超声脑成像和经颅超声治疗技术在脑损伤康复中的应用  

Applications of Ultrasonic Brain Imaging and Transcranial Ultrasound Therapy in Brain Injury Rehabilitation

作　　者：吴毅[1,2,3] WU Yi(Huashan Hospital,Fudan University,Shanghai 200040,China;National Clinical Research Center for Aging and Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China;National Center for Neurological Disorder,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院,上海200040 [2]复旦大学附属华山医院国家老年疾病临床医学研究中心,上海200040 [3]复旦大学附属华山医院国家神经疾病医学中心,上海200040

出　　处：《康复学报》2023年第2期97-102,共6页Rehabilitation Medicine

基　　金：国家重点研发计划项目(2018YFC2001700);上海市科学技术委员会项目(22Y31900202);上海市临床重点专科项目(shslczdzk02702)。

摘　　要：超声作为诊断和治疗的工具在临床上有着广泛的应用。随着技术发展,新算法和高灵敏度超声换能器的研发在一定程度上弥补了颅骨对超声波的衰减,实现了超声在脑科学领域的应用。超声技术具有无创、安全、便携、低成本及无辐射的优势,在脑损伤检测和康复治疗中具有良好的前景。经颅多普勒超声(TCD)、功能超声成像(fUS)和超声定位显微镜(ULM)等超声脑成像技术分别通过信号叠加或利用微泡的空化效应来提高信噪比,在脑血管造影中达到比CT和MRI更高的分辨率,能够获取脑血管的实时图像、量化脑血流动力学参数,还可以结合脑电图同时记录全脑血流和神经元电活动变化,对脑血管病发生后神经血管功能进行多维度评估。在超声治疗方面,经颅聚焦超声能够无创性穿透颅骨精确聚焦于大脑皮层或深层脑组织。高强度聚焦超声(HIFU)和低强度聚焦超声(LIFU)分别利用超声的热效应和机械效应起到组织消融、血脑屏障开放、药物靶向输送、辅助溶栓和神经调控的作用,可应用于脑肿瘤、脑外伤、脑卒中、帕金森病、阿尔茨海默病、癫痫和抑郁症等多种神经系统疾病和精神疾病的治疗。目前,超声脑成像技术和经颅超声治疗技术尚处于发展阶段,未来还需进一步解决颅骨衰减效应、实现3D成像、建立神经调控超声参数标准、屏蔽听觉副作用等问题,同时开展更多临床研究为超声脑成像和无创性经颅超声治疗技术在脑损伤疾病的诊断和康复治疗的应用方面提供强有力的支持。Ultrasound was widely used in clinical practice as a tool for diagnosis and treatment.With the development of technology,the research and development of new algorithms and high-sensitivity ultrasound transducers have made up for the attenuation of ultrasound in the skull to a certain extent,and realized the application of ultrasound in the field of brain science.The advantages of ultrasound technology are non-invasive,safe,portable,low-cost and radiation-free,which has a great potential in the detection and rehabilitation of brain injury.Ultrasonic brain imaging techniques such as transcranial doppler(TCD),functional ultrasound imaging(fUS)and ultrasound localization microscopy(ULM)improve the signal to noise ratio by signal superposition or the cavitation effect of microbubbles,and achieve a higher resolution than CT and MRI in cerebral angiography.These ultrasound brain imaging techniques can obtain real-time images of brain tissue structures and quantify cerebral hemodynamic parameters.It can also be combined with EEG to simultaneously record the changes of the cerebral blood flow and neural activities,so as to conduct multi-dimensional evaluation of the neurovascular function after the occurrence of cerebrovascular disease.In terms of ultrasound treatment,transcranial focused ultrasound can penetrate the skull noninvasively and focus accurately on the cortex or deep brain tissues.High intensity focused ultrasound(HIFU)and low intensity focused ultrasound(LIFU)use the thermal and mechanical effects respectively to perform tissue ablation,blood-brain barrier opening,drug targeted delivery,ultrasound-assisted catheter-directed thrombolysis and neuromodulation,and can be applied to the treatment of brain tumors,brain trauma,stroke,Parkinson's disease,Alzheimer's disease,epilepsy,depression and other neurological diseases and mental diseases.At present,ultrasound brain imaging and therapeutic transcranial ultrasound are still in development.In the future,it is necessary to make further efforts to solve the problem

关 键 词：超声脑成像 经颅超声 脑损伤 神经康复 神经调控 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]