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Han M, Song W, Lei K, Cai B, Qin D. Ultrasonic Nakagami imaging for automatically positioning and identifying the treated lesion induced by histotripsy. ULTRASONICS SONOCHEMISTRY 2024; 109:107002. [PMID: 39084943 PMCID: PMC11384263 DOI: 10.1016/j.ultsonch.2024.107002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
Histotripsy has been proposed as a non-invasive surgical procedure for clinical use that liquefies the tissue into acellular debris by utilizing the mechanical mechanism of bubbles. Accurate and reliable imaging guidance is essential for successful clinical histotripsy implementation. Nakagami imaging is a promising method to evaluate the microstructural change induced by high intensity focused ultrasound. However, practically, it is difficult for the Nakagami imaging to distinguish the treated lesion induced by histotripsy from the surrounding normal biological tissues. In this study, we introduce the use of noise-assisted correlation algorithm (NCA) in Nakagami images as a solution to suppress the background normal tissue and identify the treated lesion induced by histotripsy. Experiments are conducted on fresh porcine liver ex vivo by cavitation-cloud histotripsy. Results show that the contrast-to-noise ratio between the treated lesion and surrounding tissue corresponding to the Nakagami image after NCA and original Nakagami image is 3.434 and 0.505, respectively. The optimal artificial noise level is 1-fold of the background normal tissue amplitude, and the corresponding optimal threshold of correlation coefficient should be between 0.6 and 0.8 in the application of NCA. Therefore, the use of NCA in Nakagami image can suppress the background normal tissues without affecting the information of treated lesion for an appropriate artificial noise level and threshold used in the NCA. Moreover, the Nakagami images after the application of the NCA can also be used for automatically distinguishing and measuring the tissue fractionation accurately using binarization. The proposed Nakagami images overlaid on the B-mode images can provide a promising method for positioning and visualizing the treated lesion to achieve precise histotripsy treatment.
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Affiliation(s)
- Meng Han
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang 471023, People's Republic of China.
| | - Weidong Song
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang 471023, People's Republic of China
| | - Kun Lei
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang 471023, People's Republic of China
| | - Bianyun Cai
- School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang 471023, People's Republic of China
| | - Dui Qin
- Department of Biomedical Engineering, School of Life Health Information Science and Engineering, Chongqing University of Posts and Telecommunications, Chongqing, People's Republic of China; Postdoctoral Workstation of Chongqing General Hospital, Chongqing, People's Republic of China.
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O'Reilly MA. Exploiting the mechanical effects of ultrasound for noninvasive therapy. Science 2024; 385:eadp7206. [PMID: 39265013 DOI: 10.1126/science.adp7206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/07/2024] [Indexed: 09/14/2024]
Abstract
Focused ultrasound is a platform technology capable of eliciting a wide range of biological responses with high spatial precision deep within the body. Although focused ultrasound is already in clinical use for focal thermal ablation of tissue, there has been a recent growth in development and translation of ultrasound-mediated nonthermal therapies. These approaches exploit the physical forces of ultrasound to produce a range of biological responses dependent on exposure conditions. This review discusses recent advances in four application areas that have seen particular growth and have immense clinical potential: brain drug delivery, neuromodulation, focal tissue destruction, and endogenous immune system activation. Owing to the maturation of transcranial ultrasound technology, the brain is a major target organ; however, clinical indications outside the brain are also discussed.
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Affiliation(s)
- Meaghan A O'Reilly
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Mendiratta-Lala M, Wiggermann P, Pech M, Serres-Créixams X, White SB, Davis C, Ahmed O, Parikh ND, Planert M, Thormann M, Xu Z, Collins Z, Narayanan G, Torzilli G, Cho C, Littler P, Wah TM, Solbiati L, Ziemlewicz TJ. The #HOPE4LIVER Single-Arm Pivotal Trial for Histotripsy of Primary and Metastatic Liver Tumors. Radiology 2024; 312:e233051. [PMID: 39225612 PMCID: PMC11427859 DOI: 10.1148/radiol.233051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Histotripsy is a nonthermal, nonionizing, noninvasive, focused US technique that relies on cavitation for mechanical tissue breakdown at the focal point. Preclinical data have shown its safety and technical success in the ablation of liver tumors. Purpose To evaluate the safety and technical success of histotripsy in destroying primary or metastatic liver tumors. Materials and Methods The parallel United States and European Union and England #HOPE4LIVER trials were prospective, multicenter, single-arm studies. Eligible patients were recruited at 14 sites in Europe and the United States from January 2021 to July 2022. Up to three tumors smaller than 3 cm in size could be treated. CT or MRI and clinic visits were performed at 1 week or less preprocedure, at index-procedure, 36 hours or less postprocedure, and 30 days postprocedure. There were co-primary end points of technical success of tumor treatment and absence of procedure-related major complications within 30 days, with performance goals of greater than 70% and less than 25%, respectively. A two-sided 95% Wilson score CI was derived for each end point. Results Forty-four participants (21 from the United States, 23 from the European Union or England; 22 female participants, 22 male participants; mean age, 64 years ± 12 [SD]) with 49 tumors were enrolled and treated. Eighteen participants (41%) had hepatocellular carcinoma and 26 (59%) had non-hepatocellular carcinoma liver metastases. The maximum pretreatment tumor diameter was 1.5 cm ± 0.6 and the maximum post-histotripsy treatment zone diameter was 3.6 cm ± 1.4. Technical success was observed in 42 of 44 treated tumors (95%; 95% CI: 84, 100) and procedure-related major complications were reported in three of 44 participants (7%; 95% CI: 2, 18), both meeting the performance goal. Conclusion The #HOPE4LIVER trials met the co-primary end-point performance goals for technical success and the absence of procedure-related major complications, supporting early clinical adoption. Clinical trial registration nos. NCT04572633, NCT04573881 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Nezami and Georgiades in this issue.
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Affiliation(s)
- Mishal Mendiratta-Lala
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Philipp Wiggermann
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Maciej Pech
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Xavier Serres-Créixams
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Sarah B White
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Clifford Davis
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Osman Ahmed
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Neehar D Parikh
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Mathis Planert
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Maximilian Thormann
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Zhen Xu
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Zachary Collins
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Govindarajan Narayanan
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Guido Torzilli
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Clifford Cho
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Peter Littler
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Tze Min Wah
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Luigi Solbiati
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
| | - Timothy J Ziemlewicz
- From the Department of Radiology, University of Michigan Medicine, Ann Arbor, Mich (M.M.L., N.D.P., C.C.); Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig, Braunschweig, Germany (P.W., M.P.); Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany (M.P., M.T.); Department of Radiology, Vall d'Hebrón University Hospital, Barcelona, Spain (X.S.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); Department of Radiology, Tampa General Hospital, Tampa, Fla (C.D.); Department of Interventional Radiology, University of Chicago Pritzker School of Medicine, Chicago, Ill (O.A.); Departments of Biomedical Engineering, Radiology, and Neurosurgery, University of Michigan, Ann Arbor, Mich (Z.X.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (Z.C.); Department of Interventional Radiology, Baptist Hospital of Miami, Miami, Fla (G.N.); Department of Biomedical Science, Humanitas University & Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy (G.T., L.S.); Department of Radiology, Freeman Hospital, Newcastle, United Kingdom (P.L.); Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospital and Trust, West Yorkshire, United Kingdom (T.M.W.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (T.J.Z.)
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Samaddar A, Singh R, Yang X, Ebersole KC, Forrest ML. Investigating the potential of catheter-assisted pulsed focused ultrasound ablation for atherosclerotic plaques. Med Phys 2024; 51:5181-5189. [PMID: 38873842 PMCID: PMC11409400 DOI: 10.1002/mp.17253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Atherosclerosis is a condition in which an adhesive substance called plaque accumulates over time inside the arteries. Plaque buildup results in the constriction of arteries, causing a shortage of blood supply to tissues and organs. Removing atherosclerotic plaques controls the development of acute ischemic stroke and heart diseases. It remains imperative for positive patient outcomes. PURPOSE This study sought to develop a minimally invasive technique for removing arterial plaques by applying focused ultrasound (FUS) energy on the metal surface of a nitinol catheter wire to induce inertial cavitation. The induced cavitation can deplete plaque mechanically inside the arteries, leading towards improved recanalization of blood vessels. METHODS The enhanced cavitation effect induced by combining FUS with a metal catheter was first verified by exposing agar phantom gels with or without a 0.9-mm diameter nitinol wire to an acoustic field produced by a 0.5-MHz FUS transducer. The phenomenon was further confirmed in pork belly fat samples with or without a 3-mm diameter nitinol catheter wire. Cavitation was monitored by detecting the peaks of emitted ultrasound signals from the samples using a passive cavitation detector (PCD). Cavitation threshold values were determined by observing the jump in the peak amplitude of signals received by the PCD when the applied FUS peak negative pressure (PNP) increased. To simulate arterial plaque removal, FUS with or without a catheter was used to remove tissues from pork belly fat samples and the lipid cores of human atherosclerotic plaque samples using 2500-cycle FUS bursts at 10% duty cycle and a burst repetition rate of 20 Hz. Treatment outcomes were quantified by subtracting the weight of samples before treatment from the weight of samples after treatment. All measurements were repeated 5 times (n = 5) unless otherwise indicated, and paired t-tests were used to compare the means of two groups. A p-value of <0.05 will be considered significant. RESULTS Our results showed that with a nitinol wire, the cavitation threshold in agar phantoms was reduced to 2.6 MPa from 4.3 MPa PNP when there was no nitinol wire in the focal region of FUS. For pork belly fat samples, cavitation threshold values were 1.0 and 2.0 MPa PNP, with and without a catheter wire, respectively. Pork belly fat tissues and lipid cores of atherosclerotic plaques were depleted at the interface between a catheter and the samples at 2 and 4 MPa FUS PNP, respectively. The results showed that with a catheter wire in the focal region of a 3-min FUS treatment session, 24.7 and 25.6 mg of lipid tissues were removed from pork belly fat and human atherosclerotic samples, respectively. In contrast, the FUS-only group showed no reduction in sample weight. The differences between FUS-only and FUS-plus-catheter groups were statistically significant (p < 0.001 for the treatment on pork belly samples, and p < 0.01 for the treatment on human atherosclerotic samples). CONCLUSION This study demonstrated the feasibility of catheter-assisted FUS therapy for removing atherosclerotic plaques.
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Affiliation(s)
- Abhirup Samaddar
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Rohit Singh
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Koji C Ebersole
- Department of Neurosurgery, the University of Kansas Medical Center, Kansas City, Kansas, USA
| | - M Laird Forrest
- Department of Pharmaceutical Chemistry, the University of Kansas, Lawrence, Kansas, USA
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Xu Z, Khokhlova TD, Cho CS, Khokhlova VA. Histotripsy: A Method for Mechanical Tissue Ablation with Ultrasound. Annu Rev Biomed Eng 2024; 26:141-167. [PMID: 38346277 DOI: 10.1146/annurev-bioeng-073123-022334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Histotripsy is a relatively new therapeutic ultrasound technology to mechanically liquefy tissue into subcellular debris using high-amplitude focused ultrasound pulses. In contrast to conventional high-intensity focused ultrasound thermal therapy, histotripsy has specific clinical advantages: the capacity for real-time monitoring using ultrasound imaging, diminished heat sink effects resulting in lesions with sharp margins, effective removal of the treated tissue, a tissue-selective feature to preserve crucial structures, and immunostimulation. The technology is being evaluated in small and large animal models for treating cancer, thrombosis, hematomas, abscesses, and biofilms; enhancing tumor-specific immune response; and neurological applications. Histotripsy has been recently approved by the US Food and Drug Administration to treat liver tumors, with clinical trials undertaken for benign prostatic hyperplasia and renal tumors. This review outlines the physical principles of various types of histotripsy; presents major parameters of the technology and corresponding hardware and software, imaging methods, and bioeffects; and discusses the most promising preclinical and clinical applications.
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Affiliation(s)
- Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA;
| | - Tatiana D Khokhlova
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Clifford S Cho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Vera A Khokhlova
- Department of Acoustics, Lomonosov Moscow State University, Moscow, Russia
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Verma Y, Perera Molligoda Arachchige AS. Advances in Tumor Management: Harnessing the Potential of Histotripsy. Radiol Imaging Cancer 2024; 6:e230159. [PMID: 38639585 PMCID: PMC11148838 DOI: 10.1148/rycan.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
Tissue ablation techniques have long been used in clinical settings to treat various oncologic diseases. However, many of these techniques are invasive and can cause substantial adverse effects. Histotripsy is a noninvasive, nonionizing, nonthermal tissue ablation technique that has the potential to replace surgical interventions in various clinical settings. Histotripsy works by delivering high-intensity focused ultrasound waves to target tissue. These waves create cavitation bubbles within tissues that rapidly expand and collapse, thereby mechanically fractionating the tissue into acellular debris that is subsequently absorbed by the body's immune system. Preclinical and clinical studies have demonstrated the efficacy of histotripsy in treating a range of diseases, including liver, pancreatic, renal, and prostate tumors. Safety outcomes of histotripsy have been generally favorable, with minimal adverse effects reported. However, further studies are needed to optimize the technique and understand its long-term effects. This review aims to discuss the importance of histotripsy as a noninvasive tissue ablation technique, the preclinical and clinical literature on histotripsy and its safety, and the potential applications of histotripsy in clinical practice. Keywords: Tumor Microenvironment, Ultrasound-High-Intensity Focused (HIFU), Ablation Techniques, Abdomen/GI, Genital/Reproductive, Nonthermal Tissue Ablation, Histotripsy, Clinical Trials, Preclinical Applications, Focused Ultrasound © RSNA, 2024.
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Kutlu AZ, Minesinger GM, Laeseke PF, Speidel M, Wagner MG. A target containing phantom for accuracy assessment of cone-beam CT-guided histotripsy. J Appl Clin Med Phys 2024; 25:e14329. [PMID: 38497567 PMCID: PMC11087156 DOI: 10.1002/acm2.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Histotripsy is a nonionizing, noninvasive, and nonthermal focal tumor therapy. Cone-beam computed tomography (CBCT) guidance was developed for targeting tumors not visible on ultrasound. This approach assumes cavitation is formed at the geometrical focal point of the therapy transducer. In practice, the exact location might vary slightly between transducers. In this study, we present a phantom with an embedded target to evaluate CBCT-guided histotripsy accuracy and assess the completeness of treatments. METHODS Spherical (2.8 cm) targets with alternating layers of agar and radiopaque barium were embedded in larger phantoms with similar layers. The layer geometry was designed so that targets were visible on pre-treatment CBCT scans. The actual histotripsy treatment zone was visualized via the mixing of adjacent barium and agar layers in post-treatment CBCT images. CBCT-guided histotripsy treatments of the targets were performed in six phantoms. Offsets between planned and actual treatment zones were measured and used for calibration refinement. To measure targeting accuracy after calibration refinement, six additional phantoms were treated. In a separate investigation, two groups (N = 3) of phantoms were treated to assess visualization of incomplete treatments ("undertreatment" group: 2 cm treatment within 2.8 cm tumor, "mistarget" group: 2.8 cm treatment intentionally shifted laterally). Treatment zones were segmented (3D Slicer 5.0.3), and the centroid distance between the prescribed target and actual treatment zones was quantified. RESULTS In the calibration refinement group, a 2 mm offset in the direction of ultrasound propagation (Z) was measured. After calibration refinement, the centroid-to-centroid distance between prescribed and actual treatment volumes was 0.5 ± 0.2 mm. Average difference between the prescribed and measured treatment sizes in the incomplete treatment groups was 0.5 ± 0.7 mm. In the mistarget group, the distance between prescribed and measured shifts was 0.2 ± 0.1 mm. CONCLUSION The proposed prototype phantom allowed for accurate measurement of treatment size and location, and the CBCT visible target provided a simple way to detect misalignments for preliminary quality assurance of CBCT-guided histotripsy.
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Affiliation(s)
- Ayca Z. Kutlu
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Grace M. Minesinger
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Paul F. Laeseke
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Biomedical EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Michael Speidel
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Martin G. Wagner
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Maxwell AD, Vlaisavljevich E. Cavitation-induced pressure saturation: a mechanism governing bubble nucleation density in histotripsy. Phys Med Biol 2024; 69:10.1088/1361-6560/ad3721. [PMID: 38518377 PMCID: PMC11212395 DOI: 10.1088/1361-6560/ad3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/22/2024] [Indexed: 03/24/2024]
Abstract
Objective.Histotripsy is a noninvasive focused ultrasound therapy that mechanically disintegrates tissue by acoustic cavitation clouds. In this study, we investigate a mechanism limiting the density of bubbles that can nucleate during a histotripsy pulse. In this mechanism, the pressure generated by the initial bubble expansion effectively negates the incident pressure in the vicinity of the bubble. From this effect, the immediately adjacent tissue is prevented from experiencing the transient tension to nucleate bubbles. Approach.A Keller-Miksis-type single-bubble model was employed to evaluate the dependency of this effect on ultrasound pressure amplitude and frequency, viscoelastic medium properties, bubble nucleus size, and transducer geometric focusing. This model was further combined with a spatial propagation model to predict the peak negative pressure field as a function of position from a cavitating bubble.Main results. The single-bubble model showed the peak negative pressure near the bubble surface is limited to the inertial cavitation threshold. The predicted bubble density increased with increasing frequency, tissue viscosity, and transducer focusing angle. The simulated results were consistent with the trends observed experimentally in prior studies, including changes in density with ultrasound frequency and transducerF-number.Significance.The efficacy of the therapy is dependent on several factors, including the density of bubbles nucleated within the cavitation cloud formed at the focus. These results provide insight into controlling the density of nucleated bubbles during histotripsy and the therapeutic efficacy.
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Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, WA, 98195, United States of America
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, United States of America
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, United States of America
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Iqbal MF, Shafique MA, Abdur Raqib M, Fadlalla Ahmad TK, Haseeb A, M. A. Mhjoob A, Raja A. Histotripsy: an innovative approach for minimally invasive tumour and disease treatment. Ann Med Surg (Lond) 2024; 86:2081-2087. [PMID: 38576932 PMCID: PMC10990312 DOI: 10.1097/ms9.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
Histotripsy is a noninvasive medical technique that uses high-intensity focused ultrasound (HIFU) to treat liver tumours. The two main histotripsy methods are boiling histotripsy and cavitation cloud histotripsy. Boiling histotripsy uses prolonged ultrasound pulses to create small boiling bubbles in the tissue, which leads to the breakdown of the tissue into smaller subcellular fragments. Cavitation cloud histotripsy uses the ultrasonic cavitation effect to disintegrate target tissue into precisely defined liquefied lesions. Both methods show similar treatment effectiveness; however, boiling histotripsy ensures treatment stability by producing a stable boiling bubble with each pulse. The therapeutic effect is ascribed to mechanical damage at the subcellular level rather than thermal damage. This article discusses the mechanisms, treatment parameters, and potential of histotripsy as a minimally invasive procedure that provides precise and controlled subcellular damage.
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Affiliation(s)
| | | | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University
| | | | - Adarsh Raja
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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Ashida R, Kawabata KI, Asami R, Kitano M. Novel treatment system using endoscopic ultrasound-guided high-intensity focused ultrasound: A proof-of-concept study. Pancreatology 2024; 24:88-92. [PMID: 38036413 DOI: 10.1016/j.pan.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023]
Abstract
AIM High-intensity focused ultrasound (HIFU) is a novel minimally invasive local treatment of solid tumors. Endoscopic ultrasound-guided HIFU (EUS-HIFU) using mechanical effects would have potential benefits, including precise detection of target lesions and enhance drug delivery. The aim of this study is to develop EUS-HIFU device and to prove our concept in porcine model using a locally injected phase change nano droplet (PCND) as the sensitizer. METHOD A phospholipid PCND contained volatile perfluoro-carbon liquids. The prototype HIFU apparatus comprised a small (20 × 20 mm) transducer with center frequency of 2.1 MHz, attachable to a linear EUS transducer. Under general anesthetic, a single porcine received EUS-guided injection of PCND. The HIFU transducer was placed laparotomically in the stomach, and the liver was ablated through the gastric wall. RESULTS PCND was injected successfully and a distinct lesion was generated at the HIFU transducer focus only in injected areas that received HIFU exposure at 4.7 kW/cm2 at a duty cycle of 5 % (mean temporal intensity, 0.245 kW/cm2) for 30 s. The generated lesions were mechanically fractionated in macroscopic view. CONCLUSION The concept of transluminal HIFU ablation using novel EUS-HIFU system was proved in a porcine animal model. This novel treatment system has great potential for future cancer treatment although further investigation in more animals and different organs are warranted.
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Affiliation(s)
- Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
| | | | - Rei Asami
- Imaging Technology Center, FUJIFILM Corporation, Tokyo, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Worlikar T, Hall T, Zhang M, Mendiratta-Lala M, Green M, Cho CS, Xu Z. Insights from in vivo preclinical cancer studies with histotripsy. Int J Hyperthermia 2024; 41:2297650. [PMID: 38214171 PMCID: PMC11102041 DOI: 10.1080/02656736.2023.2297650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024] Open
Abstract
Histotripsy is the first noninvasive, non-ionizing, and non-thermal ablation technique that mechanically fractionates target tissue into acellular homogenate via controlled acoustic cavitation. Histotripsy has been evaluated for various preclinical applications requiring noninvasive tissue removal including cancer, brain surgery, blood clot and hematoma liquefaction, and correction of neonatal congenital heart defects. Promising preclinical results including local tumor suppression, improved survival outcomes, local and systemic anti-tumor immune responses, and histotripsy-induced abscopal effects have been reported in various animal tumor models. Histotripsy is also being investigated in veterinary patients with spontaneously arising tumors. Research is underway to combine histotripsy with immunotherapy and chemotherapy to improve therapeutic outcomes. In addition to preclinical cancer research, human clinical trials are ongoing for the treatment of liver tumors and renal tumors. Histotripsy has been recently approved by the FDA for noninvasive treatment of liver tumors. This review highlights key learnings from in vivo shock-scattering histotripsy, intrinsic threshold histotripsy, and boiling histotripsy cancer studies treating cancers of different anatomic locations and discusses the major considerations in planning in vivo histotripsy studies regarding instrumentation, tumor model, study design, treatment dose, and post-treatment tumor monitoring.
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Affiliation(s)
- Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Man Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Michael Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Radiation Oncology, Ann Arbor VA Healthcare, Ann Arbor, Michigan, USA
| | - Clifford S. Cho
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, Michigan, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Simon A, Edsall C, Maxwell A, Vlaisavljevich E. Effects of pulse repetition frequency on bubble cloud characteristics and ablation in single-cycle histotripsy. Phys Med Biol 2024; 69:025018. [PMID: 38041873 DOI: 10.1088/1361-6560/ad11a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/01/2023] [Indexed: 12/04/2023]
Abstract
Objective. Histotripsy is a cavitation-based ultrasound ablation method in development for multiple clinical applications. This work investigates the effects of pulse repetition frequency (PRF) on bubble cloud characteristics and ablative capabilities for histotripsy using single-cycle pulsing methods.Approach.Bubble clouds produced by a 500 kHz histotripsy system at PRFs from 0.1 to 1000 Hz were visualized using high-speed optical imaging in 1% agarose tissue phantoms at peak negative pressures,p-, of 2-36 MPa.Main results.Results showed a decrease in the cavitation cloud threshold with increasing PRF, ranging from 26.7 ± 0.5 MPa at 0.1 Hz to 15.0 ± 1.9 MPa at 1000 Hz. Bubble cloud analysis showed cavitation clouds generated at low PRFs (0.1-1 Hz) were characterized by consistently dense bubble clouds (41.7 ± 2.8 bubbles mm-2at 0.1 Hz), that closely matched regions of the focus above the histotripsy intrinsic threshold. Bubble clouds formed at higher PRFs measured lower cloud densities (23.1 ± 4.0 bubbles mm-2at 1000 Hz), with the lowest density measured for 10 Hz (8.8 ± 4.1 bubbles mm-2). Furthermore, higher PRFs showed increased pulse-to-pulse correlation, characteristic of cavitation memory effects; however, bubble clouds still filled the entire volume of the focus due to their initial density and enhanced bubble expansion from the restimulation of residual nuclei at the higher PRFs. Histotripsy ablation assessed through lesion analysis in red blood cell (RBC) phantoms showed higher PRFs generated lesions with lower adherence to the initial focal region compared to low PRF ablations; however, no trend of decreasing ablation efficiency with PRF was observed, with similar efficiencies observed for all the PRFs tested in this study.Significance.Notably, this result is different than what has previously been shown for shock-scattering histotripsy, which has shown decreased ablation efficiencies at higher PRFs. Overall, this study demonstrates the essential effects of PRF on single-cycle histotripsy procedures that should be considered to help guide future histotripsy pulsing strategies.
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Affiliation(s)
- Alex Simon
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States of America
| | - Connor Edsall
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States of America
| | - Adam Maxwell
- Department of Urology, University of Washington, Seattle, WA, United States of America
| | - Eli Vlaisavljevich
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States of America
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Nakla T, Chow JJ, Pham K, Abi-Jaoudeh N. Non-Thermal Liver Ablation: Existing and New Technology. Semin Intervent Radiol 2023; 40:497-504. [PMID: 38274216 PMCID: PMC10807968 DOI: 10.1055/s-0043-1777844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Cancer has and continues to be a complex health crisis plaguing millions around the world. Alcohol ablation was one of the initial methods used for the treatment of liver lesions. It was surpassed by thermal ablation which has played a big role in the therapeutic arsenal for primary and metastatic liver tumors. However, thermal ablation has several shortcomings and limitations that prompted the development of alternative technologies including electroporation and histotripsy. Percutaneous alcohol injection in the liver lesion leads to dehydration and coagulative necrosis. This technology is limited to the lesion with relative sparing of the surrounding tissue, making it safe to use adjacent to sensitive structures. Electroporation utilizes short high-voltage pulses to permeabilize the cell membrane and can result in cell death dependent on the threshold reached. It can effectively target the tumor margins and has lower damage rates to surrounding structures due to the short pulse duration. Histotripsy is a novel technology, and although the first human trial was just completed, its results are encouraging, given the sharp demarcation of the targeted tissue, lack of thermal damage, and potential for immunomodulation of the tumor microenvironment. Herein, we discuss these techniques, their uses, and overall clinical benefit.
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Affiliation(s)
- Tiffany Nakla
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada
| | - Jacqueline J. Chow
- School of Medicine, University of California, Irvine, Irvine, California
| | - Kathleen Pham
- Department of Radiological Sciences, University of California, Irvine, Irvine, California
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, Irvine, California
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Qi T, Jing Y, Deng J, Chang J, Sun W, Yang R, Liu X, Zhang Q, Wan M, Lu M. Boiling Histotripsy Using Dual-Frequency Protocol on Murine Breast Tumor Model and Promotes Immune Activation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1773-1785. [PMID: 37871099 DOI: 10.1109/tuffc.2023.3326561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Histotripsy is an ultrasound-guided, noninvasive, nonthermal ablation therapy that can mechanically lyse target tissues. There have been no reports of enhanced histotripsy for large-volume triple-negative breast cancer (TNBC). This study aims to verify the ability of a novel approach of dual-frequency mode combined with two-stage millisecond-length ultrasound pulses (DF-TS) to accelerate the treatment of murine subcutaneous 4T1 tumors and determine immune changes after treatment. A custom-designed 1.1-/2.2-MHz two-element confocal-annular array was used to treat approximately 6-mm tumors under ultrasound guidance and real-time monitoring. Two-stage millisecond-length ultrasound pulses were used to generate approximate cuboid ablation volumes (diagonal 5-6 mm) within each tumor, with a dose of 100 pulses/point. Immune effects were characterized by changes of pro-inflammatory cytokine levels and infiltration levels of immune cells. In all targeted treatment areas, bubble cloud activity was visualized by ultrasound monitoring. The novel protocol resulted in elliptical and controllable sized lesions, reducing the number of scanning points, and was generally well tolerated. After treatment, tumor growth experienced a seven-day stagnation period, the survival period of mice was prolonged, and the levels of pro-inflammatory cytokines and immune cell infiltration increased. This study demonstrates that DF-TS boiling histotripsy (BH) has a noninvasive, efficient, and precise ablation ability for TNBC and potentially enhances immune responses.
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15
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Edsall C, Huynh L, Hall TL, Vlaisavljevich E. Bubble cloud characteristics and ablation efficiency in dual-frequency intrinsic threshold histotripsy. Phys Med Biol 2023; 68:225006. [PMID: 37797649 PMCID: PMC10627095 DOI: 10.1088/1361-6560/ad00a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 10/07/2023]
Abstract
Histotripsy is a non-thermal focused ultrasound ablation method that destroys tissue through the generation and activity of acoustic cavitation bubble clouds. Intrinsic threshold histotripsy uses single-cycle pulses to generate bubble clouds when the dominant negative pressure phase exceeds an intrinsic threshold of ∼25-30 MPa. The ablation efficiency is dependent upon the size and density of bubbles within the bubble cloud. This work investigates the effects of dual-frequency pulsing schemes on the bubble cloud behavior and ablation efficiency in intrinsic threshold histotripsy. A modular 500 kHz:3 MHz histotripsy transducer treated agarose phantoms using dual-frequency histotripsy pulses with a 1:1 pressure ratio from 500 kHz and 3 MHz frequency elements and varying arrival times for the 3 MHz pulse relative to the arrival of the 500 kHz pulse (-100 ns, 0 ns, and +100 ns). High-speed optical imaging captured cavitation effects to characterize bubble cloud and individual bubble dynamics. The effects of dual-frequency pulsing on lesion formation and ablation efficiency were also investigated in red blood cell (RBC) phantoms. Results showed that the single bubble and bubble cloud size for dual-frequency cases were intermediate to published results for the component single-frequencies of 500 kHz and 3 MHz. Additionally, bubble cloud size and dynamics were shown to be altered by the arrival time of the 3 MHz pulse with respect to the 500 kHz pulse, with more uniform cloud expansion and collapse observed for early (-100 ns) arrival. Finally, RBC phantom experiments showed that dual-frequency exposures were capable of generating precise lesions with smaller areas and higher ablation efficiencies than previously published results for 500 kHz or 3 MHz. Overall, results demonstrate dual-frequency histotripsy's ability to modulate bubble cloud size and dynamics can be leveraged to produce precise lesions at higher ablation efficiencies than previously observed for single-frequency pulsing.
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Affiliation(s)
- Connor Edsall
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, 325 Stanger St., Blacksburg, VA, 24061, United States of America
| | - Laura Huynh
- Department of Materials Science and Engineering, Virginia Polytechnic Institute and State University, 445 Old Turner St., Blacksburg, VA 24061, United States of America
| | - Timothy L Hall
- Biomedical Engineering, University of Michigan, Carl A. Gerstacker Building, 2200 Bonisteel Blvd, Ann Arbor, MI 48109-2133, United States of America
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, 325 Stanger St., Blacksburg, VA, 24061, United States of America
- ICTAS Center for Engineered Health, Virginia Polytechnic Institute and State University, 325 Stanger St., Blacksburg, VA, 24061, United States of America
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16
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Imran KM, Gannon J, Morrison HA, Tupik JD, Tintera B, Nagai-Singer MA, Ivester H, Madanick JM, Hendricks-Wenger A, Uh K, Luyimbazi DT, Edwards M, Coutermarsh-Ott S, Eden K, Byron C, Clark-Deener S, Lee K, Vlaisavljevich E, Allen IC. Successful In Situ Targeting of Pancreatic Tumors in a Novel Orthotopic Porcine Model Using Histotripsy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2361-2370. [PMID: 37596154 PMCID: PMC10529075 DOI: 10.1016/j.ultrasmedbio.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE New therapeutic strategies and paradigms are direly needed to treat pancreatic cancer. The absence of a suitable pre-clinical animal model of pancreatic cancer is a major limitation to biomedical device and therapeutic development. Traditionally, pigs have proven to be ideal models, especially in the context of designing human-sized instruments, perfecting surgical techniques and optimizing clinical procedures for use in humans. However, pig studies have typically focused on healthy tissue assessments and are limited to general safety evaluations because of the inability to effectively model human tumors. METHODS Here, we establish an orthotopic porcine model of human pancreatic cancer using RAG2/IL2RG double-knockout immunocompromised pigs and treat the tumors ex vivo and in vivo with histotripsy. RESULTS Using these animals, we describe the successful engraftment of Panc-1 human pancreatic cancer cell line tumors and characterize their development. To illustrate the utility of these animals for therapeutic development, we determine for the first time, the successful targeting of in situ pancreatic tumors using histotripsy. Treatment with histotripsy resulted in partial ablation in vivo and reduction in collagen content in both in vivo tumor in pig pancreas and ex vivo patient tumor. CONCLUSION This study presents a first step toward establishing histotripsy as a non-invasive treatment method for pancreatic cancer and exposes some of the challenges of ultrasound guidance for histotripsy ablation in the pancreas. Simultaneously, we introduce a highly robust model of pancreatic cancer in a large mammal model that could be used to evaluate a variety biomedical devices and therapeutic strategies.
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Affiliation(s)
- Khan Mohammad Imran
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Holly A Morrison
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Juselyn D Tupik
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Benjamin Tintera
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Margaret A Nagai-Singer
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Hannah Ivester
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Justin Markov Madanick
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Alissa Hendricks-Wenger
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Kyungjun Uh
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, Columbia, MO, USA
| | - David T Luyimbazi
- Department of Surgery, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Michael Edwards
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kristin Eden
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Christopher Byron
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Sherrie Clark-Deener
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kiho Lee
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, Columbia, MO, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
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17
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Li H, He H, Tang J, Luo T, Yang G, Huang L, Dong X, Liu Z. A new sonoablation using acoustic droplet vaporization and focused ultrasound: A feasibility study. Med Phys 2023; 50:6663-6672. [PMID: 37731063 DOI: 10.1002/mp.16742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histotripsy and boiling histotripsy are two methods of mechanical ablation that use high-pressure focused ultrasound (FUS). PURPOSE Here, a new bubble sonoablation technique was investigated using low-pressure FUS in combination with local injection of perfluoropentane (PFP) in rabbit liver. METHODS Fifteen healthy New Zealand white rabbits were treated with FUS alone, FUS + PFP or PFP alone. FUS was performed using a single-element focused transducer (frequency 596 kHz, 0.27 ms pulses, 0.54% duty cycle, and peak negative pressure 2.0 MPa). Ten minutes before FUS treatment, the PFP droplet was locally injected into the rabbit liver, where the ultrasound was focused. Contrast-enhanced ultrasound (CEUS) of the liver was performed, and the temperature at the liver surface in the targeted liver region was recorded during treatment. The livers were collected for pathological examination. Statistical significance was set at p < 0.05. Paired t-tests were used to compare the pre- and post-treatment values. One-way analysis of variance was performed to compare multiple groups, and the least significant difference method was used for further comparisons between the two groups. RESULTS Analysis of CEUS data showed that the values of area under the curve (AUC) were significantly different in the PFP + FUS group pre- (10453.644 ± 1182.93) and post-treatment (4058.098 ± 2720.41), and the AUC values of PFP + FUS post-treatment (4058.098 ± 2720.41) were also significantly lower than those of the FUS (9946.694 ± 1071.54) and the PFP (10364.794 ± 2181.53) groups. The peak intensity values also showed the same results, the value of peak intensity of PFP+FUS post-treatment was 82.958 ± 13.99, whereas there was no difference between FUS (106.61 ± 7.61) and PFP (104.136 ± 10.55). Hematoxylin and eosin (H&E) staining revealed that the pathological damage ratings of the PFP + FUS, PFP, and FUS groups were grade 3, grade 1, and grade 0, respectively. Specifically, the area of liver necrosis in the PFP + FUS group (0.99 ± 0.29 cm2 ) was 198 times higher than that in the PFP group (0.005 ± 0.008 cm2 ), whereas no necrosis was observed in the livers treated with FUS alone. Simultaneously, the number of vacuoles in the liver of the PFP + FUS group (35.50 ± 23.31) was approximately five times that of the PFP group (7.00 ± 12.88), whereas no vacuoles were found in the liver treated with FUS alone. CONCLUSION PFP droplets combined with FUS can destroy liver tissue and cause tissue necrosis in the droplet injection area, without affecting the structure of surrounding tissue.
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Affiliation(s)
- Hui Li
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huan He
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jiawei Tang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Tingting Luo
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Guoliang Yang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Leidan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaoxiao Dong
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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18
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Falk KL, Laeseke PF, Kisting MA, Zlevor AM, Knott EA, Smolock AR, Bradley C, Vlaisavljevich E, Lee FT, Ziemlewicz TJ. Clinical translation of abdominal histotripsy: a review of preclinical studies in large animal models. Int J Hyperthermia 2023; 40:2272065. [PMID: 37875279 PMCID: PMC10629829 DOI: 10.1080/02656736.2023.2272065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Histotripsy is an emerging noninvasive, non-thermal, and non-ionizing focused ultrasound (US) therapy that can be used to destroy targeted tissue. Histotripsy has evolved from early laboratory prototypes to clinical systems which have been comprehensively evaluated in the preclinical environment to ensure safe translation to human use. This review summarizes the observations and results from preclinical histotripsy studies in the liver, kidney, and pancreas. Key findings from these studies include the ability to make a clinically relevant treatment zone in each organ with maintained collagenous architecture, potentially allowing treatments in areas not currently amenable to thermal ablation. Treatments across organ capsules have proven safe, including in anticoagulated models which may expand patients eligible for treatment or eliminate the risk associated with taking patients off anti-coagulation. Treatment zones are well-defined with imaging and rapidly resorb, which may allow improved evaluation of treatment zones for residual or recurrent tumor. Understanding the effects of histotripsy in animal models will help inform physicians adopting histotripsy for human clinical use.
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Affiliation(s)
- Katrina L Falk
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Emily A Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Amanda R Smolock
- Department of Radiology, Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Charles Bradley
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Fred T Lee
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
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19
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Yeats E, Hall TL. Aberration correction in abdominal histotripsy. Int J Hyperthermia 2023; 40:2266594. [PMID: 37813397 PMCID: PMC10637766 DOI: 10.1080/02656736.2023.2266594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
In transabdominal histotripsy, ultrasound pulses are focused on the body to noninvasively destroy soft tissues via cavitation. However, the ability to focus is limited by phase aberration, or decorrelation of the ultrasound pulses due to spatial variation in the speed of sound throughout heterogeneous tissue. Phase aberration shifts, broadens, and weakens the focus, thereby reducing the safety and efficacy of histotripsy therapy. This paper reviews and discusses aberration effects in histotripsy and in related therapeutic ultrasound techniques (e.g., high intensity focused ultrasound), with an emphasis on aberration by soft tissues. Methods for aberration correction are reviewed and can be classified into two groups: model-based methods, which use segmented images of the tissue as input to an acoustic propagation model to predict and compensate phase differences, and signal-based methods, which use a receive-capable therapy array to detect phase differences by sensing acoustic signals backpropagating from the focus. The relative advantages and disadvantages of both groups of methods are discussed. Importantly, model-based methods can correct focal shift, while signal-based methods can restore substantial focal pressure, suggesting that both methods should be combined in a 2-step approach. Aberration correction will be critical to improving histotripsy treatments and expanding the histotripsy treatment envelope to enable non-invasive, non-thermal histotripsy therapy for more patients.
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Affiliation(s)
- Ellen Yeats
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
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20
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Wang L, Piao Y, Guo F, Wei J, Chen Y, Dai X, Zhang X. Current progress of pig models for liver cancer research. Biomed Pharmacother 2023; 165:115256. [PMID: 37536038 DOI: 10.1016/j.biopha.2023.115256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023] Open
Abstract
Preclinical trials play critical roles in assessing the safety and efficiency of novel therapeutic strategies for human diseases including live cancer. However, most therapeutic strategies that were proved to be effective in preclinical cancer models failed in human clinical trials due to the lack of appropriate disease animal models. Therefore, it is of importance and urgent to develop a precise animal model for preclinical cancer research. Liver cancer is one of the most frequently diagnosed cancers with low 5-year survival rate. Recently, porcine attracted increasing attentions as animal model in biomedical research. Porcine liver cancer model may provide a promising platform for biomedical research due to their similarities to human being in body size, anatomical characteristics, physiology and pathophysiology. In this review, we comprehensively summarized and discussed the advantages and disadvantages, rationale, current status and progress of pig models for liver cancer research.
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Affiliation(s)
- Luyao Wang
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China
| | - Yuexian Piao
- Invasive Technology Nursing Platform, First Hospital of Jilin University, Changchun, China
| | - Fucheng Guo
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China
| | - Jiarui Wei
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China
| | - Yurong Chen
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China
| | - Xiangpeng Dai
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China.
| | - Xiaoling Zhang
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, China; National-Local Joint Engineering Laboratory of Animal Models for Human Disease, First Hospital of Jilin University, Changchun, China.
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21
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Yeats E, Lu N, Sukovich JR, Xu Z, Hall TL. Soft Tissue Aberration Correction for Histotripsy Using Acoustic Emissions From Cavitation Cloud Nucleation and Collapse. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1182-1193. [PMID: 36759271 PMCID: PMC10082475 DOI: 10.1016/j.ultrasmedbio.2023.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/01/2022] [Accepted: 01/03/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Phase aberration from soft tissue limits the efficacy of histotripsy, a therapeutic ultrasound technique based on acoustic cavitation. Previous work has shown that the acoustic emissions from cavitation can serve as "point sources" for aberration correction (AC). This study compared the efficacy of soft tissue AC for histotripsy using acoustic cavitation emissions (ACE) from bubble cloud nucleation and collapse. METHODS A 750-kHz, receive-capable histotripsy array was pulsed to generate cavitation in ex vivo porcine liver through an intervening abdominal wall. Received ACE signals were used to determine the arrival time differences to the focus and compute corrective delays. Corrections from single pulses and from the median of multiple pulses were tested. DISCUSSION On average, ACE AC obtained 96% ± 3% of the pressure amplitude obtained by hydrophone-based correction (compared with 71% ± 5% without AC). Both nucleation- and collapse-based corrections obtained >96% of the hydrophone-corrected pressure when using medians of ≥10 pulses. When using single-pulse corrections, nucleation obtained a range of 49%-99% of the hydrophone-corrected pressure, while collapse obtained 95%-99%. CONCLUSION The results suggest that (i) ACE AC can recover nearly all pressure amplitude lost owing to soft tissue aberration and that (ii) the collapse signal permits robust AC using a small number of pulses.
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Affiliation(s)
- Ellen Yeats
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Ning Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan R Sukovich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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22
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Woodacre JK, Mallay M, Brown JA. Fabrication and characterization of a flat aperture Fresnel lens based histotripsy transducer. ULTRASONICS 2023; 131:106934. [PMID: 36773482 DOI: 10.1016/j.ultras.2023.106934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Two single element, 8 mm focal depth, 6 MHz PZT-5A 40% volume fraction 1-3 composite Fresnel aluminum lens based therapeutic ultrasound transducers for use in small animal histotripsy applications were built with 15 mm outer diameters - one with a central hole of 5.7 mm diameter for future co-registration and one full-aperture. The device was built with the front face filled with acoustically transparent epoxy to create a flat aperture allowing gel-coupling to tissue, where the Fresnel lens design allowed flattening of the aperture with minimal epoxy fill. Epoxy fill resulted in a 6% loss of focal pressure. The full-aperture device achieved 37 MPa/100 V peak-to-peak focal pressures with the removed center element device achieving 25 MPa/100V - a 32% reduction, which matches COMSOL simulated results. Pulsing between 190 V and 270 V at 17 cycles and 1 kHz PRF, the full-aperture device generated bubble clouds in water ranging from 0.31 mm to 0.51 mm radially, and 0.53 mm to 0.81 mm axially. Cavitation for the removed center element device was observed to begin at 370 V, and was consistent at 400 V.
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Affiliation(s)
- Jeffrey K Woodacre
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, B3H1W2, Halifax, Canada.
| | - Matthew Mallay
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, B3H1W2, Halifax, Canada.
| | - Jeremy A Brown
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, B3H1W2, Halifax, Canada; School of Electrical Engineering, Dalhousie University, 1459 Oxford Street, B3H4R2, Halifax, Canada.
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23
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Ashar H, Ranjan A. Immunomodulation and targeted drug delivery with high intensity focused ultrasound (HIFU): Principles and mechanisms. Pharmacol Ther 2023; 244:108393. [PMID: 36965581 DOI: 10.1016/j.pharmthera.2023.108393] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/04/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
High intensity focused ultrasound (HIFU) is a non-invasive and non-ionizing sonic energy-based therapeutic technology for inducing thermal and non-thermal effects in tissues. Depending on the parameters, HIFU can ablate tissues by heating them to >55 °C to induce denaturation and coagulative necrosis, improve radio- and chemo-sensitizations and local drug delivery from nanoparticles at moderate hyperthermia (~41-43 °C), and mechanically fragment cells using acoustic cavitation (also known as histotripsy). HIFU has already emerged as an attractive modality for treating human prostate cancer, veterinary cancers, and neuromodulation. Herein, we comprehensively review the role of HIFU in enhancing drug delivery and immunotherapy in soft and calcified tissues. Specifically, the ability of HIFU to improve adjuvant treatments from various classes of drugs is described. These crucial insights highlight the opportunities and challenges of HIFU technology and its potential to support new clinical trials and translation to patients.
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Affiliation(s)
- Harshini Ashar
- Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, United States of America
| | - Ashish Ranjan
- Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, United States of America.
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Elliott J, Simon JC. Histotripsy Bubble Dynamics in Elastic, Anisotropic Tissue-Mimicking Phantoms. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:853-865. [PMID: 36577567 PMCID: PMC9908827 DOI: 10.1016/j.ultrasmedbio.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Elastic, anisotropic tissue such as tendon has proven resistant to mechanical fractionation by histotripsy, a subset of focused ultrasound that uses the creation, oscillation and collapse of cavitation bubbles to fractionate tissue. Our objective was to fabricate an optically transparent hydrogel that mimics tendon for evaluation of histotripsy bubble dynamics. Ex vivo bovine deep digital flexor tendons were obtained (n = 4), and varying formulations of polyacrylamide (PA), collagen and fibrin hydrogels (n = 3 each) were fabricated. Axial sound speeds were measured at 1 MHz for calculation of anisotropy. All samples were treated with a 1.5-MHz focused ultrasound transducer with 10-ms pulses repeated at 1 Hz (p+ = 127 MPa, p- = 35 MPa); treatments were monitored with passive cavitation imaging and high-speed photography. Dehydrated fibrin gels were found to be the most similar to tendon in cavitation emission energy (fibrin = 0.69 ± 0.24, tendon = 0.64 ± 0.19 [× 1010 V2]) and anisotropy (fibrin = 3.16 ± 1.12, tendon = 19.4). Bubble cloud area in dehydrated fibrin (0.79 ± 0.14 mm2) was significantly smaller than most other tested hydrogels. Finally, anisotropy was found to have moderately strong linear relationships with cavitation energy and bubble cloud size (r = -0.65 and -0.80, respectively). Dehydrated fibrin shows potential as a repeatable, transparent, tissue-mimicking hydrogel for evaluation of histotripsy bubble dynamics in elastic, anisotropic tissues.
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Affiliation(s)
- Jake Elliott
- Graduate Program in Acoustics, The Pennsylvania State University, University Park, Pennsylvania, USA.
| | - Julianna C Simon
- Graduate Program in Acoustics, The Pennsylvania State University, University Park, Pennsylvania, USA
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Ruger L, Yang E, Gannon J, Sheppard H, Coutermarsh-Ott S, Ziemlewicz TJ, Dervisis N, Allen IC, Daniel GB, Tuohy J, Vlaisavljevich E, Klahn S. Mechanical High-Intensity Focused Ultrasound (Histotripsy) in Dogs With Spontaneously Occurring Soft Tissue Sarcomas. IEEE Trans Biomed Eng 2023; 70:768-779. [PMID: 36006886 PMCID: PMC9969335 DOI: 10.1109/tbme.2022.3201709] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Histotripsy is a non-invasive focused ultrasound therapy that uses controlled acoustic cavitation to mechanically disintegrate tissue. To date, there are no reports investigating histotripsy for the treatment of soft tissue sarcoma (STS). OBJECTIVE This study aimed to investigate the in vivo feasibility of ablating STS with histotripsy and to characterize the impact of partial histotripsy ablation on the acute immunologic response in canine patients with spontaneous STS. METHODS A custom 500 kHz histotripsy system was used to treat ten dogs with naturally occurring STS. Four to six days after histotripsy, tumors were surgically resected. Safety was determined by monitoring vital signs during treatment and post-treatment physical examinations, routine lab work, and owners' reports. Ablation was characterized using radiologic and histopathologic analyses. Systemic immunological impact was evaluated by measuring changes in cytokine concentrations, and tumor microenvironment changes were evaluated by characterizing changes in infiltration with tumor-associated macrophages (TAMs) and tumor-infiltrating lymphocytes (TILs) using multiplex immunohistochemistry and differential gene expression. RESULTS Results showed histotripsy ablation was achievable and well-tolerated in all ten dogs. Immunological results showed histotripsy induced pro-inflammatory changes in the tumor microenvironment. Conclusion & Significance: Overall, this study demonstrates histotripsy's potential as a precise, non-invasive treatment for STS.
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Froghi S, Hall A, Hanafi Bin Jalal A, de Andrade MO, Mohammad Hadi L, Rashidi H, Gélat P, Saffari N, Davidson B, Quaglia A. Ultrasound Histotripsy on a Viable Perfused Whole Porcine Liver: Histological Aspects, Including 3D Reconstruction of the Histotripsy Site. Bioengineering (Basel) 2023; 10:bioengineering10030278. [PMID: 36978669 PMCID: PMC10044833 DOI: 10.3390/bioengineering10030278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023] Open
Abstract
Non-invasive therapeutic-focused ultrasound (US) can be used for the mechanical dissociation of tissue and is described as histotripsy. We have performed US histotripsy in viable perfused ex vivo porcine livers as a step in the development of a novel approach to hepatocyte cell transplantation. The histotripsy nidus was created with a 2 MHz single-element focused US transducer, producing 50 pulses of 10 ms duration, with peak positive and negative pressure values of P+ = 77.7 MPa and P− = –13.7 MPaat focus, respectively, and a duty cycle of 1%. Here, we present the histological analysis, including 3D reconstruction of histotripsy sites. Five whole porcine livers were retrieved fresh from the abattoir using human transplant retrieval and cold static preservation techniques and were then perfused using an organ preservation circuit. Whilst under perfusion, histotripsy was performed to randomly selected sites on the live. Fifteen lesional sites were formalin-fixed and paraffin-embedded. Sections were stained with Haematoxylin and Eosin and picro-Sirius red, and they were also stained for reticulin. Additionally, two lesion sites were used for 3D reconstruction. The core of the typical lesion consisted of eosinophilic material associated with reticulin loss, collagen damage including loss of birefringence to fibrous septa, and perilesional portal tracts, including large portal vein branches, but intact peri-lesional hepatic plates. The 3D reconstruction of two histotripsy sites was successful and confirmed the feasibility of this approach to investigate the effects of histotripsy on tissue in detail.
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Affiliation(s)
- Saied Froghi
- Department of HPB & Liver Transplantation Surgery, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, UK
- Centre for Surgical Innovation, Organ Regeneration and Transplantation, UCL Division of Surgery & Interventional Sciences, Royal Free Hospital Campus, Pond Street, Hampstead, London NW3 2QG, UK
| | - Andrew Hall
- Department of Cellular Pathology, UCL Cancer Institute Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, UK
| | - Arif Hanafi Bin Jalal
- UCL Medical School, University College London, 74 Huntley Street, London WC1E 6BT, UK
| | - Matheus Oliveira de Andrade
- Ultrasonics Group, Department of Mechanical Engineering, Roberts Engineering Building, University College London, Torrington Place, London WC1E 7JE, UK
| | - Layla Mohammad Hadi
- Centre for Surgical Innovation, Organ Regeneration and Transplantation, UCL Division of Surgery & Interventional Sciences, Royal Free Hospital Campus, Pond Street, Hampstead, London NW3 2QG, UK
| | - Hassan Rashidi
- Developmental Biology and Cancer Program, UCL Great Ormond Street, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Pierre Gélat
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, UCL, Royal Free Hospital Campus, Pond Street, Hampstead, London NW3 2QG, UK
| | - Nader Saffari
- Ultrasonics Group, Department of Mechanical Engineering, Roberts Engineering Building, University College London, Torrington Place, London WC1E 7JE, UK
| | - Brian Davidson
- Department of HPB & Liver Transplantation Surgery, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, UK
- Centre for Surgical Innovation, Organ Regeneration and Transplantation, UCL Division of Surgery & Interventional Sciences, Royal Free Hospital Campus, Pond Street, Hampstead, London NW3 2QG, UK
| | - Alberto Quaglia
- Department of Cellular Pathology, UCL Cancer Institute Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, UK
- Correspondence:
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Wagner MG, Periyasamy S, Kutlu AZ, Pieper AA, Swietlik JF, Ziemlewicz TJ, Hall TL, Xu Z, Speidel MA, Jr FTL, Laeseke PF. An X-Ray C-Arm Guided Automatic Targeting System for Histotripsy. IEEE Trans Biomed Eng 2023; 70:592-602. [PMID: 35984807 PMCID: PMC9929026 DOI: 10.1109/tbme.2022.3198600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Histotripsy is an emerging noninvasive, nonionizing and nonthermal focal cancer therapy that is highly precise and can create a treatment zone of virtually any size and shape. Current histotripsy systems rely on ultrasound imaging to target lesions. However, deep or isoechoic targets obstructed by bowel gas or bone can often not be treated safely using ultrasound imaging alone. This work presents an alternative x-ray C-arm based targeting approach and a fully automated robotic targeting system. METHODS The approach uses conventional cone beam CT (CBCT) images to localize the target lesion and 2D fluoroscopy to determine the 3D position and orientation of the histotripsy transducer relative to the C-arm. The proposed pose estimation uses a digital model and deep learning-based feature segmentation to estimate the transducer focal point relative to the CBCT coordinate system. Additionally, the integrated robotic arm was calibrated to the C-arm by estimating the transducer pose for four preprogrammed transducer orientations and positions. The calibrated system can then automatically position the transducer such that the focal point aligns with any target selected in a CBCT image. RESULTS The accuracy of the proposed targeting approach was evaluated in phantom studies, where the selected target location was compared to the center of the spherical ablation zones in post-treatment CBCTs. The mean and standard deviation of the Euclidean distance was 1.4 ±0.5 mm. The mean absolute error of the predicted treatment radius was 0.5 ±0.5 mm. CONCLUSION CBCT-based histotripsy targeting enables accurate and fully automated treatment without ultrasound guidance. SIGNIFICANCE The proposed approach could considerably decrease operator dependency and enable treatment of tumors not visible under ultrasound.
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Ruger LN, Hay AN, Vickers ER, Coutermarsh-Ott SL, Gannon JM, Covell HS, Daniel GB, Laeseke PF, Ziemlewicz TJ, Kierski KR, Ciepluch BJ, Vlaisavljevich E, Tuohy JL. Characterizing the Ablative Effects of Histotripsy for Osteosarcoma: In Vivo Study in Dogs. Cancers (Basel) 2023; 15:cancers15030741. [PMID: 36765700 PMCID: PMC9913343 DOI: 10.3390/cancers15030741] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Osteosarcoma (OS) is a malignant bone tumor treated by limb amputation or limb salvage surgeries and chemotherapy. Histotripsy is a non-thermal, non-invasive focused ultrasound therapy using controlled acoustic cavitation to mechanically disintegrate tissue. Recent ex vivo and in vivo pilot studies have demonstrated the ability of histotripsy for ablating OS but were limited in scope. This study expands on these initial findings to more fully characterize the effects of histotripsy for bone tumors, particularly in tumors with different compositions. A prototype 500 kHz histotripsy system was used to treat ten dogs with suspected OS at an intermediate treatment dose of 1000 pulses per location. One day after histotripsy, treated tumors were resected via limb amputation, and radiologic and histopathologic analyses were conducted to determine the effects of histotripsy for each patient. The results of this study demonstrated that histotripsy ablation is safe and feasible in canine patients with spontaneous OS, while offering new insights into the characteristics of the achieved ablation zone. More extensive tissue destruction was observed after histotripsy compared to that in previous reports, and radiographic changes in tumor size and contrast uptake following histotripsy were reported for the first time. Overall, this study significantly expands our understanding of histotripsy bone tumor ablation and informs future studies for this application.
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Affiliation(s)
- Lauren N. Ruger
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Alayna N. Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Elliana R. Vickers
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA 24016, USA
| | - Sheryl L. Coutermarsh-Ott
- Department of Biological Sciences and Pathobiology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Jessica M. Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Hannah S. Covell
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Gregory B. Daniel
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Paul F. Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Katharine R. Kierski
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Brittany J. Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
- Correspondence: (E.V.); (J.L.T.)
| | - Joanne L. Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
- Correspondence: (E.V.); (J.L.T.)
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Williams RP, Simon JC, Khokhlova VA, Sapozhnikov OA, Khokhlova TD. The histotripsy spectrum: differences and similarities in techniques and instrumentation. Int J Hyperthermia 2023; 40:2233720. [PMID: 37460101 PMCID: PMC10479943 DOI: 10.1080/02656736.2023.2233720] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
Since its inception about two decades ago, histotripsy - a non-thermal mechanical tissue ablation technique - has evolved into a spectrum of methods, each with distinct potentiating physical mechanisms: intrinsic threshold histotripsy, shock-scattering histotripsy, hybrid histotripsy, and boiling histotripsy. All methods utilize short, high-amplitude pulses of focused ultrasound delivered at a low duty cycle, and all involve excitation of violent bubble activity and acoustic streaming at the focus to fractionate tissue down to the subcellular level. The main differences are in pulse duration, which spans microseconds to milliseconds, and ultrasound waveform shape and corresponding peak acoustic pressures required to achieve the desired type of bubble activity. In addition, most types of histotripsy rely on the presence of high-amplitude shocks that develop in the pressure profile at the focus due to nonlinear propagation effects. Those requirements, in turn, dictate aspects of the instrument design, both in terms of driving electronics, transducer dimensions and intensity limitations at surface, shape (primarily, the F-number) and frequency. The combination of the optimized instrumentation and the bio-effects from bubble activity and streaming on different tissues, lead to target clinical applications for each histotripsy method. Here, the differences and similarities in the physical mechanisms and resulting bioeffects of each method are reviewed and tied to optimal instrumentation and clinical applications.
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Affiliation(s)
- Randall P Williams
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Julianna C Simon
- Graduate Program in Acoustics, The Pennsylvania State University, University Park, PA, USA
| | - Vera A Khokhlova
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
- Department of Acoustics, Physics Faculty, Moscow State University, Moscow, Russia
| | - Oleg A Sapozhnikov
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
- Department of Acoustics, Physics Faculty, Moscow State University, Moscow, Russia
| | - Tatiana D Khokhlova
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
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Ruger L, Yang E, Coutermarsh-Ott S, Vickers E, Gannon J, Nightengale M, Hsueh A, Ciepluch B, Dervisis N, Vlaisavljevich E, Klahn S. Histotripsy ablation for the treatment of feline injection site sarcomas: a first-in-cat in vivo feasibility study. Int J Hyperthermia 2023; 40:2210272. [PMID: 37196996 DOI: 10.1080/02656736.2023.2210272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE Feline soft tissue sarcoma (STS) and injection site sarcoma (fISS) are rapidly growing tumors with low metastatic potential, but locally aggressive behavior. Histotripsy is a non-invasive focused ultrasound therapy using controlled acoustic cavitation to mechanically disintegrate tissue. In this study, we investigated the in vivo safety and feasibility of histotripsy to treat fISS using a custom 1 MHz transducer. MATERIALS AND METHODS Three cats with naturally-occurring STS were treated with histotripsy before surgical removal of the tumor 3 to 6 days later. Gross and histological analyses were used to characterize the ablation efficacy of the treatment, and routine immunohistochemistry and batched cytokine analysis were used to investigate the acute immunological effects of histotripsy. RESULTS Results showed that histotripsy ablation was achievable and well-tolerated in all three cats. Precise cavitation bubble clouds were generated in all patients, and hematoxylin & eosin stained tissues revealed ablative damage in targeted regions. Immunohistochemical results identified an increase in IBA-1 positive cells in treated tissues, and no significant changes in cytokine concentrations were identified post-treatment. CONCLUSIONS Overall, the results of this study demonstrate the safety and feasibility of histotripsy to target and ablate superficial feline STS and fISS tumors and guide the clinical development of histotripsy devices for this application.
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Affiliation(s)
- Lauren Ruger
- Department of Biomedical Engineering and Mechanics, VA Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Ester Yang
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
| | - Sheryl Coutermarsh-Ott
- Biomedical Sciences and Pathobiology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Elliana Vickers
- Department of Biomedical Engineering and Mechanics, VA Polytechnic Institute and State University, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, VA Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Marlie Nightengale
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
| | - Andy Hsueh
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
| | - Brittany Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
| | - Nikolaos Dervisis
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, VA Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA, USA
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A Multi-centre, Single Arm, Non-randomized, Prospective European Trial to Evaluate the Safety and Efficacy of the HistoSonics System in the Treatment of Primary and Metastatic Liver Cancers (#HOPE4LIVER). Cardiovasc Intervent Radiol 2023; 46:259-267. [PMID: 36380155 PMCID: PMC9892119 DOI: 10.1007/s00270-022-03309-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Image-guided thermal ablation are established treatment options for non-surgical patients with primary and metastatic liver cancers. However, there are limitations with nonuniformity of cancer tissue destruction, heat sink effect and the risk of thermal ablative injury. The current non-thermal ablative techniques have high risk of local recurrence and are not widely adopted. Histotripsy is a treatment technology that destroys targeted tissue under ultrasound visualization via mechanical destruction through the precise application of acoustic cavitation and can offer the potential of non-invasive, non-thermal and non-ionizing radiation cancer treatment. The aim of this multi-centre non-randomized phase I/II trial is to assess the initial safety and efficacy of the prototype investigational 'System' in the treatment of primary and metastatic liver cancers. METHODS/DESIGN All non-surgical patients with primary/metastatic liver cancers having had previous liver directed therapy, radiation therapy or image-guided ablation may be offered image-guided Histotripsy as per trial protocol. The co-primary endpoints are technical success and procedural safety. Technical success is determined, at ≤ 36 h post procedure, by evaluating the histotripsy treatment size and coverage. The procedural safety is defined by procedure related major complications, defined as Common Terminology Criteria for Adverse Events (CTCAE version 5) grade 3 or higher toxicities, up to 30 days post procedure. This phase I/II trial has intended to recruit up to 45 patients to show safety and efficacy of image-guided histotripsy in liver cancers. TRAIL REGISTRATION Clinicaltrials.gov identifier-NCT04573881; NIHR CRN CPMS-ID 47572.
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Gannon J, Imran KM, Hendricks-Wenger A, Edwards M, Covell H, Ruger L, Singh N, Nagai-Singer M, Tintera B, Eden K, Mendiratta-Lala M, Vidal-Jove J, Luyimbazi D, Larson M, Clark-Deener S, Coutermarsh-Ott S, Allen IC, Vlaisavljevich E. Ultrasound-guided noninvasive pancreas ablation using histotripsy: feasibility study in an in vivo porcine model. Int J Hyperthermia 2023; 40:2247187. [PMID: 37643768 PMCID: PMC10839746 DOI: 10.1080/02656736.2023.2247187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
Pancreatic cancer is a malignant disease associated with poor survival and nearly 80% present with unresectable tumors. Treatments such as chemotherapy and radiation therapy have shown overall improved survival benefits, albeit limited. Histotripsy is a noninvasive, non-ionizing, and non-thermal focused ultrasound ablation modality that has shown efficacy in treating hepatic tumors and other malignancies. In this novel study, we investigate histotripsy for noninvasive pancreas ablation in a pig model. In two studies, histotripsy was applied to the healthy pancreas in 11 pigs using a custom 32-element, 500 kHz histotripsy transducer attached to a clinical histotripsy system, with treatments guided by real-time ultrasound imaging. A pilot study was conducted in 3 fasted pigs with histotripsy applied at a pulse repetition frequency (PRF) of 500 Hz. Results showed no pancreas visualization on coaxial ultrasound imaging due to overlying intestinal gas, resulting in off-target injury and no pancreas damage. To minimize gas, a second group of pigs (n = 8) were fed a custard diet containing simethicone and bisacodyl. Pigs were euthanized immediately (n = 4) or survived for 1 week (n = 4) post-treatment. Damage to the pancreas and surrounding tissue was characterized using gross morphology, histological analysis, and CT imaging. Results showed histotripsy bubble clouds were generated inside pancreases that were visually maintained on coaxial ultrasound (n = 4), with 2 pigs exhibiting off-target damage. For chronic animals, results showed the treatments were well-tolerated with no complication signs or changes in blood markers. This study provides initial evidence suggesting histotripsy's potential for noninvasive pancreas ablation and warrants further evaluation in more comprehensive studies.
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Affiliation(s)
- Jessica Gannon
- Department of Biomedical Engineering and Mechanics, VA Tech, Blacksburg, VA, USA
| | - Khan Mohammad Imran
- Department of Biomedical Sciences and Pathobiology, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
| | - Alissa Hendricks-Wenger
- Department of Biomedical Engineering and Mechanics, VA Tech, Blacksburg, VA, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Michael Edwards
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, US
| | - Hannah Covell
- Department of Biomedical Engineering and Mechanics, VA Tech, Blacksburg, VA, USA
| | - Lauren Ruger
- Department of Biomedical Engineering and Mechanics, VA Tech, Blacksburg, VA, USA
| | - Neha Singh
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Margaret Nagai-Singer
- Department of Biomedical Sciences and Pathobiology, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | - Benjamin Tintera
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Kristin Eden
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | | | - Joan Vidal-Jove
- Interventional Oncology Institute Khuab, Comprehensive Tumor Center, Barcelona, Spain
| | - David Luyimbazi
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Department of Surgery, Carilion Clinic, Roanoke, VA, USA
| | - Martha Larson
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Sherrie Clark-Deener
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | - Irving C. Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-MD College of Veterinary Medicine, Blacksburg, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- ICTAS Center for Engineering Health, Virginia Tech, Blacksburg, VA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, VA Tech, Blacksburg, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
- ICTAS Center for Engineering Health, Virginia Tech, Blacksburg, VA
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Imran KM, Ganguly A, Paul T, Powar M, Vlaisavljevich E, Cho CS, Allen IC. Magic bubbles: utilizing histotripsy to modulate the tumor microenvironment and improve systemic anti-tumor immune responses. Int J Hyperthermia 2023; 40:2244206. [PMID: 37580047 PMCID: PMC10430775 DOI: 10.1080/02656736.2023.2244206] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023] Open
Abstract
Focused Ultrasound (FUS) is emerging as a promising primary and adjunct therapy for the treatment of cancer. This includes histotripsy, which is a noninvasive, non-ionizing, non-thermal ultrasound guided ablation modality. As histotripsy has progressed from bench-to-bedside, it has become evident that this therapy has benefits beyond local tumor ablation. Specifically, histotripsy has the potential to shift the local tumor microenvironment from immunologically 'cold' to 'hot'. This is associated with the production of damage associated molecular patterns, the release of a selection of proinflammatory mediators, and the induction of inflammatory forms of cell death in cells just outside of the treatment zone. In addition to the induction of this innate immune response, histotripsy can also improve engagement of the adaptive immune system and promote systemic anti-tumor immunity targeting distal tumors and metastatic lesions. These tantalizing observations suggest that, in settings of widely metastatic disease burden, selective histotripsy of a limited number of accessible tumors could be a means of maximizing responsiveness to systemic immunotherapy. More work is certainly needed to optimize treatment strategies that best synergize histotripsy parameters with innate and adaptive immune responses. Likewise, rigorous clinical studies are still necessary to verify the presence and repeatability of these phenomena in human patients. As this technology nears regulatory approval for clinical use, it is our expectation that the insights and immunomodulatory mechanisms summarized in this review will serve as directional guides for rational clinical studies to validate and optimize the potential immunotherapeutic role of histotripsy tumor ablation.
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Affiliation(s)
- Khan M. Imran
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
| | - Anutosh Ganguly
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tamalika Paul
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Manali Powar
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
- Institute for Critical and Applied Science Center for Engineered Health, Virginia Tech, Blacksburg, VA, USA
| | - Clifford S. Cho
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, USA
| | - Irving C. Allen
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
- Institute for Critical and Applied Science Center for Engineered Health, Virginia Tech, Blacksburg, VA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Toydemir C, Hall S, Demirel E, Elmaci DN, Gol D, Vlaisavljevich E, Yuksel Durmaz Y. Bioconjugated β-Cyclodextrin-Perfluorohexane Nanocone Clusters as Functional Nanoparticles for Nanoparticle-Mediated Histotripsy. Biomacromolecules 2022; 23:5297-5311. [PMID: 36418020 DOI: 10.1021/acs.biomac.2c01110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nanocone clusters (NCCs) are new-generation agents of nanoparticle-mediated histotripsy (NMH) recently developed to address the limitations of previously designed nanodroplets (NDs). NCCs can be obtained by simply mixing FDA-approved cyclodextrins (CD) and suitable perfluorocarbons (PFCs), which result in smaller size aggregates, detectable PFC amount, and more stable long-term storage since the obtained powder can be stored and redispersed as needed. Previous experimental and computational studies showed that NCCs consist of an organization of inclusion complexes of CD and PFC around free PFC droplets, and their aggregate behavior depends on the localization of PFC in the cavity and the water solubility of CD derivatives. It has been shown that β-cyclodextrin (βCD) and perfluorohexane (PFH) are ideal candidates for NCCs that can be isolated as a powder with high PFC content among various CD and PFC derivatives. This study focuses on the further development of the selected NCC composition to enhance the potential of NMH therapy while also enabling more detailed future experiments in vitro and in vivo. It is aimed to show the bioconjugation potential of NCCs through the example of the most commonly used functionalization methods such as targeting, PEGylation, and fluorescent labeling. For this purpose, βCD as a building block was monofunctionalized with groups such as azide, alkyne, and amine groups that allow for effective coupling reactions such as the "click" reaction and N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide (EDC/NHS) coupling. These monofunctional βCDs were used as building blocks of NCCs in the presence of PFH to obtain functional NCCs as precursors of bioconjugation. EPPT1 as a synthetic peptide specific to uMUC1 and folic acid (FA) as the most commonly used targeting agent along with PEGylation were successfully shown as bioconjugation examples. Lastly, fluorescently labeled NCCs were obtained via fluorescein isothiocyanate (FITC) and alkyne functional NCC reaction through propargyl amine and isothiocyanate group reaction. The obtained bioconjugates were tested in vitro to validate the conjugation, and the ability to lower the histotripsy cavitation threshold, which is necessary for NMH, was demonstrated for all bioconjugates. Overall, the results showed that all obtained bioconjugates successfully lowered the cavitation threshold pressure while also fulfilling the desired bioconjugation metrics to serve as improved tools to enhance NMH as a targeted noninvasive ablation method.
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Affiliation(s)
| | - Sarah Hall
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia24061, United States
| | | | | | | | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia24061, United States
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Ponomarchuk EM, Hunter C, Song M, Khokhlova VA, Sapozhnikov OA, Yuldashev PV, Khokhlova TD. Mechanical damage thresholds for hematomas near gas-containing bodies in pulsed HIFU fields. Phys Med Biol 2022; 67:10.1088/1361-6560/ac96c7. [PMID: 36179703 PMCID: PMC9645587 DOI: 10.1088/1361-6560/ac96c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022]
Abstract
Objective. Boiling histotripsy (BH) is a novel high intensity focused ultrasound (HIFU) application currently being developed for non-invasive mechanical fractionation of soft tissues and large hematomas. In the context of development of BH treatment planning approaches for ablating targets adjacent to gas-containing organs, this study aimed at investigation of the ultrasound pressure thresholds of atomization-induced damage to the tissue-air interface and correlation of the danger zone dimensions with spatial structure of nonlinear HIFU field parameters.Approach. A flat interface with air of freshly clotted bovine blood was used as anex vivomodel due to its homogenous structure and higher susceptibility to ultrasound-induced mechanical damage compared to soft tissues. Three 1.5 MHz transducers of differentF-numbers (0.77, 1 and 1.5) were focused at various distances before or beyond a flat clot surface, and a BH exposure was delivered either at constant, high-amplitude output level, or at gradually increasing level until a visible damage to the clot surface occurred. The HIFU pressure field parameters at the clot surface were determined through a combination of hydrophone measurements in water, forward wave propagation simulation using 'HIFU beam' software and an image source method to account for the wave reflection from the clot surface and formation of a standing wave. The iso-levels of peak negative pressure in the resulting HIFU field were correlated to the outlines of surface erosion to identify the danger zone around the BH focus.Main results. The outline of the danger zone was shown to differ from that of a typical BH lesion produced in a volume of clot material. In the prefocal area, the zone was confined within the 4 MPa contour of the incident peak-to-peak pressure; within the main focal lobe it was determined by the maximum BH lesion width, and in the postfocal area-by the transverse size of the focal lobe and position of the first postfocal pressure axial null.Significance. The incident HIFU pressure-based danger zone boundaries were outlined around the BH focus and can be superimposed onto in-treatment ultrasound image to avoid damage to adjacent gas-containing bodies.
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Affiliation(s)
| | - Christopher Hunter
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle, United States of America
| | - Minho Song
- Department of Gastroenterology, University of Washington, Seattle, United States of America
| | - Vera A Khokhlova
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle, United States of America
| | - Oleg A Sapozhnikov
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle, United States of America
| | - Petr V Yuldashev
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Tatiana D Khokhlova
- Department of Gastroenterology, University of Washington, Seattle, United States of America
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Hersh AM, Bhimreddy M, Weber-Levine C, Jiang K, Alomari S, Theodore N, Manbachi A, Tyler BM. Applications of Focused Ultrasound for the Treatment of Glioblastoma: A New Frontier. Cancers (Basel) 2022; 14:4920. [PMID: 36230843 PMCID: PMC9563027 DOI: 10.3390/cancers14194920] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Glioblastoma (GBM) is an aggressive primary astrocytoma associated with short overall survival. Treatment for GBM primarily consists of maximal safe surgical resection, radiation therapy, and chemotherapy using temozolomide. Nonetheless, recurrence and tumor progression is the norm, driven by tumor stem cell activity and a high mutational burden. Focused ultrasound (FUS) has shown promising results in preclinical and clinical trials for treatment of GBM and has received regulatory approval for the treatment of other neoplasms. Here, we review the range of applications for FUS in the treatment of GBM, which depend on parameters, including frequency, power, pulse duration, and duty cycle. Low-intensity FUS can be used to transiently open the blood-brain barrier (BBB), which restricts diffusion of most macromolecules and therapeutic agents into the brain. Under guidance from magnetic resonance imaging, the BBB can be targeted in a precise location to permit diffusion of molecules only at the vicinity of the tumor, preventing side effects to healthy tissue. BBB opening can also be used to improve detection of cell-free tumor DNA with liquid biopsies, allowing non-invasive diagnosis and identification of molecular mutations. High-intensity FUS can cause tumor ablation via a hyperthermic effect. Additionally, FUS can stimulate immunological attack of tumor cells, can activate sonosensitizers to exert cytotoxic effects on tumor tissue, and can sensitize tumors to radiation therapy. Finally, another mechanism under investigation, known as histotripsy, produces tumor ablation via acoustic cavitation rather than thermal effects.
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Affiliation(s)
- Andrew M. Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Mechanical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Betty M. Tyler
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Stocker GE, Lundt JE, Sukovich JR, Miller RM, Duryea AP, Hall TL, Xu Z. A Modular, Kerf-Minimizing Approach for Therapeutic Ultrasound Phased Array Construction. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2766-2775. [PMID: 35617178 PMCID: PMC9594968 DOI: 10.1109/tuffc.2022.3178291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A novel method for fabricating a modular, kerf-minimizing histotripsy phased array was developed and tested. The method utilizes arbitrarily shaped elements, 3-D printing, water jet cutting, and a thin, 125- [Formula: see text] electrically insulating epoxy coating to maximize aperture utilization while allowing for replacement of individual transducer modules. The method was used to fabricate a 750-kHz truncated circular aperture array (165 mm ×234 mm) transducer with a focal length of 142 mm. The aperture was segmented into 260 arc-shaped modular elements, each approximately 11.5 mm ×11.5 mm, arranged in concentric rings. The resulting aperture utilization was 92%. The full-width-half-maximum (FWHM) focal zone of the array was measured to be 1.6 mm ×1.1 mm ×4.5 mm, and the FWHM electrical steering range was measured to be 38.5 mm ×33 mm 40 mm. The array was estimated to be capable of generating approximately 120-MPa peak negative pressure at the geometric focus. In addition, the array was used to ablate a 5-cm3 volume of tissue with electric focal steering.
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Affiliation(s)
- Greyson E. Stocker
- Department of Biomedical Engineering at the University of Michigan, Ann Arbor, MI 48109
| | | | - Jonathan R. Sukovich
- Department of Biomedical Engineering at the University of Michigan, Ann Arbor, MI 48109
| | | | | | - Timothy L. Hall
- Department of Biomedical Engineering at the University of Michigan, Ann Arbor, MI 48109
| | - Zhen Xu
- Department of Biomedical Engineering at the University of Michigan, Ann Arbor, MI 48109
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Simon A, Robinson F, Anzivino A, Boyer M, Hendricks-Wenger A, Guilliams D, Casey J, Grider D, Valea F, Vlaisavljevich E. Histotripsy for the Treatment of Uterine Leiomyomas: A Feasibility Study in Ex Vivo Uterine Fibroids. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1652-1662. [PMID: 35641394 DOI: 10.1016/j.ultrasmedbio.2022.04.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Uterine fibroids (leiomyomas), the most common benign tumors in women of reproductive age, are a frequent cause of abnormal vaginal bleeding and other reproductive complaints among women. This study investigates the feasibility of using histotripsy, a non-invasive, non-thermal focused ultrasound ablation method, to ablate uterine fibroids. Human fibroid samples (n = 16) were harvested after hysterectomy or myomectomy procedures at Carilion Memorial Hospital. Histotripsy was applied to ex vivo fibroids in two sets of experiments using a 700-kHz clinical transducer to apply multicycle histotripsy pulses and a prototype 500-kHz transducer to apply single-cycle histotripsy pulses. Ultrasound imaging was used for real-time treatment monitoring, and post-treatment ablation was quantified histologically using hematoxylin and eosin and Masson trichrome stains. Results revealed that multicycle histotripsy generated diffuse cavitation in targeted fibroids, with minimal cellular ablative changes after treatment with 2000 pulses/point. Single-cycle pulsing generated well-confined bubble clouds with evidence of early coagulative necrosis on histological assessment in samples treated with 2000 pulses/point, near-complete ablation in samples treated with 4000 pulses/point and complete tissue destruction in samples treated with 10,000 pulses/point. This study illustrates that histotripsy is capable of fibroid ablation under certain pulsing parameters and warrants further investigation as an improved non-invasive ablation method for the treatment of leiomyomas.
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Affiliation(s)
- Alex Simon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Faith Robinson
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Anthony Anzivino
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Maggie Boyer
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, USA
| | - Alissa Hendricks-Wenger
- Department of Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, USA
| | - Danielle Guilliams
- Department of Research and Development, Carilion Clinic, Roanoke, Virginia, USA
| | - James Casey
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Obstetrics and Gynecology, Carilion Clinic Gynecological Oncology, Roanoke, Virginia, USA
| | - Douglas Grider
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Dominion Pathology Associates, Roanoke, Virginia, USA
| | - Fidel Valea
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Obstetrics and Gynecology, Carilion Clinic Gynecological Oncology, Roanoke, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.
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de Andrade MO, Haqshenas R, Pahk KJ, Saffari N. Mechanisms of nuclei growth in ultrasound bubble nucleation. ULTRASONICS SONOCHEMISTRY 2022; 88:106091. [PMID: 35839705 PMCID: PMC9287806 DOI: 10.1016/j.ultsonch.2022.106091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This paper interrogates the intersections between bubble dynamics and classical nucleation theory (CNT) towards constructing a model that describes intermediary nucleation events between the extrema of cavitation and boiling. We employ Zeldovich's hydrodynamic approach to obtain a description of bubble nuclei that grow simultaneously via hydrodynamic excitation by the acoustic field and vapour transport. By quantifying the relative dominance of both mechanisms, it is then possible to discern the extent to which viscosity, inertia, surface tension and vapour transport shape the growth of bubble nuclei through non-dimensional numbers that naturally arise within the theory. The first non-dimensional number Φ12/Φ2 is analogous to the Laplace number, representing the balance between surface tension and inertial constraints to viscous effects. The second non-dimensional number δ represents how enthalpy transport into the bubble can reduce nucleation rates by cooling the surrounding liquid. This formulation adds to the current understanding of ultrasound bubble nucleation by accounting for bubble dynamics during nucleation, quantifying the physical distinctions between "boiling" and "cavitation" bubbles through non-dimensional parameters, and outlining the characteristic timescales of nucleation according to the growth mechanism of bubbles throughout the histotripsy temperature range. We observed in our simulations that viscous effects control the process of ultrasound nucleation in water-like media throughout the 0-120 °C temperature range, although this dominance decreases with increasing temperatures. Enthalpy transport was found to reduce nucleation rates for increasing temperatures. This effect becomes significant at temperatures above 30 °C and favours the creation of fewer nuclei that are larger in size. Conversely, negligible enthalpy transport at lower temperatures can enable the nucleation of dense clusters of small nuclei, such as cavitation clouds. We find that nuclei growth as modelled by the Rayleigh-Plesset equation occurs over shorter timescales than as modelled by vapour-dominated growth. This suggests that the first stage of bubble nuclei growth is hydrodynamic, and vapour transport effects can only be observed over longer timescales. Finally, we propose that this framework can be used for comparison between different experiments in bubble nucleation, towards standardisation and dosimetry of protocols.
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Affiliation(s)
| | - Reza Haqshenas
- UCL Mechanical Engineering, University College London, London, United Kingdom
| | - Ki Joo Pahk
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Nader Saffari
- UCL Mechanical Engineering, University College London, London, United Kingdom
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Ruger LN, Hay AN, Gannon JM, Sheppard HO, Coutermarsh-Ott SL, Daniel GB, Kierski KR, Ciepluch BJ, Vlaisavljevich E, Tuohy JL. Histotripsy Ablation of Spontaneously Occurring Canine Bone Tumors In Vivo. IEEE Trans Biomed Eng 2022; PP:10.1109/TBME.2022.3191069. [PMID: 35834467 PMCID: PMC9921194 DOI: 10.1109/tbme.2022.3191069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Osteosarcoma (OS) is a devastating primary bone tumor in dogs and humans with limited non-surgical treatment options. As the first completely non-invasive and non-thermal ablation technique, histotripsy has the potential to significantly improve the standard of care for patients with primary bone tumors. INTRODUCTION Standard of care treatment for primary appendicular OS involves surgical resection via either limb amputation or limb-salvage surgery for suitable candidates. Biological similarities between canine and human OS make the dog an informative comparative oncology research model to advance treatment options for primary OS. Evaluating histotripsy for ablating spontaneous canine primary OS will build a foundation upon which histotripsy can be translated clinically into a standard of care therapy for canine and human OS. METHODS Five dogs with suspected spontaneous OS were treated with a 500 kHz histotripsy system guided by real-time ultrasound image guidance. Spherical ablation volumes within each tumor (1.25-3 cm in diameter) were treated with single cycle histotripsy pulses applied at a pulse repetition frequency of 500 Hz and a dose of 500 pulses/point. RESULTS Tumor ablation was successfully identified grossly and histologically within the targeted treatment regions of all subjects. Histotripsy treatments were well-tolerated amongst all patients with no significant clinical adverse effects. Conclusion & Significance: Histotripsy safely and effectively ablated the targeted treatment volumes in all subjects, demonstrating its potential to serve as a non-invasive treatment modality for primary bone tumors.
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Childers C, Edsall C, Mehochko I, Mustafa W, Durmaz YY, Klibanov AL, Rao J, Vlaisavljevich E. Particle-Mediated Histotripsy for the Targeted Treatment of Intraluminal Biofilms in Catheter-Based Medical Devices. BME FRONTIERS 2022; 2022:9826279. [PMID: 37850182 PMCID: PMC10521694 DOI: 10.34133/2022/9826279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 10/19/2023] Open
Abstract
Objective. This paper is an initial work towards developing particle-mediated histotripsy (PMH) as a novel method of treating catheter-based medical device (CBMD) intraluminal biofilms. Impact Statement. CBMDs commonly become infected with bacterial biofilms leading to medical device failure, infection, and adverse patient outcomes. Introduction. Histotripsy is a noninvasive focused ultrasound ablation method that was recently proposed as a novel method to remove intraluminal biofilms. Here, we explore the potential of combining histotripsy with acoustically active particles to develop a PMH approach that can noninvasively remove biofilms without the need for high acoustic pressures or real-time image guidance for targeting. Methods. Histotripsy cavitation thresholds in catheters containing either gas-filled microbubbles (MBs) or fluid-filled nanocones (NCs) were determined. The ability of these particles to sustain cavitation over multiple ultrasound pulses was tested after a series of histotripsy exposures. Next, the ability of PMH to generate selective intraluminal cavitation without generating extraluminal cavitation was tested. Finally, the biofilm ablation and bactericidal capabilities of PMH were tested using both MBs and NCs. Results. PMH significantly reduced the histotripsy cavitation threshold, allowing for selective luminal cavitation for both MBs and NCs. Results further showed PMH successfully removed intraluminal biofilms in Tygon catheters. Finally, results from bactericidal experiments showed minimal reduction in bacteria viability. Conclusion. The results of this study demonstrate the potential for PMH to provide a new modality for removing bacterial biofilms from CBMDs and suggest that additional work is warranted to develop histotripsy and PMH for treatment of CBMD intraluminal biofilms.
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Affiliation(s)
| | - Connor Edsall
- Department of Biomedical Engineering and Mechanics, Virginia Tech, USA
| | - Isabelle Mehochko
- Department of Biomedical Engineering and Mechanics, Virginia Tech, USA
| | - Waleed Mustafa
- Department of Biomedical Engineering, Istanbul Medipol University, Turkey
| | | | - Alexander L. Klibanov
- Division of Cardiovascular Medicine (Department of Medicine) and Robert M. Berne Cardiovascular Research Center at University of Virginia School of Medicine, University of Virginia, USA
| | - Jayasimha Rao
- Department of Medicine, Division of Infectious Diseases, Virginia Tech Carilion School of Medicine, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, USA
- ICTAS Center for Engineered Health, Virginia Polytechnic Institute and State University, USA
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Fite BZ, Wang J, Ghanouni P, Ferrara KW. A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation. BME FRONTIERS 2022; 2022:9758652. [PMID: 35957844 PMCID: PMC9364780 DOI: 10.34133/2022/9758652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Ultrasound ablation techniques are minimally invasive alternatives to surgical resection and have rapidly increased in use. The response of tissue to HIFU ablation differs based on the relative contributions of thermal and mechanical effects, which can be varied to achieve optimal ablation parameters for a given tissue type and location. In tumor ablation, similar to surgical resection, it is desirable to include a safety margin of ablated tissue around the entirety of the tumor. A factor in optimizing ablative techniques is minimizing the recurrence rate, which can be due to incomplete ablation of the target tissue. Further, combining focal ablation with immunotherapy is likely to be key for effective treatment of metastatic cancer, and therefore characterizing the impact of ablation on the tumor microenvironment will be important. Thus, visualization and quantification of the extent of ablation is an integral component of ablative procedures. The aim of this review article is to describe the radiological findings after ultrasound ablation across multiple imaging modalities. This review presents readers with a general overview of the current and emerging imaging methods to assess the efficacy of ultrasound ablative treatments.
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Affiliation(s)
- Brett Z. Fite
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - James Wang
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
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Woodacre JK, Landry TG, Brown JA. Fabrication and Characterization of a 5 mm × 5 mm Aluminum Lens-Based Histotripsy Transducer. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1442-1451. [PMID: 35171768 DOI: 10.1109/tuffc.2022.3152174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Two 5 mm by 5 mm square aluminum lenses with a 6 mm depth of focus were machined and tested for histotripsy with a 40% volume fraction 1-3 PZT-5A composite and a Meggitt Pz-39 porous ceramics lapped to 315 [Formula: see text] as the piezoelectric elements. The devices were air-backed, and an 89 [Formula: see text] layer of Parylene-C was deposited on the lens, matching aluminum to water. Both devices were driven single-ended at 5.8 MHz, their optimal frequency after bonding to the lens, with ten cycles at a PRF of 1 kHz. The composite-based device showed no sign of free-field cavitation in water up to a drive level of 600 V, whereas the Pz39-based device was able to cavitate in water at a drive level of 220 V. In vivo ablation of a rat brain tissue was demonstrated through an opening in the skull and required the drive voltage be increased to 280 V. The ablation was monitored using B-mode imaging with an endoscopic 30 MHz ultrasound phased array and power Doppler overlay. Ablation was maintained for 12 s and, in the power Doppler image, the ablation zone grew steadily over this time to 1.9 mm by 3.4 mm. Immediately after treatment, the ablated area appeared anechoic, slowly filling with specular material.
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Worlikar T, Zhang M, Ganguly A, Hall TL, Shi J, Zhao L, Lee FT, Mendiratta-Lala M, Cho CS, Xu Z. Impact of Histotripsy on Development of Intrahepatic Metastases in a Rodent Liver Tumor Model. Cancers (Basel) 2022; 14:1612. [PMID: 35406383 PMCID: PMC8996987 DOI: 10.3390/cancers14071612] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Histotripsy has been used for tumor ablation, through controlled, non-invasive acoustic cavitation. This is the first study to evaluate the impact of partial histotripsy ablation on immune infiltration, survival outcomes, and metastasis development, in an in vivo orthotopic, immunocompetent rat HCC model (McA-RH7777). At 7−9 days post-tumor inoculation, the tumor grew to 5−10 mm, and ~50−75% tumor volume was treated by ultrasound-guided histotripsy, by delivering 1−2 cycle histotripsy pulses at 100 Hz PRF (focal peak negative pressure P− >30 MPa), using a custom 1 MHz transducer. Complete local tumor regression was observed on MRI in 9/11 histotripsy-treated rats, with no local recurrence or metastasis up to the 12-week study end point, and only a <1 mm residual scar tissue observed on histology. In comparison, 100% of untreated control animals demonstrated local tumor progression, developed intrahepatic metastases, and were euthanized at 1−3 weeks. Survival outcomes in histotripsy-treated animals were significantly improved compared to controls (p-value < 0.0001). There was evidence of potentially epithelial-to-mesenchymal transition (EMT) in control tumor and tissue healing in histotripsy-treated tumors. At 2- and 7-days post-histotripsy, increased immune infiltration of CD11b+, CD8+ and NK cells was observed, as compared to controls, which may have contributed to the eventual regression of the untargeted tumor region in histotripsy-treated tumors.
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Affiliation(s)
- Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
| | - Man Zhang
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (M.Z.); (M.M.-L.)
| | - Anutosh Ganguly
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA; (A.G.); (C.S.C.)
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
| | - Jiaqi Shi
- Department of Pathology & Clinical Labs, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Fred T. Lee
- Department of Radiology, University of Wisconsin, Madison, WI 53705, USA;
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (M.Z.); (M.M.-L.)
| | - Clifford S. Cho
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA; (A.G.); (C.S.C.)
- Department of Surgery, Ann Arbor VA Healthcare, Ann Arbor, MI 48105, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
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45
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Zhang W, Shi Y, Abd Shukor S, Vijayakumaran A, Vlatakis S, Wright M, Thanou M. Phase-shift nanodroplets as an emerging sonoresponsive nanomaterial for imaging and drug delivery applications. NANOSCALE 2022; 14:2943-2965. [PMID: 35166273 DOI: 10.1039/d1nr07882h] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nanodroplets - emerging phase-changing sonoresponsive materials - have attracted substantial attention in biomedical applications for both tumour imaging and therapeutic purposes due to their unique response to ultrasound. As ultrasound is applied at different frequencies and powers, nanodroplets have been shown to cavitate by the process of acoustic droplet vapourisation (ADV), causing the development of mechanical forces which promote sonoporation through cellular membranes. This allows drugs to be delivered efficiently into deeper tissues where tumours are located. Recent reviews on nanodroplets are mostly focused on the mechanism of cavitation and their applications in biomedical fields. However, the chemistry of the nanodroplet components has not been discussed or reviewed yet. In this review, the commonly used materials and preparation methods of nanodroplets are summarised. More importantly, this review provides examples of variable chemistry components in nanodroplets which link them to their efficiency as ultrasound-multimodal imaging agents to image and monitor drug delivery. Finally, the drawbacks of current research, future development, and future direction of nanodroplets are discussed.
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Affiliation(s)
- Weiqi Zhang
- School of Cancer & Pharmaceutical Sciences, King's College London, UK.
| | - Yuhong Shi
- School of Cancer & Pharmaceutical Sciences, King's College London, UK.
| | | | | | - Stavros Vlatakis
- School of Cancer & Pharmaceutical Sciences, King's College London, UK.
| | - Michael Wright
- School of Cancer & Pharmaceutical Sciences, King's College London, UK.
| | - Maya Thanou
- School of Cancer & Pharmaceutical Sciences, King's College London, UK.
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Hendricks-Wenger A, Saunier S, Simon A, Grider D, Luyimbazi D, Allen IC, Vlaisavljevich E. Histotripsy for the Treatment of Cholangiocarcinoma in a Patient-Derived Xenograft Mouse Model. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:293-303. [PMID: 34750030 DOI: 10.1016/j.ultrasmedbio.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
Histotripsy is a focused ultrasound ablation therapy being developed for the treatment of liver tumors. A recent study investigating the feasibility of using histotripsy for the ablation of cholangiocarcinoma (CC), bile duct cancer that is difficult to treat with current therapies because of its location near critical structures and fibrous tissue, reported the feasibility of treating CC in an acute mouse model. Here, we investigate histotripsy for the in vivo ablation of CC in a chronic study using a 1-MHz transducer at an applied dose of 500 pulses/point. A pilot study determined that treating the CC tumors plus a 1- to 2-mm margin induced significant injuries to intestinal tissues, thus precluding the use of this strategy. Next, histotripsy was applied to CCs (n = 6) with the treatment contained to the tumor. Post-treatment, the ablation was visualized using ultrasound, and subjects were monitored over time. Histotripsy achieved an average of 73% reduction of tumor diameter 26 d after treatment, with no significant adverse events. Notably, three of six treated tumors were undetectable after 2.5 wk. The treated animals were found to have significantly increased tumor progression-free and overall survival. Overall, results indicate that histotripsy can be used as a safe and effective method for treating CC.
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Affiliation(s)
- Alissa Hendricks-Wenger
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA
| | - Sofie Saunier
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Alexander Simon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Douglas Grider
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Dominion Pathology Associates, Roanoke, Virginia, USA
| | - David Luyimbazi
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Surgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA; Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Dominion Pathology Associates, Roanoke, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA; Institute for Critical Technology and Applied Sciences Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA.
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47
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Lu N, Gupta D, Daou BJ, Fox A, Choi D, Sukovich JR, Hall TL, Camelo-Piragua S, Chaudhary N, Snell J, Pandey AS, Noll DC, Xu Z. Transcranial Magnetic Resonance-Guided Histotripsy for Brain Surgery: Pre-clinical Investigation. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:98-110. [PMID: 34615611 PMCID: PMC9404674 DOI: 10.1016/j.ultrasmedbio.2021.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 05/25/2023]
Abstract
Histotripsy has been previously applied to target various cranial locations in vitro through an excised human skull. Recently, a transcranial magnetic resonance (MR)-guided histotripsy (tcMRgHt) system was developed, enabling pre-clinical investigations of tcMRgHt for brain surgery. To determine the feasibility of in vivo transcranial histotripsy, tcMRgHt treatment was delivered to eight pigs using a 700-kHz, 128-element, MR-compatible phased-array transducer inside a 3-T magnetic resonance imaging (MRI) scanner. After craniotomy to open an acoustic window to the brain, histotripsy was applied through an excised human calvarium to target the inside of the pig brain based on pre-treatment MRI and fiducial markers. MR images were acquired pre-treatment, immediately post-treatment and 2-4 h post-treatment to evaluate the acute treatment outcome. Successful histotripsy ablation was observed in all pigs. The MR-evident lesions were well confined within the targeted volume, without evidence of excessive brain edema or hemorrhage outside of the target zone. Histology revealed tissue homogenization in the ablation zones with a sharp demarcation between destroyed and unaffected tissue, which correlated well with the radiographic treatment zones on MRI. These results are the first to support the in vivo feasibility of tcMRgHt in the pig brain, enabling further investigation of the use of tcMRgHt for brain surgery.
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Affiliation(s)
- Ning Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinank Gupta
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam Fox
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Dave Choi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan R Sukovich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - John Snell
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas C Noll
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
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Hendricks-Wenger A, Nagai-Singer MA, Uh K, Vlaisavljevich E, Lee K, Allen IC. Employing Novel Porcine Models of Subcutaneous Pancreatic Cancer to Evaluate Oncological Therapies. Methods Mol Biol 2022; 2394:883-895. [PMID: 35094364 DOI: 10.1007/978-1-0716-1811-0_47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Immunocompromised mice are commonly utilized to study pancreatic cancer and other malignancies. The ability to xenograft tumors in either subcutaneous or orthotopic locations provides a robust model to study diverse biological features of human malignancies. However, there is a dire need for large animal models that better recapitulate human anatomy in terms of size and physiology. These models will be critical for biomedical device development, surgical optimization, and drug discovery. Here, we describe the generation and application of immunocompromised pigs lacking RAG2 and IL2RG as a novel model for human xenograft studies. These SCID-like pigs closely resemble NOD scid gamma mice and are receptive to human tumor tissue, cell lines, and organoid xenografts. However, due to their immunocompromised nature, these immunocompromised animals require housing and maintenance under germfree conditions. In this protocol, we describe the use of these pigs in a subcutaneous tumor injection study with human PANC1 cells. The tumors demonstrate a steady, linear growth curve, reaching 1.0 cm within 30 days post injection. The model described here is focused on subcutaneous injections behind the ear. However, it is readily adaptable for other locations and additional human cell types.
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Affiliation(s)
- Alissa Hendricks-Wenger
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Margaret A Nagai-Singer
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kyungjun Uh
- Department of Animal and Poultry Sciences, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Eli Vlaisavljevich
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Kiho Lee
- Department of Animal and Poultry Sciences, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Irving C Allen
- Graduate Program in Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA.
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
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49
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Hendricks-Wenger A, Arnold L, Gannon J, Simon A, Singh N, Sheppard H, Nagai-Singer MA, Imran KM, Lee K, Clark-Deener S, Byron C, Edwards MR, Larson MM, Rossmeisl JH, Coutermarsh-Ott SL, Eden K, Dervisis N, Klahn S, Tuohy J, Allen IC, Vlaisavljevich E. Histotripsy Ablation in Preclinical Animal Models of Cancer and Spontaneous Tumors in Veterinary Patients: A Review. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:5-26. [PMID: 34478363 PMCID: PMC9284566 DOI: 10.1109/tuffc.2021.3110083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
New therapeutic strategies are direly needed in the fight against cancer. Over the last decade, several tumor ablation strategies have emerged as stand-alone or combination therapies. Histotripsy is the first completely noninvasive, nonthermal, and nonionizing tumor ablation method. Histotripsy can produce consistent and rapid ablations, even near critical structures. Additional benefits include real-time image guidance, high precision, and the ability to treat tumors of any predetermined size and shape. Unfortunately, the lack of clinically and physiologically relevant preclinical cancer models is often a significant limitation with all focal tumor ablation strategies. The majority of studies testing histotripsy for cancer treatment have focused on small animal models, which have been critical in moving this field forward and will continue to be essential for providing mechanistic insight. While these small animal models have notable translational value, there are significant limitations in terms of scale and anatomical relevance. To address these limitations, a diverse range of large animal models and spontaneous tumor studies in veterinary patients have emerged to complement existing rodent models. These models and veterinary patients are excellent at providing realistic avenues for developing and testing histotripsy devices and techniques designed for future use in human patients. Here, we provide a review of animal models used in preclinical histotripsy studies and compare histotripsy ablation in these models using a series of original case reports across a broad spectrum of preclinical animal models and spontaneous tumors in veterinary patients.
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50
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Arnold L, Hendricks-Wenger A, Coutermarsh-Ott S, Gannon J, Hay AN, Dervisis N, Klahn S, Allen IC, Tuohy J, Vlaisavljevich E. Histotripsy Ablation of Bone Tumors: Feasibility Study in Excised Canine Osteosarcoma Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3435-3446. [PMID: 34462159 PMCID: PMC8578360 DOI: 10.1016/j.ultrasmedbio.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 05/29/2023]
Abstract
Osteosarcoma (OS) is a primary bone tumor affecting both dogs and humans. Histotripsy is a non-thermal, non-invasive focused ultrasound method using controlled acoustic cavitation to mechanically disintegrate tissue. In this study, we investigated the feasibility of treating primary OS tumors with histotripsy using a 500-kHz transducer on excised canine OS samples harvested after surgery at the Veterinary Teaching Hospital at Virginia Tech. Samples were embedded in gelatin tissue phantoms and treated with the 500-kHz histotripsy system using one- or two-cycle pulses at a pulse repetition frequency of 250 Hz and a dosage of 4000 pulses/point. Separate experiments also assessed histotripsy effects on normal canine bone and nerve using the same pulsing parameters. After treatment, histopathological evaluation of the samples was completed. To determine the feasibility of treating OS through intact skin/soft tissue, additional histotripsy experiments assessed OS with overlying tissues. Generation of bubble clouds was achieved at the focus in all tumor samples at peak negative pressures of 26.2 ± 4.5 MPa. Histopathology revealed effective cell ablation in treated areas for OS tumors, with no evidence of cell death or tissue damage in normal tissues. Treatment through tissue/skin resulted in generation of well-confined bubble clouds and ablation zones inside OS tumors. Results illustrate the feasibility of treating OS tumors with histotripsy.
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Affiliation(s)
- Lauren Arnold
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Alissa Hendricks-Wenger
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia, USA
| | - Alayna N Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Nikolaos Dervisis
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA; Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA
| | - Joanne Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA.
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