Ultrasound allows physicians to do much more
than just diagnoses. Sound waves have long been used for therapy, for instance
for patients with malignant tumours and too much hip fat. What is possible
using ultrasound will again be one of the main topics at MEDICA 2010, World
Forum for Medicine – International Trade Fair and Congress, to be held from
November 17 – 20, 2010 in Düsseldorf, Germany. With more than 4,000 exhibitors
from over 60 countries, it is the world’s largest international medical trade
fair and congress. While the latest developments in ultrasound technology will
be shown within the framework of the trade fair, many of the speakers at the
accompanying congress will present the various application options, for
instance in oncology. There will again be practice-oriented sonography courses
as well.

Ultrasound has been firmly established in
diagnostics for more than 20 years. But physicians are increasingly using
sonography for therapy. So-called high-intensity focused ultrasound (HIFU),
also known as high energy ultrasound, works with concentrated energy: A hollow
mirror concentrates the waves emitted by the probe head. With the heat that is
created – up to 90 degrees centigrade – doctors can target and destroy tumors
in the prostate or liver, for example. Surrounding tissue is not destroyed, as
the high temperatures develop only in the focal point. Hence there are fewer
cases of incontinence and impotence in prostate cancer patients after treatment
with HIFU than after conventional surgery.

For instance, there was quite a stir last year
after the first successful brain surgery using transcranial (through the skull)
high-energy ultrasound performed by a research team under the leadership of
Professor Daniel Jeanmonod from the Department of Functional Neurosurgery of
the University Hospital of Zurich and Professor Ernst Martin, Director of the
Magnetic Resonance Centre of the University Children’s Hospital. The completely
non-invasive procedure opens up new horizons for neurosurgery and the therapy
of neurological patients. Overall, the Zurich scientists treated ten patients
with therapy-resistant unbearable pain – for instance caused by neurinoma or
trigeminal neuralgia. The surgery in Zurich was performed in a 3-tesla magnetic
resonance system. This MRT system was retrofitted with the ExAblate 4000
high-energy ultrasound system from the Israeli cooperation partner InSightec to
form a platform for image-guided, non-invasive surgery. Last year at Brigham
and Women’s Hospital in Boston, a small study with high-energy ultrasound was
started with patients suffering from glioblastomas and brain metastases.

Therapeutic ultrasound is on the advance

Whereas high-energy ultrasound in neurosurgery
is still at a very experimental stage, in other areas it has already advanced
significantly. For instance, therapeutic ultrasound has long been used in
urology on prostate carcinomas, but above all in gynaecology for instance, as
an alternative to hysterectomy in infertile women with uterine myomas. At the
Marienhospital in Bottrop (Germany), for example, magnetic-resonance-guided
focused ultrasound (MRgFUS) has been used since last summer, mainly in therapy
for women with uterine myomas. This ultrasound therapy (MR guided Focused
Ultrasound Surgery, MRgFUS) was developed by the American company GE Healthcare
in cooperation with InSightec. Integrated into a special MRT treatment table is
a probe head whose sound waves can melt tissue with precision at specific
points. Similar to a magnifying glass that concentrates sunlight, the
ultrasound wave is focused on a point inside the myoma. A local temperature of
60 to 80 degrees Celsius is created, thereby melting the myoma but sparing the
surrounding tissue. The body then casts off the dead tissue. The temperature
within the body is continuously measured under MRT monitoring so that the
attending physician can follow the progress of therapy and verify its success.

The surgery is an outpatient procedure,
patients can go home just hours later and generally go about their daily chores
the following day. Another decisive advantage for patients of child-bearing age
is that with MRgFUS treatment of myomas their fertility is maintained.  “Because hysterectomy is still the most common
treatment method for symptomatic uterine myomas. However, many patients would
like a treatment option that spares the womb,” explains Dr. Hans-Christian
Kolberg, Chief Physician of Gynaecology and Obstetrics at the Marienhospital.
In addition, the more gentle procedure is also offered as palliative care in
cases of bone metastases. Research is also being carried out in cooperation
with InSightec on the use of MRgFUS to treat mastocarcinoma. The MEDICA 2010 exhibitor
Philips Healthcare’s Sonalleve MR-HIFU is another MRT-guided ultrasound system
for myoma therapy.

“Bloodless scalpel” for an increasing number
of applications

For a long time, oncologist have also been
testing the “bloodless scalpel” on patients with completely different, even
malignant, tumors such as malignomas of the kidneys, liver, pancreas and
bladder. Even primary malignant bone tumors such as osteosarcomas and
chondrosarcomas are now being successfully “attacked” with high-energy
ultrasound, sometimes in combination with chemotherapy, as recently reported by
Chinese scientists (source: „Radiology“ June 2010; 255(3):967-78). Successful
means primarily that patients are spared an amputation (standard therapy in
cases of primary bone malignomas) and that the survival rate and length of
survival are improved.

Perhaps the newest trend in therapeutic
ultrasound is the removal of excess subcutaneous fatty tissue (“love handles”) using
high-energy sound waves. A bloodless and anaesthetic-free procedure such as the
LipoSonix System from Medicis Technologies Corporation in the U.S. offers an
easier option. With this treatment, undesirable fat cells are heated and destroyed
by means of focused high-frequency ultrasound waves that penetrate the skin to
a depth of about 1.5 centimetres. This does not damage the skin, assures Dr.
Ute Gleichmann, who uses this procedure in her private practice in Bad
Oeynhausen. After treatment the wound healing process begins and the destroyed
fat cells are carried off. According to Dr. Gleichmann, waist size can be
reduced by three to four centimetres, i.e. one clothing size. Results are
visible after 8 to 12 weeks. That is the length of time required by the body to
naturally break down the destroyed fat cells. Some patients experience minor
discomfort during the treatment. They may feel cold, slight pricking, tickling,
heat, mild discomfort or pain. After treatment, a temporary redness, small
bruises, mild discomfort and swelling may occur. Most treatments take approximately
45 minutes, depending on the area to be treated. No special diet is required.

Dermatologist Dr. Afschin Fatemi from the
S-Thetic Clinic in Düsseldorf (Germany) reports quite positive results with the
procedure. However, this gentle technique cannot always replace conventional
liposuction. According to the manufacturer, it should not be used on patients
with a BMI of more than 30 kg/m2. And: Patients must carry the cost themselves.

For additional information on the products and
technologies discussed in this article, see MEDICA 2010.