Role of acoustic cavitation in the delivery and monitoring of cancer treatment by high-intensity focused ultrasound (HIFU)

A Novel High-Intensity Focused Ultrasound-Treated Herpes Simplex Virus 2 Vaccine Induces Long-Term Protective Immunity against Lethal Challenge in Mice

High-intensity focused ultrasound (HIFU), a noninvasive ablation therapy that has been widely used clinically in ablation of solid tumors, induces immune sensitization. We therefore in this study investigated whether HIFU treatment could enhance the efficacy of a herpes simplex virus 2 (HSV-2) vaccine. First, we observed that in HSV-2-positive cervical intraepithelial neoplasia (CIN) II patients, HIFU treatment induced significantly higher anti-HSV-2 neutralization response than surgical removal. Next, we tested the efficacy of HIFU-treated, UV-inactivated HSV-2-infected cells as a proof-of-concept vaccine in mice. Our data showed that HIFU-treated formulation significantly enhanced HSV-2 antibody titers and neutralization titers, compared to UV-, microwave (MW)-, or freeze-thaw (FT)-treated formulations. HIFU treatment also promoted the Th1/2 cell-mediated response. A long-term full protection was observed in mice that received the HIFU-treated formulation, and no weight loss was detected. Our findings indicate that the novel application of HIFU in vaccine production may represent a rational way to improve vaccine efficacy.IMPORTANCE High-intensity focused ultrasound (HIFU) is mainly used in tumor ablation and tumor vaccinology study. It has been shown to induce immune sensitization and enhance tumor responsiveness to other therapies. Our study has shown enhanced anti-HSV-2 response in HIFU-treated CIN II patients. Furthermore, in a murine model, we have demonstrated that HIFU-treated HSV-2 vaccine induced long-term protective immunity against lethal challenge. Our findings indicate that the novel application of HIFU in vaccine production may represent a rational way to improve vaccine efficacy.

Focused Ultrasound-Induced Cavitation Sensitizes Cancer Cells to Radiation Therapy and Hyperthermia

Focused ultrasound (FUS) has become an important non-invasive therapy for solid tumor ablation via thermal effects. The cavitation effect induced by FUS is thereby avoided but applied for lithotripsy, support drug delivery and the induction of blood vessel destruction for cancer therapy. In this study, head and neck cancer (FaDu), glioblastoma (T98G), and prostate cancer (PC-3) cells were exposed to FUS by using an in vitro FUS system followed by single-dose X-ray radiation therapy (RT) or water bath hyperthermia (HT). Sensitization effects of short FUS shots with cavitation (FUS-Cav) or without cavitation (FUS) to RT or HT (45 °C, 30 min) were evaluated. FUS-Cav significantly increases the sensitivity of cancer cells to RT and HT by reducing long-term clonogenic survival, short-term cell metabolic activity, cell invasion, and induction of sonoporation. Our results demonstrated that short FUS treatment with cavitation has good potential to sensitize cancer cells to RT and HT non-invasively.

Critical corrections to models of nonlinear power dissipation of ultrasonically excited bubbles

Current models for calculating nonlinear power dissipation during the oscillations of acoustically excited bubbles generate non-physical values for the radiation damping (D_rd) term for some frequency and pressure regions that include near resonance oscillations. Moreover, the ratio of the dissipated powers significantly deviate from the values that are calculated by the linear model at low amplitude oscillations (acoustic excitation pressure of P_A=1 kPa and expansion ratio of <≊1.01). In high amplitude oscillation regimes (P_a⩾20 kPa), the dissipated power due to D_rd deviates largely from the dissipated power as calculated by the widely accepted approach that uses the scattered power by the bubbles. We provide critical corrections to the present models. The validity of the results was examined in regimes of low amplitude oscillations and high amplitude oscillations. In the low amplitude regime, the ratio of the dissipated powers as calculated by the current and proposed model were compared with the linear model predictions. At higher amplitude oscillations, the dissipated power by radiation loss as calculated by the current and the proposed models were compared with the dissipated power calculated using the scattered power by the bubbles. We show that non-physical values are absent in the proposed model. Moreover, predictions of the proposed approach are identical to the predictions of the linear model and the dissipated power estimated using the scattered pressure by the bubble. We show that damping due to thermal effects, liquid viscosity and radiation heavily depend on the excitation pressure and that the linear model estimations are not valid even at pressures as low as 20 kPa.

Clinical and Microbiological Effects of Weekly Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide and Formation of Cavitation Bubbles in Gingival Tissues after This Irrigation: A Six-Month Randomized Clinical Trial

Introduction

The study investigated the effect of weekly supragingival irrigation with aerosolized 0.5% hydrogen peroxide (H₂O₂) solution as a maintenance periodontal therapy on clinical and microbiological parameters in patients with chronic periodontitis. The other purpose was to investigate whether cavitation bubbles can penetrate not only into periodontitis-damaged tissues but also into ex vivo porcine healthy periodontal tissues.

Materials and Methods

The study included 35 systemically healthy patients with chronic periodontitis (CP). After nonsurgical periodontal debridement (NSPD), all patients were randomized into two groups: the Control group (NSDP alone, n = 18) and the Test group (NSDP plus supragingival irrigation, n = 17). Clinical (Approximal Plaque Index (API), Bleeding Index (BI), and Modified Gingival Index (MGI)) and microbiological (Polymerase Chain Reaction technology (using a micro-IDent® kit)) measurements were performed at the initial time point, 3 months, and 6 months after NSPD. The impact of supragingival irrigation on diseased gingival tissues of CP patients (n = 5) and on ex vivo porcine healthy gingival tissue samples (n = 3) was evaluated to estimate morphological changes in healthy and diseased gingival tissues.

Results

Morphological data revealed that supragingival irrigation caused the formation of cavitation bubbles in diseased gingival tissue of CP patients and in healthy porcine gingival tissues. The decrease in API, BI, and MGI scores after 6 months in the Test group significantly (p ≤ 0.01, p ≤ 0.05, and p ≤ 0.01, respectively) exceeded that in the Control group. Test group patients demonstrated a decrease in periodontal sites showing Pocket Probing Depth > 4 mm and, after 6 months, a statistically significant decrease in the proportion of periopathogenic bacteria.

Conclusion

The effectiveness of mechanical periodontal treatment combined with weekly supragingival irrigation with aerosolized 0.5% H₂O₂ solution on clinical and microbiological parameters of periodontal tissues of periodontitis patients is reliably higher than that of mechanical periodontal debridement alone. It has been found that cavitation bubbles as a result of irrigation with the aerosolized 0.5% hydrogen peroxide solution can form not only in periodontal tissues of periodontitis patients but also in ex vivo porcine healthy gingival tissues.

Impact of focused ultrasound on the ethanol ablation of VX2 liver tumours in rabbits

OBJECTIVES

In this study, a treatment combining ethanol ablation (EA) and focused ultrasound (FUS) was performed to investigate its synergistic ablation effect on normal liver and VX2 liver tumours in rabbits.

METHODS

A total of 59 healthy New Zealand white rabbits were included. For normal liver ablation, 39 animals were treated with FUS alone (n = 12), EA alone (n = 12), EA+FUS combination treatment (n = 12), or the control treatment (n = 3). The other 20 rabbits with implanted VX2 liver tumours were treated with EA alone (n = 10) or EA+FUS (n = 10). For FUS, the liver was exposed to 1 MHz FUS with an intensity of 33.0 W/cm² (I_SPTA) for 20 s. The EA group received an injection of absolute ethanol in the liver or liver tumours. For EA+FUS combination therapy, FUS was focused at the EA injection site, and both methods were carried out at the same time.

RESULTS

In normal liver tissues, the ablated volume treated by FUS combined with EA (1.46 ± 0.30 cm³) was approximately 3 times larger than that of EA alone (0.51 ± 0.17 cm³); in VX2 liver tumours, the tumour necrosis rate of the combination therapy was 90.27%, which was much higher than that of EA treatment (63.55%).

CONCLUSION

The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis.

KEY POINTS

• This study demonstrated a novel method for enhancing ethanol ablation and elucidated its potential to enhance percutaneous ethanol ablation (PEA) in a simple non-invasive way. • Ethanol excited by focused ultrasound (FUS) exposure tended to accumulate at the injection site, which could prevent ethanol from being washed out by the bloodstream. • The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis.

Acoustic Microfluidics

Acoustic microfluidic devices are powerful tools that use sound waves to manipulate micro- or nanoscale objects or fluids in analytical chemistry and biomedicine. Their simple device designs, biocompatible and contactless operation, and label-free nature are all characteristics that make acoustic microfluidic devices ideal platforms for fundamental research, diagnostics, and therapeutics. Herein, we summarize the physical principles underlying acoustic microfluidics and review their applications, with particular emphasis on the manipulation of macromolecules, cells, particles, model organisms, and fluidic flows. We also present future goals of this technology in analytical chemistry and biomedical research, as well as challenges and opportunities.

Speed of Sound and Attenuation Temperature Dependence of Bovine Brain: Ex Vivo Study

OBJECTIVES

Brain treatments using focused ultrasound (FUS) offer a new range of noninvasive transcranial therapies. The acoustic energy deposition during these procedures may induce a temperature elevation in the tissue; therefore, noninvasive thermal monitoring is essential. Magnetic resonance imaging is the current adopted monitoring modality, but its high operational costs and limited availability may hinder the accessibility to FUS treatments. Aiming at the development of a thermometric ultrasound (US) method for the brain, the specific objective of this investigation was to study the acoustic thermal response of the speed of sound (SOS) and attenuation coefficient (AC) of different brain tissues: namely white matter (WM) and cortical matter.

METHODS

Sixteen ex vivo bovine brain samples were investigated. These included 7 WM and 9 cortical matter samples. The samples were gradually heated to about 45°C and then repeatedly scanned while cooling using a computerized US system in the through-transmission mode. The temperature was simultaneously registered with thermocouples. From the scans, the normalized SOS and AC for both tissues were calculated.

RESULTS

The results demonstrated a characteristic cooldown temporal behavior for the normalized AC and SOS curves, which were related to the temperature. The SOS curves enabled clear differentiation between the tissue types but depicted more scattered trajectories for the WM tissue. As for the AC curves, the WM depicted a linear behavior in relation to the temperature. However, both tissue types had rather similar temperature patterns.

CONCLUSIONS

These findings may contribute to the development of a US temperature-monitoring method during FUS procedures.

Ultrasound-Assisted Extraction of Polyphenols From Crude Pollen

The aim of this study was to evaluate the extraction efficiency of polyphenols from crude pollen by an ultrasonic process. Prior to the polyphenols extraction, the crude pollen was defatted. The extraction from defatted pollen was carried out by varying four extraction parameters: ultrasonic amplitude (20%, 60% and 100%), solid/liquid ratio (10 g/L, 20 g/L and 30 g/L), temperature (35, 50 and 65 °C) and time (10, 20 and 30 min). The extracts were analyzed in terms of extraction yield (%), total phenolic content (TPC) and total flavones content (TFC). The extracted oil was analyzed in terms of fatty acids composition; myristic acid (159.1 µg × g^-1) and cis-14-pentadecenoic acid (106.6 µg·g^-1) were found in the highest amount in the pollen oil. The optimum conditions of extraction were determined and were, as follows: 100% amplitude of ultrasonic treatment, 30 g/L solid/liquid ratio, 40.85 °C and 14.30 min, which led to the extraction of 366.1 mg GAE/L of TPC and 592.2 mg QE/g of TFC, and also to an extraction yield of 1.92%.

Numerical and Experimental Studies on the Effect of Surface Roughness and Ultrasonic Frequency on Bubble Dynamics in Acoustic Cavitation

With many emerging applications such as chemical reactions and ultrasound therapy, acoustic cavitation plays a vital role in having improved energy efficiency. For example, acoustic cavitation results in substantial enhancement in the rates of various chemical reactions. In this regard, an applied acoustic field within a medium generates acoustic streaming, where cavitation bubbles appear due to preexisting dissolved gas in the working fluid. Upon cavitation inception, bubbles can undergo subsequent growth and collapse. During the last decade, the studies on the effects of different parameters on acoustic cavitation such as applied ultrasound frequency and power have been conducted. The bubble growth and collapse mechanisms and their distribution within the medium have been classified. Yet, more research is necessary to understand the complex mechanism of multi-bubble behavior under an applied acoustic field. Various parameters affecting acoustic cavitation such as surface roughness of the acoustic generator should be investigated in more detail in this regard. In this study, single bubble lifetime, bubble size and multi-bubble dynamics were investigated by changing the applied ultrasonic field. The effect of surface roughness on bubble dynamics was presented. In the analysis, images from a high-speed camera and fast video recording techniques were used. Numerical simulations were also done to investigate the effect of acoustic field frequency on bubble dynamics. Bubble cluster behavior and required minimum bubble size to be affected by the acoustic field were obtained. Numerical results suggested that bubbles with sizes of 50 µm or more could be aligned according to the radiation potential map, whereas bubbles with sizes smaller than 10 µm were not affected by the acoustic field. Furthermore, it was empirically proven that surface roughness has a significant effect on acoustic cavitation phenomena.

A new frequency domain passive acoustic mapping method using passive Hilbert beamforming to reduce the computational complexity of fast Fourier transform

Passive acoustic mapping (PAM) is the current state-of-the-art imaging tool for monitoring cavitation activity during focused ultrasound therapy such as blood-brain barrier opening. However, PAM incurs huge computational complexity. To address this issue, frequency-domain PAM (FD-PAM) was proposed. Nevertheless, FD-PAM still requires a large number of fast Fourier transforms (FFTs) to produce the frequency components utilized for cavitation monitoring with PAM. Hence, in this paper, we proposes a frequency domain PAM method using passive Hilbert beamforming (PHB-PAM), which can significantly reduce the number of input samples for FFT by down-sampling the analytic signal of the received RF samples at each channel at a rate equal to the bandwidth of the frequency components of interest. The experimental results show that the proposed PHB-PAM provides comparable image quality to that of FD-PAM (correlation coefficient > 0.98). Additionally, the study experimentally verifies that the pre-processing block for generating the decimated analytic signal and FFT in PHB-PAM can be realized using lesser logic resources than FFT in FD-PAM when implemented in an FPGA. Especially, with 128-fold decimation, PHB-PAM reduces the amount of LUTs and DSP slices to implement the pre-processing block by 72.16% and 53.4%, respectively, compared to those of FD-PAM, which allows the 64-channel implementation of the pre-processing block in a low-cost single FPGA. Finally, a hardware-efficient architecture for the pre-processing block of PHB-PAM is described, which can be implemented by replacing the two lowpass filters of an off-the-shelf analog front-end component for ultrasound imaging with a pair of band-pass filters. If PHB-PAM is realized using such a component, it can truly minimize the computational complexity of FD-PAM.

The current state and future perspectives of high intensity focused ultrasound (HIFU) ablation for benign thyroid nodules

High intensity focused ultrasound (HIFU) is a new thermoablation technique used to treat benign thyroid nodules. In this method, the ultrasound beam passes through the patient's skin and focuses very precisely on the target lesion at a distance far from the source of ultrasound generation, making HIFU the only truly non-invasive method of thermoablation developed to date. HIFU is therefore an attractive alternative to surgery and other thermoablative techniques. This review describes the principles of HIFU treatment, the selection of patients suitable for HIFU, the course and effects of treatment, and future perspectives.

Collective nonlinear behavior of interacting polydisperse microbubble clusters

Acoustically excited microbubbles (MBs) have shown to exhibit rich dynamics, enabling them to be employed in various applications ranging from chemistry to medicine. Exploiting the full potential of MBs for applications requires a good understanding of their complex dynamics. Improved understanding of MB oscillations can lead to further enhancement in optimizing their efficacy in many applications and also invent new ones. Oscillating MBs have been shown to generate secondary pressure waves that modify the dynamics of the MBs in their proximity. A modified Keller-Miksis equation is used to account for inter-bubble interactions. The oscillatory dynamics of each MB within clusters was computed by numerically solving the resulting system of coupled nonlinear second order differential equations in potential fluid flow. Frequency response analysis and bifurcation diagrams were employed to track the dynamics of interacting MBs. We start with investigating the effect of inter-bubble interactions for cases of three and four MBs over a wide range of acoustic and geometric parameters. Emergent collective behavior was observed which are dominated by the dynamics of the largest MB within the cluster. The emergent dynamics of smaller MBs within clusters can be characterized by constructive and destructive inter-bubble interactions. In constructive interactions, the radial oscillations of smaller MBs matched those of the largest MB and their oscillations are amplified. In destructive interactions, the oscillations of smaller bubbles are suppressed so that their oscillations match those of the largest MB. Furthermore, a special case of constructive interactions is presented where dominant MB (largest) can force smaller MBs into period doubling and subharmonic oscillations. The collective behavior is further investigated in large MB cluster and it is shown that largest MBs, even in small numbers can force smaller ones into period doubling and subharmonic oscillations.

Delivering Focused Ultrasound to Intervertebral Discs Using Time-Reversal

Chronic low back pain causes more disability worldwide than any other condition and is thought to arise in part through loss of biomechanical function of degenerate intervertebral discs (IVDs). Current treatments can involve replacing part or all of the degenerate IVDs by invasive surgery. Our vision is to develop a minimally invasive approach in which high intensity focused ultrasound (HIFU) is used to mechanically fractionate degenerate tissue in an IVD; a fine needle is then used to first remove the fractionated tissue and then inject a biomaterial able to restore normal physiologic function. The goal of this manuscript is to demonstrate the feasibility of trans-spinal HIFU delivery using simulations of 3-D ultrasound propagation in models derived from patient computed tomography (CT) scans. The CT data were segmented into bone, fat and other soft tissue for three patients. Ultrasound arrays were placed around the waist of each patient model, and time-reversal was used to determine the source signals necessary to create a focus in the center of the disc. The simulations showed that for 0.5 MHz ultrasound, a focus could be created in most of the lumbar IVDs, with the pressure focal gain ranging from 3.2-13.7. In conclusion, it is shown that with patient-specific planning, focusing ultrasound into an IVD is possible in the majority of patients despite the complex acoustic path introduced by the bony structures of the spine.

A simple method to analyze the super-harmonic and ultra-harmonic behavior of the acoustically excited bubble oscillator

The bubble oscillator is a highly nonlinear system, which makes it difficult to generate a comprehensive understanding of its oscillatory behavior. One method used to investigate such complex dynamical systems is the bifurcation analysis. Numerous investigations have employed the method of bifurcation diagrams to study the effect of different control parameters on the bubble behavior. These studies, however, focused mainly on investigating the subharmonic (SH) and chaotic oscillations of the bubbles. Super-harmonic (SuH) and ultra-harmonic (UH) bubble oscillations remain under-investigated. One reason is that the conventional method used for generating bifurcation diagrams cannot reliably identify features that are responsible for the identification of SuH and UH oscillations. Additionally, the conventional method cannot distinguish between the UHs and SHs. We introduce a simple procedure to address this shortcoming. In this method, the maxima of the bubble oscillatory response were selected and plotted alongside the traditional bifurcation points for the corresponding control parameter. Results show that depending on the control parameters the conventional method or the method of maxima may miss intricate details of the oscillations. In order to have a comprehensive knowledge on the rich dynamics of the system, the two methods should be employed side by side. Through plotting the two bifurcation structures in tandem, the oscillatory behavior of the bubble was analyzed with more detail, and stable SuH and UH bubble oscillations were investigated. Based on this new analysis, the conditions for the generation and amplification of UH and SuH regimes are discussed.

Passive cavitation mapping using dual apodization with cross-correlation in ultrasound therapy monitoring

Recently, passive acoustic mapping (PAM) has been successfully applied for dynamic monitoring of ultrasound therapy by beamforming acoustic emissions of cavitation activity during ultrasound exposure. The most widely used PAM algorithm in the literature is time exposure acoustics (TEA), which is a standard delay, sum, and integrate algorithm. However, it results in large point spread function (PSF) and serious imaging artifacts for the case where a narrow-aperture receiving array such as a standard B-mode linear array is used, therefore degrading the quality of cavitation image. To address these challenges, in this paper, we proposed a novel PAM algorithm namely dual apodization with cross-correlation (DAX)-based TEA, in which DAX was originally used as a reconstruction algorithm in medical ultrasound imaging. In the proposed algorithm, two sets of signals were beamformed by two receive apodization functions with alternating elements enabled, and the cross-correlation coefficient of the two signals served as a weighting factor that would be multiplied to the sum of the two signals. The performance of the proposed algorithm was tested on simulated channel data obtained using a multi-bubble model, and experiments were also performed in an in vitro vessel phantom with flowing microbubbles as cavitation nuclei. The reconstructed cavitation images were evaluated quantitatively using established quality metrics including full width at half maximum (FWHM), A_-6dB area, and signal-to-noise ratio (SNR). The results suggested that the proposed algorithm significantly outperformed the conventionally used TEA algorithm. This work may have the potential of providing a useful tool for highly accurate localization of cavitation activity during ultrasound therapy.

Enhancement of HIFU ablation by sonosensitizer-loading liquid fluorocarbon nanoparticles with pre-targeting in a mouse model

High intensity focused ultrasound (HIFU) is a noninvasive thermal ablation technique for the treatment of benign and malignant solid masses. To improve the efficacy of HIFU ablation, we developed poly (lactide-co-glycolide) (PLGA) nanoparticles encapsulating perfluoropentane (PFP) and hematoporphyrin monomethyl ether (HMME) as synergistic agents (HMME+PFP/PLGA). Two-step biotin-avidin pre-targeting technique was applied for the HIFU ablation. We further modified the nanoparticles with streptavidin (HMME+PFP/PLGA-SA). HMME+PFP/PLGA-SA were highly dispersed with spherical morphology (477.8 ± 81.8 nm in diameter). The encapsulation efficiency of HMME and PFP were 46.6 ± 3.3% and 40.1 ± 2.6%, respectively. The binding efficiency of nanoparticles to streptavidin was 95.5 ± 2.5%. The targeting ability of the HMME+PFP/PLGA-SA nanoparticles was tested by parallel plate flow chamber in vitro. In the pre-targeting group (HMME+PFP/PLGA-SA), a large number of nanoparticles bound to the peripheral and surface of the cell. In the HIFU ablation experiment in vivo, compared with the other groups, the largest gray-scale changes and coagulation necrosis areas were observed in the pre-targeting (HMME+PFP/PLGA-SA) group, with the lowest energy efficiency factor value. Moreover, the microvessel density and proliferation index declined, while the apoptotic index increased, in the tumor tissue surrounding the coagulation necrosis area in the pre-targeting group. Meanwhile, the survival time of the tumor-bearing nude mice in the pre-targeting group was significantly longer than that in the HIFU treatment group. These results suggest that HMME+PFP/PLGA-SA have high potential to act as synergistic agents in HIFU ablation.

Simulation of cavitation enhanced temperature elevation in a soft tissue during high-intensity focused ultrasound thermal therapy

The present study aims to investigate temperature distribution caused by bubble oscillations in a soft tissue during focused ultrasound therapy by introducing a coupled temperature-cavitation model. The proposed model is capable of describing bubble dynamics, viscoelastic properties of surrounding tissue-like medium, temperature distribution inside and outside the bubble, vapor diffusion within the bubble and vapor flux through the bubble wall to the exterior. The continuous temperature distribution inside and outside the oscillating bubble in soft tissue subject to ultrasound wave with high acoustic pressure is presented. The temperature close to the bubble wall can reach the value of about 10³ K. The elasticity of soft tissue reduces temperature values. The relaxation time effect strongly depends on the period of the ultrasound wave. If the vapor mass flux effect is taken into account in the simulations, the rectified growth effect can be observed, which can lead to the decrease of the temperature values. Due to the growth of the bubble, the effects of elasticity and relaxation time on the temperature become less prominent during several bubble oscillation cycles. The impact of cavitation heat source terms on the exterior temperature was examined and led us to draw conclusion that, even though these heat sources can increase the outside temperature values, they can not be treated as main mechanisms for the temperature elevation during a few microseconds. The performed comparison with uncoupled conventional model for the outside temperature calculation revealed that coupling with inside temperature model delivers incomparably higher values to the bubble's exterior and, therefore, it is essential for the accurate description of the treatment process.

Temperature-Responsive Hydrophobic Silica Nanoparticle Ultrasound Contrast Agents Directed by Phospholipid Phase Behavior

In this paper, we report ultrasonically active nanoscale contrast agents that behave as thermometric sensors through phase change in their stabilizing phospholipid monolayer. Phospholipid-stabilized, hydrophobic mesoporous silica nanoparticles (P@hMSNs) are known to interact with high-intensity focused ultrasound (HIFU) to promote cavitation at their surfaces, which can be used for both imaging and therapy. We show that the lateral lipid phase behavior of the phosphocholine lipid dictates the acoustic contrast of the P@hMSNs. When the lipids are in the gel phase below their melting temperature, the P@hMSNs generate detectable microbubbles when exposed to HIFU. However, if the lipids exhibit a liquid expanded phase, the P@hMSNs cease to generate bubbles in response to HIFU insonation. We verify that the heating and subsequent transition of lipid coating the hMSN are associated with the loss of acoustic response by doping laurdan dye into the lipid monolayer and imaging lipid phase through red shifts in emission spectra. Similarly, cessation of cavitation was also induced by adding a fluidizing surfactant such as Triton X, which could be reversed upon washing away the excess surfactant. Finally, by controlling for the partial fluidization caused by the adsorption of protein, P@hMSNs may be used as thermometric sensors of the bulk fluid temperature. These findings not only impact the utilization of nanoscale agents as stimulus-responsive ultrasound contrast agents but also have broader implications for how cavitation may be initiated at surfaces coated by a surfactant.

SVD-Based Separation of Stable and Inertial Cavitation Signals Applied to Passive Cavitation Mapping During HIFU

Detection of inertial and stable cavitation is important for guiding high-intensity focused ultrasound (HIFU). Acoustic transducers can passively detect broadband noise from inertial cavitation and the scattering of HIFU harmonics from stable cavitation bubbles. Conventional approaches to cavitation noise diagnostics typically involve computing the Fourier transform of the time-domain noise signal, applying a custom comb filter to isolate the frequency components of interest, followed by an inverse Fourier transform. We present an alternative technique based on singular value decomposition (SVD) that efficiently separates the broadband emissions and HIFU harmonics. Spatiotemporally resolved cavitation detection was achieved using a 128-element, 5-MHz linear-array ultrasound imaging system operating in the receive mode at 15 frames/s. A 1.1-MHz transducer delivered HIFU to tissue-mimicking phantoms and excised liver tissue for a duration of 5 s. Beamformed radio frequency signals corresponding to each scan line in a frame were assembled into a matrix, and SVD was performed. Spectra of the singular vectors obtained from a tissue-mimicking gel phantom were analyzed by computing the peak ratio ( R ), defined as the ratio of the peak of its fifth-order polynomial fit and the maximum spectral peak. Singular vectors that produced an were classified as those representing stable cavitation, i.e., predominantly containing harmonics of HIFU. The projection of data onto this singular base reproduced stable cavitation signals. Similarly, singular vectors that produced an were classified as those predominantly containing broadband noise associated with inertial cavitation. These singular vectors were used to isolate the inertial cavitation signal. The R -value thresholds determined using gel data were then employed to analyze cavitation data obtained from bovine liver ex vivo. The SVD-based method faithfully reproduced the structural details in the spatiotemporal cavitation maps produced using the more cumbersome comb-filter approach with a maximum root-mean-squared error of 10%.

High-Intensity Focused Ultrasound Lesion Detection Using Adaptive Compressive Sensing Based on Empirical Mode Decomposition

Background:

The main goal of ultrasound therapy is to have clinical effects in the tissue without damage to the intervening and surrounding tissues. Treatments have been developed for both in vitro and in clinical applications. HIFU therapy is one of these. Non-invasive surgeries, such as HIFU, have been developed to treat tumors or to stop bleeding. In this approach, an adequate imaging method for monitoring and controlling the treatment is required.

Methods:

In this paper, an adaptive compressive sensing representation of ultrasound RF echo signals is presented based on empirical mode decomposition (EMD). According to the different numbers of intrinsic mode functions (IMFs) produced by the EMD, the ultrasound signals is adaptively compressive sampled in the source and then adaptively reconstructed in the receiver domains. In this paper, a new application of compressive sensing based on EMD (CS-EMD) in the monitoring of high-intensity focused ultrasound (HIFU) treatment is presented. Non-invasive surgeries such as HIFU have been developed for various therapeutic applications. In this technique, a suitable imaging method is necessary for monitoring of the treatment to achieve adequate treatment safety and efficacy. So far, several methods have been proposed, such as ultrasound radiofrequency (RF) signal processing techniques, and imaging methods such as X-ray, MRI, and ultrasound to monitor HIFU lesions.

Results:

In this paper, a CS-EMD method is used to detect the HIFU thermal lesion dimensions using different types of wavelet transform. The results of the processing on the real data demonstrate the potential for this technique in image-guided HIFU therapy.

Conclusions:

In this study, a new application of compressive sensing in the field of monitoring of the HIFU treatment is presented. To the best of our knowledge, so far no studies on compressive sensing have been carried out in the monitoring of the HIFU. Based on the results obtained, it was showed that the number of measurements and Intrinsic Mode Functions have the function of noise reduction. In addition, results were shown that the successful reconstruction of the compressive sensing signals can be gained using a threshold based algorithm. To this end, in this paper it was shown that by selecting an suitable number of measurements, the sparse transform, and a thresholding algorithm, we can achieve a more accurate detection of the HIFU thermal lesion size.

Spatially Specific Liposomal Cancer Therapy Triggered by Clinical External Sources of Energy

This review explores the use of energy sources, including ultrasound, magnetic fields, and external beam radiation, to trigger the delivery of drugs from liposomes in a tumor in a spatially-specific manner. Each section explores the mechanism(s) of drug release that can be achieved using liposomes in conjunction with the external trigger. Subsequently, the treatment's formulation factors are discussed, highlighting the parameters of both the therapy and the medical device. Additionally, the pre-clinical and clinical trials of each triggered release method are explored. Lastly, the advantages and disadvantages, as well as the feasibility and future outlook of each triggered release method, are discussed.

Dynamics of bubble-bubble interactions experiencing viscoelastic drag

The subject of the present theoretical study is the dynamics of bubble-bubble interactions in a viscoelastic medium. First, new equations for calculating the viscoelastic drag exerted on bubbles during their translational motion in a viscoelastic medium are derived. The drag equations are incorporated in the bubble-bubble interaction model in which, thereby, both the translational and radial motions of the bubbles are affected by the viscoelastic features of the medium. Second, the derived equations are applied to investigate how the viscoelastic properties of the medium can affect the dynamics of multiple bubbles, as well as how the bubbles can affect each other. It was discovered that the bubble-bubble interaction can significantly influence the dynamics of a single bubble. As the distance between the bubbles increases, their effect on each other decreases, and at a distance of several millimeters, this effect can be neglected. Moreover, it was concluded that with increasing elasticity and viscosity of the medium, as well with decreasing relaxation time, the effects of other bubbles on the current bubble's radial motion can become negligible. The translational motion of the bubbles was investigated for different viscoelastic models. The elasticity resists the motion of bubbles in space, resulting in a dynamical steady state of the distance between the bubbles at high elasticity values. The relaxation time of the medium was also found to be important in terms of the bubbles' translational movement.

Mechanochemical Disruption Suppresses Metastatic Phenotype and Pushes Prostate Cancer Cells toward Apoptosis

Chemical-based medicine that targets specific oncogenes or proteins often leads to cancer recurrence due to tumor heterogeneity and development of chemoresistance. This challenge can be overcome by mechanochemical disruption of cancer cells via focused ultrasound (FUS) and sensitizing chemical agents such as ethanol. We demonstrate that this disruptive therapy decreases the viability, proliferation rate, tumorigenicity, endothelial adhesion, and migratory ability of prostate cancer cells in vitro. It sensitized the cells to TNFR1-- and Fas--mediated apoptosis and reduced the expression of metastatic markers CD44 and CD29. Using a prostate cancer xenograft model, we observed that the mechanochemical disruption led to complete tumor regression in vivo. This switch to a nonaggressive cell phenotype was caused by ROS and Hsp70 overproduction and subsequent impairment of NFκB signaling. FUS induces mechanical perturbations of diverse cancer cell populations, and its combination with agents that amplify and guide remedial cellular responses can stop lethal cancer progression. IMPLICATIONS: Mechanochemical disruption therapy in which FUS is combined with ethanol can be curative for locally aggressive and castration-resistant prostate cancer.

Micron-sized PFOB liquid core droplets stabilized with tailored-made perfluorinated surfactants as a new class of endovascular sono-sensitizers for focused ultrasound thermotherapy

The effect of micro-droplet concentration on HIFU beam absorption.

High-intensity focused ultrasound (HIFU) ablation by the frequency chirps: Enhanced thermal field and cavitation at the focus

High-intensity focused ultrasound (HIFU) has become popular in the noninvasive ablation of a variety of solid tumors and cancers with promising clinical outcomes. Its ablation efficiency should be improved for the reduced treatment duration, especially for a large target. The frequency chirps were proposed and investigated for the enhanced lesion production and bubble cavitation at the focus during HIFU ablation. First, a nonlinear wave model was used to simulate the acoustic field using different excitation strategies (at the constant frequency excitation, downward and upward frequency chirps) and subsequently, the bubble dynamics and cavitation-enhanced temperature elevation were calculated by the Gilmore and Bioheat equations, respectively. Then the temperature rises and the produced lesion in the gel phantom were measured by the thermocouple and recorded photographically, respectively. Bubble activities at the focus were measured by passive cavitation detection (PCD) to quantify the scattering and inertial cavitation levels using short-time Fourier-transform (STFT). Finally, the enhanced temperature elevation, lesion production, and bubble cavitation were further confirmed in the ex vivo tissue samples. It is found that the frequency sweeping time plays a more important role in the enhancement of HIFU-produced lesion in the gel phantom while the frequency sweeping range seems more critical in the tissue. Altogether, large frequency sweeping range in a short time is preferable, and the frequency sweeping direction has little influence on the lesion enhancement.

Weighting the Passive Acoustic Mapping Technique With the Phase Coherence Factor for Passive Ultrasound Imaging of Ultrasound-Induced Cavitation

Ultrasound (US) cavitation is currently being explored for low-invasive therapy techniques applied to a wide panel of pathologies. Because of the random behavior of cavitation, a real-time spatial monitoring system may be required. For this purpose, the US passive imaging techniques have been recently investigated. In particular, the passive acoustic mapping (PAM) beamforming method enables the reconstruction of cavitation activity maps by beamforming acoustic signals passively recorded by an array transducer. In this paper, an optimized version of PAM, PAM weighted with a phase coherence factor (PAM-PCF), is considered. A general validation process is developed including simulations on a point source and experiments on a wire. Furthermore, using a focused regulated US-induced cavitation generator, reproducible cavitation experiments are conducted in water and in agar gel. The spatial behavior of a bubble cavitation cloud is determined using the PAM-PCF beamforming method to localize the focal cavitation point in two perpendicular imaging planes.

The enhanced HIFU-induced thermal effect via magnetic ultrasound contrast agent microbubbles

High intensity focused ultrasound (HIFU) has been regarded as a promising technology for treating cancer and other severe diseases noninvasively. In the present study, dual modality magnetic ultrasound contrast agent microbubbles (MBs) were synthesized by loading the super paramagnetic iron oxide nanoparticles (SPIOs) into the albumin-shelled MBs (referred as SPIO-albumin MBs). Then, both experimental measurements and numerical simulations were performed to evaluate the ability of SPIO-albumin MBs of enhancing HIFU-induced thermal effect. The results indicated that, comparing with regular albumin-shelled MBs, the SPIO-albumin MBs would lead to quicker temperature elevation rate and higher peak temperature. This phenomenon could be explained by the changes in MBs' physical and thermal properties induced by the integration of SPIOs into MB shell materials. In addition, more experimental results demonstrated that the enhancement effect on HIFU-induced temperature elevation could be further strengthened with more SPIOs combined with albumin-shell MBs. These observations suggested that more violent cavitation behaviors might be activated by ultrasound exposures with the presence of SPIOs, which in turn amplified ultrasound-stimulated thermal effect. Based on the present studies, it is reasonable to expect that, with the help of properly designed dual-modality magnetic MBs, the efficiency of HIFU-induced thermal effect could be further improved to achieve better therapeutic outcomes.

Characterization of cavitation-radiated acoustic power using diffraction correction

A method is developed for compensating absolute pressure measurements made by a calibrated passive cavitation detector (PCD) to estimate the average acoustic power radiated from a region of interest (ROI) defined to encompass all cavitating bubbles. A diffraction correction factor for conversion of PCD-measured pressures to cavitation-radiated acoustic power per unit area or volume is derived as a simple analytic expression, accounting for position- and frequency-dependent PCD sensitivity. This approach can be applied to measurements made by any PCD without precise knowledge of the number, spatial, or temporal distribution of cavitating bubbles. The diffraction correction factor is validated in simulation for a wide range of ROI dimensions and frequencies. The correction factor is also applied to emission measurements obtained during in vitro ultrasound-enhanced sonophoresis experiments, allowing comparison of stable cavitation levels between therapeutic configurations with different source center frequencies. Results incorporating sonication at both 0.41 and 2.0 MHz indicate that increases in skin permeability correlate strongly with the acoustic power of subharmonic emissions radiated per unit skin area.

Ex Vivo Assessment of Multiple Parameters in High Intensity Focused Ultrasound

High Intensity Focused Ultrasound (HIFU) is a very promising technology for a non-invasive treatment of several pathologies, especially in oncology. However, optimizing the stimulation parameters for better tuning the induced lethal effects (thermal and/or mechanical) in the targeted area is not trivial and it has not been achieved yet. The aim of this study is to present the results of a combined analysis of temperature, acoustic cavitation and lesion geometry induced in ex vivo tissues during HIFU procedures by varying power, sonication time and duty cycle. Temperature rise was analyzed using a thin wire thermocouple embedded in the sonicated tissue; stable and inertial cavitation were measured using a passive cavitation detector (PCD), and lesion volume was assessed using both ultrasound imaging and optical visualization. The obtained results may represent an important guideline for clinical treatments, providing useful nformation for better tuning HIFU operational parameters to induce a desired type of ablation (i.e. thermal, mechanical or a combination of both).

Coalescence of residual histotripsy cavitation nuclei using low-gain regions of the therapy beam during electronic focal steering

Following collapse of a histotripsy cloud, residual microbubbles may persist for seconds, distributed throughout the focus. Their presence can attenuate and scatter subsequent pulses, hindering treatment speed and homogeneity. Previous studies have demonstrated use of separate low-amplitude (~1 MPa) pulses interleaved with histotripsy pulses to drive bubble coalescence (BC), significantly improving treatment speed without sacrificing homogeneity. We propose that by using electronic focal steering (EFS) to direct the therapy focus throughout specially-designed EFS sequences, it is possible to use low-gain regions of the therapy beam to accomplish BC during EFS without any additional acoustic sequence. First, to establish proof of principle for an isolated focus, a 50-foci EFS sequence was constructed with the first position isolated near the geometric focus and remaining positions distributed post-focally. EFS sequences were evaluated in tissue-mimicking phantoms with gas concentrations of 20% and 100% with respect to saturation. Results using an isolated focus demonstrated that at 20% gas concentration, 49 EFS pulses were sufficient to achieve BC in all samples for pulse repetition frequency (PRF)  ⩽  800 Hz and 84.1%  ±  3.0% of samples at 5 kHz PRF. For phantoms prepared with 100% gas concentration, BC was achieved by 49 EFS pulses in 39.2%  ±  4.7% of samples at 50 Hz PRF and 63.4%  ±  15.3% of samples at 5 kHz. To show feasibility of using the EFS-BC method to ablate a large volume quickly, a 1000-foci EFS sequence covering a volume of approximately 27 ml was tested. Results indicate that the BC effect was similarly present. A treatment rate of 27  ±  6 ml min^-1 was achieved, which is signficantly faster than standard histotripsy and ultrasound thermal ablation. This study demonstrates that histotripsy with EFS can achieve BC without employing a separate acoustic sequence which has the potential to accelerate large-volume ablation while minimizing energy deposition.

A review on the use of magnetic fields and ultrasound for non-invasive cancer treatment

Current popular cancer treatment options, include tumor surgery, chemotherapy, and hormonal treatment. These treatments are often associated with some inherent limitations. For instances, tumor surgery is not effective in mitigating metastases; the anticancer drugs used for chemotherapy can quickly spread throughout the body and is ineffective in killing metastatic cancer cells. Therefore, several drug delivery systems (DDS) have been developed to target tumor cells, and release active biomolecule at specific site to eliminate the side effects of anticancer drugs. However, common challenges of DDS used for cancer treatment, include poor site-specific accumulation, difficulties in entering the tumor microenvironment, poor metastases and treatment efficiency. In this context, non-invasive cancer treatment approaches, with or without DDS, involving the use of light, heat, magnetic field, electrical field and ultrasound appears to be very attractive. These approaches can potentially improve treatment efficiency, reduce recovery time, eliminate infections and scar formation. In this review we focus on the effects of magnetic fields and ultrasound on cancer cells and their application for cancer treatment in the presence of drugs or DDS.

The effects on thermal lesion shape and size from bubble clouds produced by acoustic droplet vaporization

BACKGROUND

Bubbles formed by acoustic droplet vaporization (ADV) have proven to be an effective method for significant enlargement of the thermal lesions produced by high intensity focused ultrasound (HIFU). We investigated the influences of bubble cloud shape and droplet concentration on HIFU thermal lesions, as these relate to the ADV technique.

METHODS

Unlike previous studies where the droplets were simultaneously vaporized with the HIFU exposure for thermal lesion formation, droplets were vaporized by pulse wave (PW) ultrasound prior to continuous wave (CW) ultrasound heating in this experimental study. Under different experimental conditions, we recorded and quantified by the image processing methods the morphology and size of the bubble clouds created and the corresponding thermal lesions formed.

RESULTS

The results demonstrated that different ADV droplet concentrations produced a variety of thermal lesion shapes and sizes. The lesion volume could be increased using PW ultrasound followed by CW exposure, especially for higher droplet concentrations, e.g. 3.41 × 10⁶/mL yielded a tenfold increase over that seen using CW alone.

CONCLUSION

These findings could lead to optimization of HIFU therapy by selecting a bubble forming strategy and droplet concentrations, especially using lower ultrasound powers which is desirable in clinical applications.

Microbubble-assisted MRI-guided focused ultrasound for hyperthermia at reduced power levels

PURPOSE

Ultrasound contrast agent microbubbles were combined with magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) as a means to achieve mild hyperthermia at reduced power levels.

METHODS

MRgFUS hyperthermia (42°C for 20 min) was evaluated in rabbit thigh muscle or Vx2 tumors using infusions of microbubbles (Definity, 20 µL/kg) or saline (sham) administered over 5 min. The impact of treatments on drug uptake was assessed with liposomal doxorubicin (Caelyx, 2.5 mg/kg). Applied power levels before and after the injection of microbubbles or saline were compared, and drug uptake was evaluated with fluorometry of tissues harvested 24 hr post-treatment.

RESULTS

MRgFUS hyperthermia in muscle and tumors resulted in accurate temperature control (mean =42.0°C, root mean square error (RMSE) = 0.3°C). The power dropped significantly following the injection of microbubbles in muscle and tumors compared to exposures without microbubbles (-21.9% ± 12.5% vs -5.9% ± 7.8%, p = .009 in muscle; -33.8% ± 9.9% vs -3.0% ± 7.2%, p < .001 in tumors). Cavitation monitoring indicated emission of subharmonic, ultraharmonic, and elevated levels of fourth to sixth harmonic frequencies following microbubble injection. The drug delivery was elevated significantly in muscle with the use of microbubble-assisted relative to conventional heating (0.5 ± 0.5 ng/mg vs 0.20 ± 0.04 ng/mg, p = .05), whereas in tumors similar levels were found (11 ± 3 ng/mg vs 16 ± 4 ng/mg, p = .13).

CONCLUSIONS

The finding that microbubbles reduce the applied power requirements for hyperthermia has considerable clinical implications. The elevated levels of drug found in muscle but not tumor tissue suggest a complex interplay between the heating effects of microbubbles with those of enhanced permeabilization and possible vascular damage.

Controllable Nucleation of Cavitation from Plasmonic Gold Nanoparticles for Enhancing High Intensity Focused Ultrasound Applications

In this study, plasmonic gold nanoparticles were simultaneously exposed to pulsed near-infrared laser light and high intensity focused ultrasound (HIFU) for the controllable nucleation of cavitation in tissue-mimicking gel phantoms. This in vitro protocol was developed to demonstrate the feasibility of this approach, for both enhancement of imaging and therapeutic applications for cancer. The same apparatus can be used for both imaging and therapeutic applications by varying the exposure duration of the HIFU system. For short duration exposures (10 µs), broadband acoustic emissions were generated through the controlled nucleation of inertial cavitation around the gold nanoparticles. These emissions provide direct localization of nanoparticles. For future applications, these particles may be functionalized with molecular-targeting antibodies (e.g. anti-HER2 for breast cancer) and can provide precise localization of cancerous regions, complementing routine diagnostic ultrasound imaging. For continuous wave (CW) exposures, the cavitation activity was used to increase the localized heating from the HIFU exposures resulting in larger thermal damage in the gel phantoms. The acoustic emissions generated from inertial cavitation activity during these CW exposures was monitored using a passive cavitation detection (PCD) system to provide feedback of cavitation activity. Increased localized heating was only achieved through the unique combination of nanoparticles, laser light and HIFU. Further validation of this technique in pre-clinical models of cancer is necessary.

Histotripsy Using Fundamental and Second Harmonic Superposition Combined with Hundred-Microsecond Ultrasound Pulses

A novel histotripsy approach based on fundamental and second harmonic superposition and incorporating hundred-microsecond-long pulses and two-stage pulse protocol is proposed in this study to rapidly generate mechanically homogenized lesions. Two pulse stages were applied: stage 1, pulses with a pulse duration of 500-600 μs and pulse repetition frequency of 100 Hz, and stage 2, multiple periods, each composed of multiple pulses with the same pulse duration and pulse repetition frequency as those in stage 1, but with an off-time of 600 ms between periods. A custom-designed 1.1/2.2-MHz two-element confocal-annular array, with an f-number of 0.69, and lateral and axial full width at half-maximum pressure dimensions of approximately 1.0 and 6.0 mm, was used. The peak positive/negative pressures at the focus were +22/-7 MPa for 1.1 MHz and +56/-14 MPa with shock wave for 2.2 MHz. To investigate the feasibility of this approach, experiments were designed and performed in tissue-mimicking polyacrylamide gel phantoms with bovine serum albumin and in ex vivo porcine tissues. Cavitation and boiling activities were observed through high-speed photography, and the corresponding acoustic emissions were recorded through passive cavitation detection. Ex vivo experimental results revealed that complete tissue homogeneous regions with regular long tear shape and typical dimensions of 5.80 ± 0.19 mm in axial and 2.20 ± 0.26 mm in lateral were successfully generated in porcine kidney samples. The hematoxylin and eosin staining evidenced that the lesions were thoroughly homogenized and sharply demarcated from untreated regions. These results indicated that the histotripsy approach using fundamental and second harmonic superposition combined with hundred-microsecond pulses and two-stage pulse protocol can efficiently obtain a mechanical disruption of soft tissues with spatial precision, and this approach may have the potential to be developed as a useful tool for precise tumor treatment.

Transurethral ultrasound therapy of the prostate in the presence of calcifications: A simulation study

PURPOSE

Transurethral ultrasound therapy is an investigational treatment modality which could potentially be used for the localized treatment of prostate cancer. One of the limiting factors of this therapy is prostatic calcifications. These attenuate and reflect ultrasound and thus reduce the efficacy of the heating. The aim of this study is to investigate how prostatic calcifications affect therapeutic efficacy, and to identify the best sonication strategy when calcifications are present.

METHODS

Realistic computational models were used on clinical patient data in order to simulate different therapeutic situations with naturally occurring calcifications as well as artificial calcifications of different sizes (1-10 mm) and distances (5-15 mm). Furthermore, different sonication strategies were tested in order to deliver therapy to the untreated tissue regions behind the calcifications.

RESULTS

The presence of calcifications in front of the ultrasound field was found to increase the peak pressure by 100% on average while the maximum temperature only rose by 9% during a 20-s sonication. Losses in ultrasound energy were due to the relatively large acoustic impedance mismatch between the prostate tissue and the calcifications (1.63 vs 3.20 MRayl) and high attenuation coefficient (0.78 vs 2.64 dB/MHz^1.1 /cm), which together left untreated tissue regions behind the calcifications. In addition, elevated temperatures were seen in the region between the transducer and the calcifications. Lower sonication frequencies (1-4 MHz) were not able to penetrate through the calcifications effectively, but longer sonication durations (20-60 s) with selective transducer elements were effective in treating the tissue regions behind the calcifications.

CONCLUSIONS

Prostatic calcifications limit the reach of therapeutic ultrasound treatment due to reflections and attenuation. The tissue regions behind the calcifications can possibly be treated using longer sonication durations combined with proper transducer element selection. However, caution should be taken with calcifications located close to sensitive organs such as the urethra, bladder neck, or rectal wall.

Efficient and controllable thermal ablation induced by short-pulsed HIFU sequence assisted with perfluorohexane nanodroplets

A HIFU sequence with extremely short pulse duration and high pulse repetition frequency can achieve thermal ablation at a low acoustic power using inertial cavitation. Because of its cavitation-dependent property, the therapeutic outcome is unreliable when the treatment zone lacks cavitation nuclei. To overcome this intrinsic limitation, we introduced perfluorocarbon nanodroplets as extra cavitation nuclei into short-pulsed HIFU-mediated thermal ablation. Two types of nanodroplets were used with perfluorohexane (PFH) as the core material coated with bovine serum albumin (BSA) or an anionic fluorosurfactant (FS) to demonstrate the feasibility of this study. The thermal ablation process was recorded by high-speed photography. The inertial cavitation activity during the ablation was revealed by sonoluminescence (SL). The high-speed photography results show that the thermal ablation volume increased by ∼643% and 596% with BSA-PFH and FS-PFH, respectively, than the short-pulsed HIFU alone at an acoustic power of 19.5 W. Using nanodroplets, much larger ablation volumes were created even at a much lower acoustic power. Meanwhile, the treatment time for ablating a desired volume significantly reduced in the presence of nanodroplets. Moreover, by adjusting the treatment time, lesion migration towards the HIFU transducer could also be avoided. The SL results show that the thermal lesion shape was significantly dependent on the inertial cavitation in this short-pulsed HIFU-mediated thermal ablation. The inertial cavitation activity became more predictable by using nanodroplets. Therefore, the introduction of PFH nanodroplets as extra cavitation nuclei made the short-pulsed HIFU thermal ablation more efficient by increasing the ablation volume and speed, and more controllable by reducing the acoustic power and preventing lesion migration.

Frequency-sum beamforming for passive cavitation imaging

Beamforming includes a variety of spatial filtering techniques that may be used for determining sound source locations from near-field sensor array recordings. For this scenario, beamforming resolution depends on the acoustic frequency, array geometry, and target location. Random scattering in the medium between the source and the array may degrade beamforming resolution with higher frequencies being more susceptible to degradation. The performance of frequency-sum (FS) beamforming for reducing such sensitivity to mild scattering while increasing resolution is reported here. FS beamforming was used with a data-dependent [minimum variance (MV)] or data-independent (delay-and-sum, DAS) weight vector to produce higher frequency information from lower frequency signal components via a quadratic product of complex signal amplitudes. The current findings and comparisons are based on simulations and passive cavitation imaging experiments using 3 MHz and 6 MHz emissions recorded by a 128-element linear array. FS beamforming results are compared to conventional DAS and MV beamforming using four metrics: point spread function (PSF) size, axial and lateral contrast, and computation time. FS beamforming produces a smaller PSF than conventional DAS beamforming with less computation time than MV beamforming in free space and mild scattering environments. However, it may fail when multiple unknown sound sources are present.

Numerical and Experimental Evaluation of High-Intensity Focused Ultrasound-Induced Lesions in Liver Tissue Ex Vivo

OBJECTIVES

Recent advances in the field of acoustics and piezoelectric and ultrasound transducers have led to new approaches to the diagnosis and treatment of certain diseases. One method of treatment with ultrasonic waves is high-intensity focused ultrasound (HIFU) treatment, which is a thermal therapeutic method used to treat malignant tumors. Although a variety of treatment-planning strategies using ultrasonic waves have been investigated, little clinical success has been achieved. Computational modeling is a powerful tool for predicting device performance.

METHODS

The heating induced by a concave transducer with operating powers of 85 and 135 W was studied, and the experimental results presented in this article verify its applicability. Numerical simulations of the nonlinear acoustic field were performed by using the Westervelt and Khokhlov-Zabolotskaya-Kuznetsov equations. Heat transfer was measured for the 2 operational powers, and the results were compared with ex vivo experimental results. In addition, thermal dose contours for both the simulation and experimental results were calculated to investigate the ablated area.

RESULTS

Good agreement was found between the experimental and numerical results. The results show that the average temperature deviations calculated at the focal point were 12.8% and 4.3% for transducer powers of 85 and 135 W, respectively.

CONCLUSIONS

This study provides guidance to HIFU practitioners in determining lesion size and identifying nonlinear effects that should be considered in HIFU procedures.

In Vivo Targeted, Responsive, and Synergistic Cancer Nanotheranostics by Magnetic Resonance Imaging-Guided Synergistic High-Intensity Focused Ultrasound Ablation and Chemotherapy

As one of the most representative noninvasive therapeutic modalities, high-intensity focused ultrasound (HIFU) has shown great promise for cancer therapy, but its low therapeutic efficacy and biosafety significantly hinder further extensive clinical translation and application. In this work, we report on the construction of a multifunctional theranostic nanoplatform to synergistically enhance the HIFU-therapeutic efficacy based on nanomedicine. A targeted and temperature-responsive theranostic nanoplatform (PFH/DOX@PLGA/Fe₃O₄-FA) has been designed and fabricated for efficient ultrasound/magnetic resonance dual-modality imaging-guided HIFU/chemo synergistic therapy. Especially, the folate was conjugated onto the surface of the nanoplatform for achieving active targeting to hepatoma cells by receptor-ligand interaction, which facilitates accumulation of the nanoplatforms into the tumor site. The integrated superparamagnetic iron oxide nanoparticles could generate the contrast enhancement in T₂-weighted magnetic resonance imaging. By virtue of the thermal effect as generated by HIFU, liquid-gas phase transition of perfluorohexane (PFH) in nanocomposites was induced to generate PFH microbubbles, which achieved the contrast-enhanced ultrasound imaging and significantly improved the HIFU ablation efficacy. The loaded anticancer drugs could be released from the nanocomposites in a controllable manner (both pH and HIFU responsiveness). These multifunctional nanocomposites have been demonstrated to efficiently suppress the tumor growth based on the enhanced and synergistic chemotherapy and HIFU ablation, providing an efficient theranostic nanoplatform for cancer treatment.

Performance characterisation of a passive cavitation detector optimised for subharmonic periodic shock waves from acoustic cavitation in MHz and sub-MHz ultrasound

We describe the design, construction and characterisation of a broadband passive cavitation detector, with the specific aim of detecting low frequency components of periodic shock waves, with high sensitivity. A finite element model is used to guide selection of matching and backing layers for the shock wave passive cavitation detector (swPCD), and the performance is evaluated against a commercially available device. Validation of the model, and characterisation of the swPCD is achieved through experimental detection of laser-plasma bubble collapse shock waves. The final swPCD design is 20 dB more sensitive to the subharmonic component, from acoustic cavitation driven at 220 kHz, than the comparable commercial device. This work may be significant for monitoring cavitation in medical applications, where sensitive detection is critical, and higher frequencies are more readily absorbed by tissue.

Layered acoustofluidic resonators for the simultaneous optical and acoustic characterisation of cavitation dynamics, microstreaming, and biological effects

The study of the effects of ultrasound-induced acoustic cavitation on biological structures is an active field in biomedical research. Of particular interest for therapeutic applications is the ability of oscillating microbubbles to promote both cellular and tissue membrane permeabilisation and to improve the distribution of therapeutic agents in tissue through extravasation and convective transport. The mechanisms that underpin the interaction between cavitating agents and tissues are, however, still poorly understood. One challenge is the practical difficulty involved in performing optical microscopy and acoustic emissions monitoring simultaneously in a biologically compatible environment. Here we present and characterise a microfluidic layered acoustic resonator (μLAR) developed for simultaneous ultrasound exposure, acoustic emissions monitoring, and microscopy of biological samples. The μLAR facilitates in vitro ultrasound experiments in which measurements of microbubble dynamics, microstreaming velocity fields, acoustic emissions, and cell-microbubble interactions can be performed simultaneously. The device and analyses presented provide a means of performing mechanistic in vitro studies that may benefit the design of predictable and effective cavitation-based ultrasound treatments.

Numerical investigation of the inertial cavitation threshold by dual-frequency excitation in the fluid and tissue

Inertial cavitation thresholds, which are defined as bubble growth by 2-fold from the equilibrium radius, by two types of ultrasonic excitation (at the classical single-frequency mode and dual-frequency mode) were calculated. The effect of the dual-frequency excitation on the inertial cavitation threshold in the different surrounding media (fluid and tissue) was studied, and the paramount parameters (driving frequency, amplitude ratio, phase difference, and frequency ratio) were also optimized to maximize the inertial cavitation. The numerical prediction confirms the previous experimental results that the dual-frequency excitation is capable of reducing the inertial cavitation threshold in comparison to the single-frequency one at the same output power. The dual-frequency excitation at the high frequency (i.e., 3.1 + 3.5 MHz vs. 1.1 + 1.3 MHz) is preferred in this study. The simulation results suggest that the same amplitudes of individual components, zero phase difference, and large frequency difference are beneficial for enhancing the bubble cavitation. Overall, this work may provide a theoretical model for further investigation of dual-frequency excitation and guidance of its applications for a better outcome.

A dual-mode hemispherical sparse array for 3D passive acoustic mapping and skull localization within a clinical MRI guided focused ultrasound device

Previous work has demonstrated that passive acoustic imaging may be used alongside MRI for monitoring of focused ultrasound therapy. However, past implementations have generally made use of either linear arrays originally designed for diagnostic imaging or custom narrowband arrays specific to in-house therapeutic transducer designs, neither of which is fully compatible with clinical MR-guided focused ultrasound (MRgFUS) devices. Here we have designed an array which is suitable for use within an FDA-approved MR-guided transcranial focused ultrasound device, within the bore of a 3 Tesla clinical MRI scanner. The array is constructed from 5  ×  0.4 mm piezoceramic disc elements arranged in pseudorandom fashion on a low-profile laser-cut acrylic frame designed to fit between the therapeutic elements of a 230 kHz InSightec ExAblate 4000 transducer. By exploiting thickness and radial resonance modes of the piezo discs the array is capable of both B-mode imaging at 5 MHz for skull localization, as well as passive reception at the second harmonic of the therapy array for detection of cavitation and 3D passive acoustic imaging. In active mode, the array was able to perform B-mode imaging of a human skull, showing the outer skull surface with good qualitative agreement with MR imaging. Extension to 3D showed the array was able to locate the skull within  ±2 mm/2° of reference points derived from MRI, which could potentially allow registration of a patient to the therapy system without the expense of real-time MRI. In passive mode, the array was able to resolve a point source in 3D within a  ±10 mm region about each axis from the focus, detect cavitation (SNR ~ 12 dB) at burst lengths from 10 cycles to continuous wave, and produce 3D acoustic maps in a flow phantom. Finally, the array was used to detect and map cavitation associated with microbubble activity in the brain in nonhuman primates.