过去必须进行侵入性开放手术才能进入肿瘤块以进行切除或切除。随后开发了微创腹腔镜手术以及基于导管的方法，例如支架置入术、血管内手术、化疗栓塞、近距离放射治疗，这些方法最大限度地减少了副作用并降低了患者的风险。完全无创的手术在降低风险、手术时间、恢复时间、感染可能性或其他副作用方面带来了更多好处。事实证明，将来自体外的超声波专门聚焦在疾病部位是一种安全的无创方法，可用于局部消融热疗、机械消融和靶向药物输送。几十年前就提出了聚焦超声作为一种医疗干预措施，但只有利用先进的放射成像功能来规划、指导、监测和控制治疗过程才变得可行。本次综述的目的是描述执行这些任务的成像能力和方法，重点是磁共振成像和超声。一些程序已经投入临床实践，更多程序处于临床试验阶段。成像完全集成在工作流程中，包括以下内容：（1）规划，定义目标区域和有风险的邻近器官； （2）通过测温成像、空化反馈和运动控制进行实时治疗监测，以确保邻近正常组织的靶向性和安全性； (3)通过评估消融和生理参数（例如血液供应）来评估治疗效果。本综述还重点关注声敏微粒和纳米颗粒，例如注入血液中的微泡。它们能够将超声能量沉积到微血管水平，诱导血管炎症和关闭，加速血栓溶解，并进行靶向药物递送干预，包括局灶性基因递送。尤其令人兴奋的是通过在大脑内所需区域打开血脑屏障来进行无创药物输送的能力。总体而言，图像引导下的聚焦超声正在迅速发展，成为治疗疾病和治愈患者的首选无创介入放射学工具。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 出版

Invasive open surgery used to be compulsory to access tumor mass to perform excision or resection. Development of minimally invasive laparoscopic procedures followed, as well as catheter-based approaches, such as stenting, endovascular surgery, chemoembolization, brachytherapy, which minimize side effects and reduce the risks to patients. Completely noninvasive procedures bring further benefits in terms of reducing risk, procedure time, recovery time, potential of infection, or other side effects. Focusing ultrasound waves from the outside of the body specifically at the disease site has proven to be a safe noninvasive approach to localized ablative hyperthermia, mechanical ablation, and targeted drug delivery. Focused ultrasound as a medical intervention was proposed decades ago, but it only became feasible to plan, guide, monitor, and control the treatment procedures with advanced radiological imaging capabilities. The purpose of this review is to describe the imaging capabilities and approaches to perform these tasks, with the emphasis on magnetic resonance imaging and ultrasound. Some procedures already are in clinical practice, with more at the clinical trial stage. Imaging is fully integrated in the workflow and includes the following: (1) planning, with definition of the target regions and adjacent organs at risk; (2) real-time treatment monitoring via thermometry imaging, cavitation feedback, and motion control, to assure targeting and safety to adjacent normal tissues; and (3) evaluation of treatment efficacy, via assessment of ablation and physiological parameters, such as blood supply. This review also focuses on sonosensitive microparticles and nanoparticles, such as microbubbles injected in the bloodstream. They enable ultrasound energy deposition down to the microvascular level, induce vascular inflammation and shutdown, accelerate clot dissolution, and perform targeted drug delivery interventions, including focal gene delivery. Especially exciting is the ability to perform noninvasive drug delivery via opening of the blood-brain barrier at the desired areas within the brain. Overall, focused ultrasound under image guidance is rapidly developing, to become a choice noninvasive interventional radiology tool to treat disease and cure patients.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.