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DOI: 10.1055/s-2001-17913
Kavitation in biologischem Gewebe
Cavitations in Biological TissuesPublikationsverlauf
Publikationsdatum:
18. Oktober 2001 (online)
![](https://www.thieme-connect.de/media/ultraschall/200105/lookinside/thumbnails/10.1055-s-2001-17913-1.jpg)
Zusammenfassung
Ziel: Einer der wohl wichtigsten Gründe für die Beliebtheit und die weite Verbreitung des diagnostischen Ultraschalls ist seine Freiheit von Nebenwirkungen. Mit zunehmender Ausgangsleistung diagnostischer Ultraschallgeräte steigt allerdings, wie im Folgenden beschrieben, die Wahrscheinlichkeit, unerwünschte thermische und mechanische Gewebeeffekte zu induzieren. Methode und Resultate: Insbesondere die in den letzten Jahren steigenden negativen Spitzendrücke der applizierten diagnostischen Ultraschallpulse erhöhen das Risiko, Kavitationen im Körper hervorzurufen. Das Schädigungspotenzial ultraschallinduzierter Kavitationsblasen liegt unter anderem in der Dynamik solcher Blasen, die z. B. im Schallfeld stark oszillieren und somit große Strömungen hervorrufen können, aber auch im möglichen Kollaps der Blasen, bei dem lokal hohe Energien freigesetzt werden. Diese Energiefreisetzung bedingt einige biologisch relevante Sekundäreffekte wie die Bildung von Schockwellen, Flüssigkeitsjets oder auch freier Radikale. Um dem Anwender einen Anhaltspunkt für das Auftreten mechanischer Bioeffekte zu geben, wurde der Mechanische Index (MI) eingeführt, der inzwischen bei fast allen neueren diagnostischen Ultraschallgeräten online angezeigt wird. In zunehmendem Maße werden für die Diagnostik Ultraschall-Kontrastmittel eingesetzt. Es ist davon auszugehen, dass diese kleinen stabilisierten Gasblasen die Schwelle für das Auftreten von Kavitation erniedrigen und somit die Wahrscheinlichkeit biologischer Effekte erhöhen. Mechanische ultraschallbedingte Nebenwirkungen wurden in vielen In-vivo-Studien an Tieren überprüft. Hierbei konnten im Bereich des diagnostischen Ultraschalls nur bei Beschallungen gegen Gas-Gewebe-Grenzschichten - wie sie in Lunge und Darm vorkommen - oder bei hohen Kontrastmitteldosen Nebenwirkungen wie Hämorrhagien oder kapilläre Rupturen festgestellt werden. Schlussfolgerungen: Obwohl in zahlreichen klinischen Studien am Menschen keine ultraschallbedingten Nebenwirkungen beobachtet wurden, sind nach derzeitigem Kenntnisstand Schädigungen möglich. Aus diesem Grund haben Verbände wie z. B. der WFUMB Leitlinien für eine sichere Anwendung von diagnostischem Ultraschall erlassen.
Cavitations in Biological Tissues
Aim: An important reason for the high popularity of diagnostic ultrasound is its lack of hazardous side effects. However, as described below, the probability of inducing undesirable thermal and mechanical effects in tissue increases with a rise in the output of diagnostic ultrasound machines. Methods and Results: The use of increasing negative peak pressures of the applied ultrasound pulse enhances the risk of inducing cavitation inside the body. The potential damage of cavitation results from the dynamic, e. g. wild pulsation, and a collapse of bubbles in the respective sound field. The collapse, especially, releases a high amount of energy, related to secondary effects like shock waves, jet formation and the formation of free radicals. To estimate the likelihood of cavitation and ensuing mechanical biological effects the so-called mechanical index was defined. Nowadays, the mechanical index is displayed in real-time on modern diagnostic ultrasound machines. Echo-contrast agents play an increasing role in sonography. These stabilised gas particles increase the likelihood of cavitation formation and the occurrence of other biological side effects. The potential for mechanically induced side effects of diagnostic ultrasound was tested in many animal studies. As for the use of ultrasound for diagnostic purposes, adverse side effects, like haemorrhage or rupture of capillaries, were only observed in the presence of tissue-gas interfaces - as found in the lung or the intestine - or with high concentrations of contrast media. Conclusion: Even though no adverse effects of diagnostic ultrasound have been reported in humans, potentially damaging effect of advanced ultrasound techniques cannot be denied. Various ultrasound organizations, e. g. WFUMB, have therefore formulated recommendations for the safe use of diagnostic ultrasound.
Schlüsselwörter:
Ultraschalltechniken - Nebenwirkungen - Biologische Schäden - Kavitationen - Mechanischer Index
Key words:
Ultrasound techniques - Side effects - Biological damage - Cavitations - Contrast media - Mechanical index
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Dr. J. Jenne
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