1321, the target tissue may be ablated for a predetermined period of time, for example, between 0.5 and 20 minutes for a single ablation.
In step 1326, a blood perfusion level of the target tissue may be determined after a predetermined treatment period. For example, the user may make this determination manually by viewing an updated real-time image that includes doppler ultrasound and/or contrast enhanced ultrasound information. Alternatively or in combination, the
In step 1331, the current "post-ablation" blood perfusion level may be compared to an initial blood perfusion level. If the current blood perfusion level is not below the threshold compared to the initial blood perfusion level, then the step 1321 of ablating the target tissue, etc. may be repeated. If the current blood perfusion level is below the threshold, the protocol may proceed to step 1336, where ablation of the target tissue is ended. The threshold may include, for example, 50% or less, 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, 15% or less, 10% or less, or 5% or less of the initial blood perfusion amount of the target tissue. In some embodiments, a 30% or more reduction in blood perfusion (i.e., the current blood perfusion level is 30% or less of the initial blood perfusion level) may be considered a successful treatment.
In some embodiments, perfusion monitoring of the ablation boundary during treatment is used as a treatment guidance tool. Ablation may be stopped if the user or system observes that the treatment region has spread beyond the target region. Contrast enhanced images may also facilitate such user viewing. Ablation may be interrupted or stopped manually or automatically to ensure patient safety.
Finally, in step 1341, the ablation elements (typically the
While the above steps illustrate a
One or more steps of the
Fig. 14A-14D show exemplary real-time images of a target muscle tumor F during an ablation protocol as described herein. As described herein, these real-time images may include B-mode ultrasound images showing tissue morphology, which are overlaid with doppler-mode ultrasound images showing blood perfusion taken at various points in time.
Fig. 14A shows a first real-
Fig. 14B shows a second real-time image 1400B showing the uterus U and the target hysteromyoma F after a first ablation time period. As shown in the second real-
Fig. 14C shows a third real-time image 1400C showing the uterus U and the target hysteromyoma F after a period of further ablation. As shown in the third real-
Fig. 14D shows a fourth real-time image 1400D showing the uterus U and the target hysteromyoma F after yet another ablation time period. As shown in the fourth real-time image 1400d, the ablation region 1450d within the treatment boundary TB may now nearly match the treatment boundary TB, and may be nearly free of the
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will occur to those skilled in the art without departing from the invention herein. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.