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Campbell WA, Makary MS. Advances in Image-Guided Ablation Therapies for Solid Tumors. Cancers (Basel) 2024; 16:2560. [PMID: 39061199 PMCID: PMC11274819 DOI: 10.3390/cancers16142560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Image-guided solid tumor ablation methods have significantly advanced in their capability to target primary and metastatic tumors. These techniques involve noninvasive or percutaneous insertion of applicators to induce thermal, electrochemical, or mechanical stress on malignant tissue to cause tissue destruction and apoptosis of the tumor margins. Ablation offers substantially lower risks compared to traditional methods. Benefits include shorter recovery periods, reduced bleeding, and greater preservation of organ parenchyma compared to surgical intervention. Due to the reduced morbidity and mortality, image-guided tumor ablation offers new opportunities for treatment in cancer patients who are not candidates for resection. Currently, image-guided ablation techniques are utilized for treating primary and metastatic tumors in various organs with both curative and palliative intent, including the liver, pancreas, kidneys, thyroid, parathyroid, prostate, lung, breast, bone, and soft tissue. The invention of new equipment and techniques is expanding the criteria of eligible patients for therapy, as now larger and more high-risk tumors near critical structures can be ablated. This article provides an overview of the different imaging modalities, noninvasive, and percutaneous ablation techniques available and discusses their applications and associated complications across various organs.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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2
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Kim S, Jo Y, Im GH, Lee C, Oh C, Kook G, Kim SG, Lee HJ. Miniaturized MR-compatible ultrasound system for real-time monitoring of acoustic effects in mice using high-resolution MRI. Neuroimage 2023; 276:120201. [PMID: 37269955 DOI: 10.1016/j.neuroimage.2023.120201] [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: 03/18/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/05/2023] Open
Abstract
Visualization of focused ultrasound in high spatial and temporal resolution is crucial for accurately and precisely targeting brain regions noninvasively. Magnetic resonance imaging (MRI) is the most widely used noninvasive tool for whole-brain imaging. However, focused ultrasound studies employing high-resolution (> 9.4 T) MRI in small animals are limited by the small size of the radiofrequency (RF) volume coil and the noise sensitivity of the image to external systems such as bulky ultrasound transducers. This technical note reports a miniaturized ultrasound transducer system packaged directly above a mouse brain for monitoring ultrasound-induced effects using high-resolution 9.4 T MRI. Our miniaturized system integrates MR-compatible materials with electromagnetic (EM) noise reduction techniques to demonstrate echo-planar imaging (EPI) signal changes in the mouse brain at various ultrasound acoustic intensities. The proposed ultrasound-MRI system will enable extensive research in the expanding field of ultrasound therapeutics.
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Affiliation(s)
- Subeen Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Yehhyun Jo
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Geun Ho Im
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon 16419, South Korea
| | - Chanhee Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon 16419, South Korea
| | - Chaerin Oh
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Geon Kook
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon 16419, South Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, South Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, South Korea.
| | - Hyunjoo J Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, South Korea; KAIST Institute for Nano Century (KINC), Daejeon 34141, South Korea.
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Mehkri Y, Pierre K, Woodford SJ, Davidson CG, Urhie O, Sriram S, Hernandez J, Hanna C, Lucke-Wold B. Surgical Management of Brain Tumors with Focused Ultrasound. Curr Oncol 2023; 30:4990-5002. [PMID: 37232835 DOI: 10.3390/curroncol30050377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Focused ultrasound is a novel technique for the treatment of aggressive brain tumors that uses both mechanical and thermal mechanisms. This non-invasive technique can allow for both the thermal ablation of inoperable tumors and the delivery of chemotherapy and immunotherapy while minimizing the risk of infection and shortening the time to recovery. With recent advances, focused ultrasound has been increasingly effective for larger tumors without the need for a craniotomy and can be used with minimal surrounding soft tissue damage. Treatment efficacy is dependent on multiple variables, including blood-brain barrier permeability, patient anatomical features, and tumor-specific features. Currently, many clinical trials are currently underway for the treatment of non-neoplastic cranial pathologies and other non-cranial malignancies. In this article, we review the current state of surgical management of brain tumors using focused ultrasound.
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Affiliation(s)
- Yusuf Mehkri
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Kevin Pierre
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32608, USA
| | - Samuel Joel Woodford
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Caroline Grace Davidson
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Ogaga Urhie
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Sai Sriram
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Jairo Hernandez
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Chadwin Hanna
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, 1505 SW Archer Rd, Gainesville, FL 32608, USA
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Chen S, Nazeri A, Baek H, Ye D, Yang Y, Yuan J, Rubin JB, Chen H. A review of bioeffects induced by focused ultrasound combined with microbubbles on the neurovascular unit. J Cereb Blood Flow Metab 2022; 42:3-26. [PMID: 34551608 PMCID: PMC8721781 DOI: 10.1177/0271678x211046129] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 01/29/2023]
Abstract
Focused ultrasound combined with circulating microbubbles (FUS+MB) can transiently enhance blood-brain barrier (BBB) permeability at targeted brain locations. Its great promise in improving drug delivery to the brain is reflected by a rapidly growing number of clinical trials using FUS+MB to treat various brain diseases. As the clinical applications of FUS+MB continue to expand, it is critical to have a better understanding of the molecular and cellular effects induced by FUS+MB to enhance the efficacy of current treatment and enable the discovery of new therapeutic strategies. Existing studies primarily focus on FUS+MB-induced effects on brain endothelial cells, the major cellular component of BBB. However, bioeffects induced by FUS+MB expand beyond the BBB to cells surrounding blood vessels, including astrocytes, microglia, and neurons. Together these cell types comprise the neurovascular unit (NVU). In this review, we examine cell-type-specific bioeffects of FUS+MB on different NVU components, including enhanced permeability in endothelial cells, activation of astrocytes and microglia, as well as increased intraneuron protein metabolism and neuronal activity. Finally, we discuss knowledge gaps that must be addressed to further advance clinical applications of FUS+MB.
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Affiliation(s)
- Si Chen
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Arash Nazeri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Hongchae Baek
- Imaging Institute and Neurological Institute, Cleveland Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Dezhuang Ye
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yaoheng Yang
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Jinyun Yuan
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Joshua B Rubin
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, Saint Louis, MO, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
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5
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Barnat N, Grisey A, Gerold B, Yon S, Anquez J, Aubry JF. Vein wall shrinkage induced by thermal coagulation with high-intensity-focused ultrasound: numerical modeling and in vivo experiments in sheep. Int J Hyperthermia 2021; 37:1238-1247. [PMID: 33164625 DOI: 10.1080/02656736.2020.1834626] [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: 10/23/2022] Open
Abstract
BACKGROUND Varicose veins are a common disease that may significantly affect quality of life. Different approaches are currently used in clinical practice to treat this pathology. MATERIALS AND METHODS In thermal therapy (radiofrequency or laser therapy), the vein is directly heated to a high temperature to induce vein wall coagulation, and the heat induces denaturation of the intramural collagen, which results macroscopically in vein shrinkage. Thermal vein shrinkage is a physical indicator of the efficiency of endovenous treatment. High-intensity focused ultrasound (HIFU) is a noninvasive technique that can thermally coagulate vein walls and induce vein shrinkage. In this study, we evaluated the vein shrinkage induced in vivo by extracorporeal HIFU ablation of sheep veins: six lateral saphenous veins (3.4mm mean diameter) were sonicated for 8 s with 3MHz continuous waves. Ultrasound imaging was performed before and immediately post-HIFU to quantify the HIFU-induced shrinkage. RESULTS Luminal constriction was observed in 100% (6/6) of the treated veins. The immediate findings showed a mean diameter constriction of 53%. The experimental HIFU-induced shrinkage data were used to validate a numerical model developed to predict the thermally induced vein contraction during HIFU treatment. CONCLUSIONS This model is based on the use of the k-wave library and published contraction rates of vessels immersed in hot water baths. The simulation results agreed well with those of in vivo experiments, showing a mean percent difference of 5%. The numerical model could thus be a valuable tool for optimizing ultrasound parameters as functions of the vein diameter, and future clinical trials are anticipated.
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Affiliation(s)
- Nesrine Barnat
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France.,Theraclion, Malakoff, France
| | | | | | | | | | - Jean-François Aubry
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France
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Seto ES, Coorg R. Epilepsy Surgery: Monitoring and Novel Surgical Techniques. Neurol Clin 2021; 39:723-742. [PMID: 34215384 DOI: 10.1016/j.ncl.2021.04.001] [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: 10/21/2022]
Abstract
Drug-resistant epilepsy warrants referral to an epilepsy surgery center for consideration of alternative treatments including epilepsy surgery. Advances in technology now allow for minimally invasive neurophysiologic monitoring and surgical interventions, approaches that are attractive to families because large craniotomies and associated morbidity are avoided. This work reviews the presurgical evaluation process and discusses the use of invasive stereo-electroencephalography monitoring to localize seizure onset zones. Minimally invasive surgical techniques are described for the treatment of focal and generalized epilepsies. These approaches have expanded our capacity to palliate and cure epilepsy in the pediatric population.
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Affiliation(s)
- Elaine S Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA
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Zhou Y, Lim WCD. Influence of High-Intensity Focused Ultrasound (HIFU) Ablation on Arteries: Ex Vivo Studies. MICROMACHINES 2021; 12:485. [PMID: 33922879 PMCID: PMC8145754 DOI: 10.3390/mi12050485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
High-intensity focused ultrasound (HIFU) has been used to ablate solid tumors and cancers. Because of the hypervascular structure of the tumor and circulating blood inside it, the interaction between the HIFU burst and vessel is a critical issue in the clinical environment. Influences on lesion production and the potential of vessel rupture were investigated in this study for the efficiency and safety of clinical ablation. An extracted porcine artery was embedded in a transparent polyacrylamide gel phantom, with bovine serum albumin (BSA) as an indicator of the thermal lesion, and degassed water was driven through the artery sample. The HIFU focus was aligned to the anterior wall, middle of the artery, and posterior wall. After HIFU ablation, the produced lesion was photographically recorded, and then its size was quantified and compared with that in the gel phantom without artery. In addition, the bubble dynamics (i.e., generation, expansion, motion, and shrinkage of bubbles and their interaction with the artery) were captured using high-speed imaging. It was found that the presence of the artery resulted in a decrease in lesion size in both the axial and lateral directions. The characteristics of the lesion are dependent on the focus alignment. Acoustic and hydrodynamic cavitation play important roles in lesion production and interaction with the artery. Both thermal and mechanical effects were found on the surface of the artery wall after HIFU ablation. However, no vessel rupture was found in this ex vivo study.
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Affiliation(s)
- Yufeng Zhou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore;
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Wei Chun Daniel Lim
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore;
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8
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Joiner JB, Pylayeva-Gupta Y, Dayton PA. Focused Ultrasound for Immunomodulation of the Tumor Microenvironment. THE JOURNAL OF IMMUNOLOGY 2021; 205:2327-2341. [PMID: 33077668 DOI: 10.4049/jimmunol.1901430] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Focused ultrasound (FUS) has recently emerged as a modulator of the tumor microenvironment, paving the way for FUS to become a safe yet formidable cancer treatment option. Several mechanisms have been proposed for the role of FUS in facilitating immune responses and overcoming drug delivery barriers. However, with the wide variety of FUS parameters used in diverse tumor types, it is challenging to pinpoint FUS specifications that may elicit the desired antitumor response. To clarify FUS bioeffects, we summarize four mechanisms of action, including thermal ablation, hyperthermia/thermal stress, mechanical perturbation, and histotripsy, each inducing unique vascular and immunological effects. Notable tumor responses to FUS include enhanced vascular permeability, increased T cell infiltration, and tumor growth suppression. In this review, we have categorized and reviewed recent methods of using therapeutic ultrasound to elicit an antitumor immune response with examples that reveal specific solutions and challenges in this new research area.
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Affiliation(s)
- Jordan B Joiner
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Yuliya Pylayeva-Gupta
- Department of Genetics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; .,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; and
| | - Paul A Dayton
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; .,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; and.,Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599
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9
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Izadifar Z, Izadifar Z, Chapman D, Babyn P. An Introduction to High Intensity Focused Ultrasound: Systematic Review on Principles, Devices, and Clinical Applications. J Clin Med 2020; 9:jcm9020460. [PMID: 32046072 PMCID: PMC7073974 DOI: 10.3390/jcm9020460] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
Ultrasound can penetrate deep into tissues and interact with human tissue via thermal and mechanical mechanisms. The ability to focus an ultrasound beam and its energy onto millimeter-size targets was a significant milestone in the development of therapeutic applications of focused ultrasound. Focused ultrasound can be used as a non-invasive thermal ablation technique for tumor treatment and is being developed as an option to standard oncologic therapies. High-intensity focused ultrasound has now been used for clinical treatment of a variety of solid malignant tumors, including those in the pancreas, liver, kidney, bone, prostate, and breast, as well as uterine fibroids and soft-tissue sarcomas. Magnetic resonance imaging and Ultrasound imaging can be combined with high intensity focused ultrasound to provide real-time imaging during ablation. Magnetic resonance guided focused ultrasound represents a novel non-invasive method of treatment that may play an important role as an alternative to open neurosurgical procedures for treatment of a number of brain disorders. This paper briefly reviews the underlying principles of HIFU and presents current applications, outcomes, and complications after treatment. Recent applications of Focused ultrasound for tumor treatment, drug delivery, vessel occlusion, histotripsy, movement disorders, and vascular, oncologic, and psychiatric applications are reviewed, along with clinical challenges and potential future clinical applications of HIFU.
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Affiliation(s)
- Zahra Izadifar
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
- Correspondence: ; Tel.: +1-306-966-7827; Fax: +1-306-966-4651
| | - Zohreh Izadifar
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Dean Chapman
- Anatomy & Cell Biology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Paul Babyn
- Department of Medical Imaging, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
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10
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Wu M, Song Z, Zhang S, Dan Q, Tang C, Peng C, Liang Y, Zhang L, Wang H, Li Y. Local Tumor Ischemia-Reperfusion Mediated By Ultrasound-Targeted Microbubble Destruction Enhances The Anti-Tumor Efficacy Of Doxorubicin Chemotherapy. Cancer Manag Res 2019; 11:9387-9395. [PMID: 31807068 PMCID: PMC6842279 DOI: 10.2147/cmar.s225607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
Background Ultrasound-targeted microbubble destruction (UTMD) has been shown to be a promising noninvasive technique to change the tumor circulation, thus providing a potential method to increase reactive oxygen species (ROS) levels in tumors by inducing tumor tissue ischemia-reperfusion (IR). In this study, we investigated the feasibility of local tumor IR through UTMD to enhance the anti-tumor efficacy of doxorubicin (DOX) chemotherapy. Methods UTMD was used to induce local tumor IR. After the major blood supply of the tumor was restored, DOX was intravenously injected into the tumor-bearing mice. The superoxide dismutase (SOD) and catalase (CAT) activity and ROS levels were examined, and the anti-tumor efficacy was evaluated. Results UTMD blocked the circulation to the tumor for 30 mins. Slow reperfusion began to occur after 30 mins, and major blood supply was restored after 1 hr. The blood perfusion of the tumor completely recovered at 2 hrs. The activity of SOD in the tumors was significantly decreased at 2 hrs and 1 day after IR treatment with or without DOX treatment. The CAT activity showed no obvious changes at 2 hrs after IR treatment, whereas a significant decrease was found after 1 day in both the IR and DOX/IR groups. Moreover, higher levels of ROS were produced in the IR group and IR/DOX group. In vivo anti-tumor study indicated that the local tumor IR strategy may significantly enhance the anti-tumor efficacy of DOX chemotherapy. Conclusion UTMD provides a novel, simple and non-invasive technique for tumor IR. In combination with chemotherapy, UTMD may have high great potential to improve the anti-tumor efficacy of chemotherapeutic drugs.
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Affiliation(s)
- Manxiang Wu
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhuqing Song
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Shiyu Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Qing Dan
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Caiyun Tang
- Pharmaceutical Analysis Department, College of Pharmacy, Jiamusi University, Jiamusi, People's Republic of China
| | - Chao Peng
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yu Liang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Li Zhang
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hao Wang
- Department of Neurosurgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China
| | - Yingjia Li
- Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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11
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Harmon JN, Kabinejadian F, Seda R, Fabiilli ML, Kuruvilla S, Kuo CC, Greve JM, Fowlkes JB, Bull JL. Minimally invasive gas embolization using acoustic droplet vaporization in a rodent model of hepatocellular carcinoma. Sci Rep 2019; 9:11040. [PMID: 31363130 PMCID: PMC6667465 DOI: 10.1038/s41598-019-47309-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/11/2019] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma is the third leading cause of cancer-related deaths worldwide. Many patients are not eligible for curative therapies, such as surgical resection of the tumor or a liver transplant. Transarterial embolization is one therapy clinically used in these cases; however, this requires a long procedure and careful placement of an intraarterial catheter. Gas embolization has been proposed as a fast, easily administered, more spatially selective, and less invasive alternative. Here, we demonstrate the feasibility and efficacy of using acoustic droplet vaporization to noninvasively generate gas emboli within vasculature. Intravital microscopy experiments were performed using the rat cremaster muscle to visually observe the formation of occlusions. Large gas emboli were produced within the vasculature in the rat cremaster, effectively occluding blood flow. Following these experiments, the therapeutic efficacy of gas embolization was investigated in an ectopic xenograft model of hepatocellular carcinoma in mice. The treatment group exhibited a significantly lower final tumor volume (ANOVA, p = 0.008) and growth rate than control groups - tumor growth was completely halted. Additionally, treated tumors exhibited significant necrosis as determined by histological analysis. To our knowledge, this study is the first to demonstrate the therapeutic efficacy of gas embolotherapy in a tumor model.
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Affiliation(s)
- Jennifer N Harmon
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Foad Kabinejadian
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Robinson Seda
- Data Office for Clinical and Translational Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sibu Kuruvilla
- Department of Oncology, Stanford University, Stanford, California, USA
| | - Cathleen C Kuo
- Department of Neuroscience, Tulane University, New Orleans, Louisiana, USA
| | - Joan M Greve
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph L Bull
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA.
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12
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Barnat N, Grisey A, Lecuelle B, Anquez J, Gerold B, Yon S, Aubry JF. Noninvasive vascular occlusion with HIFU for venous insufficiency treatment: preclinical feasibility experience in rabbits. ACTA ACUST UNITED AC 2019; 64:025003. [DOI: 10.1088/1361-6560/aaf58d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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13
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Acconcia CN, Jones RM, Hynynen K. Receiver array design for sonothrombolysis treatment monitoring in deep vein thrombosis. Phys Med Biol 2018; 63:235017. [PMID: 30484436 DOI: 10.1088/1361-6560/aaee91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High intensity focused ultrasound (HIFU) can disintegrate blood clots through the generation and stimulation of bubble clouds within thrombi. This work examined the design of a device to image bubble clouds for monitoring cavitation-based HIFU treatments of deep vein thrombosis (DVT). Acoustic propagation simulations were carried out on multi-layered models of the human thigh using two patient data sets from the Visible Human Project. The design considerations included the number of receivers (32, 64, 128, 256, and 512), their spatial positioning, and the effective angular array aperture (100° and 180° about geometric focus). Imaging array performance was evaluated for source frequencies of 250, 750, and 1500 kHz. Receiver sizes were fixed relative to the wavelength (pistons, diameter = λ/2) and noise was added at levels that scaled with receiver area. With a 100° angular aperture the long axis size of the -3 dB main lobe was ~1.2λ-i.e. on the order of the vessel diameter at 250 kHz (~7 mm). Increasing the array aperture to span 180° about the geometric focus reduced the long axis by a factor of ~2. The smaller main lobe sizes achieved by imaging at higher frequencies came at the cost of increased levels of sensitivity to phase aberrations induced during acoustic propagation through the intervening soft tissue layers. With noise added to receiver signals, images could be reconstructed with peak sidelobe ratios < -3 dB using single-cycle integration times for source frequencies of 250 and 750 kHz (NRx ⩾ 128). At 1500 kHz, longer integration times and/or higher element counts were required to achieve similar peak sidelobe ratios. Our results suggest that a modest number of receivers(i.e. NRx = 128) arranged on a semi-cylindrical shell may be sufficient to enable passive acoustic imaging with single-cycle integration times (i.e. volumetric rates up to 0.75 MHz) for monitoring cavitation-based HIFU treatments of DVT.
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Affiliation(s)
- Christopher N Acconcia
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada. Department of Medical Biophysics, University of Toronto, Toronto, Canada
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Shaw CJ, Rivens I, Civale J, Botting KJ, Ter Haar G, Giussani DA, Lees CC. Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound. Sci Rep 2018; 8:13631. [PMID: 30206278 PMCID: PMC6134117 DOI: 10.1038/s41598-018-31914-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
Pre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3-4.4 kW.cm-2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3-3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was not different between sham and treatment groups. We report the first successful application of fully non-invasive HIFU for occlusion of placental blood flow in a pregnant sheep model, with a low risk of significant complications. This proof of concept study demonstrates the potential of this technique for clinical translation.
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Affiliation(s)
- Caroline J Shaw
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
- Institute of Reproductive and Developmental Biology, Imperial College London, London, W12 0HS, UK
| | - Ian Rivens
- Joint Department of Physics, Institute of Cancer Research, Sutton, London, SM2 5NG, UK
| | - John Civale
- Joint Department of Physics, Institute of Cancer Research, Sutton, London, SM2 5NG, UK
| | - Kimberley J Botting
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
- Cardiovascular Strategic Research Initiative, University of Cambridge, Cambridge, UK
| | - Gail Ter Haar
- Joint Department of Physics, Institute of Cancer Research, Sutton, London, SM2 5NG, UK
| | - Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
- Cardiovascular Strategic Research Initiative, University of Cambridge, Cambridge, UK
| | - Christoph C Lees
- Institute of Reproductive and Developmental Biology, Imperial College London, London, W12 0HS, UK.
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000, Leuven, Belgium.
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Harmon JN, Kabinejadian F, Seda R, Fabiilli ML, Kuruvilla SP, Greve JM, Fowlkes BJ, Bull JL. Gas Embolization in a Rodent Model of Hepatocellular Carcinoma Using Acoustic Droplet Vaporization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:6048-6051. [PMID: 30441715 PMCID: PMC6839763 DOI: 10.1109/embc.2018.8513518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Trans-arterial embolization is a commonly used therapy in unresectable hepatocellular carcinoma. Current methods involve the careful placement of an intraarterial catheter and the deposition of embolizing particles. Gas embolotherapy has been proposed as an embolization method with the potential for high spatial resolution without the need for a catheter. This method involves vaporizing intravenouslyadministered droplets into gas bubbles using focused ultrasound - a process termed acoustic droplet vaporization. The bubbles can become lodged in the vasculature, thereby creating an embolus. Here, we initially demonstrate the feasibility of achieving significant targeted embolization with this method in the rat cremaster using intravital microscopy. The therapy was then tested in an ectopic xenograft mouse model of hepatocellular carcinoma. Gas embolotherapy was shown to maintain the tumor volume at baseline over a twoweek treatment course while control groups showed significant tumor growth. These preliminary results demonstrate thatgas embolotherapy could serve as an effective noninvasive method for the management of unresectable hepatocellular carcinoma.
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16
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Guan L, Xu G. Destructive effect of HIFU on rabbit embedded endometrial carcinoma tissues and their vascularities. Oncotarget 2017; 8:19577-19591. [PMID: 28121624 PMCID: PMC5386707 DOI: 10.18632/oncotarget.14751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/27/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To evaluate damage effect of High-intensity focused ultrasound on early stage endometrial cancer tissues and their vascularities. MATERIALS AND METHODS Rabbit endometrial cancer models were established via tumor blocks implantation for a prospective control study. Ultrasonic ablation efficacy was evaluated by pathologic and imaging changes. The target lesions of experimental rabbits before and after ultrasonic ablation were observed after autopsy. The slides were used for hematoxylin-eosin staining, elastic fiber staining and endothelial cell staining; the slides were observed by optical microscopy. One slide was observed by electron microscopy. Then the target lesions of experimental animals with ultrasonic ablation were observed by vascular imaging, one group was visualized by digital subtract angiography, one group was quantified by color Doppler flow imaging, and one group was detected by dye perfusion.SPSS 19.0 software was used for statistical analyses. RESULTS Histological examination indicated that High-intensity focused ultrasound caused the tumor tissues and their vascularities coagulative necrosis. Tumor vascular structure components including elastic fiber, endothelial cells all were destroyed by ultrasonic ablation. Digital subtract angiography showed tumor vascular shadow were dismissed after ultrasonic ablation. After ultrasonic ablation, gray-scale of tumor nodules enhanced in ultrasonography, tumor peripheral and internal blood flow signals disappeared or significantly reduced in color Doppler flow imaging. Vascular perfusion performed after ultrasonic ablation, tumor vessels could not filled by dye liquid. CONCLUSION High-intensity focused ultrasound as a noninvasive method can destroy whole endometrial cancer cells and their supplying vascularities, which maybe an alternative approach of targeted therapy and new antiangiogenic strategy for endometrial cancer.
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Affiliation(s)
- Liming Guan
- Department of Obstetrics and Gynaecology, Zhabei District Central Hospital, Zhabei District, Shanghai 200000, China
| | - Gang Xu
- Department of Radiotherapy, Tumor Hospital, Peking University, Fengtai District, Beijing 100000, China
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17
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18
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Wolfram F, Dietrich G, Boltze C, Jenderka KV, Lesser TG. Effects of HIFU induced cavitation on flooded lung parenchyma. J Ther Ultrasound 2017; 5:21. [PMID: 28794877 PMCID: PMC5545873 DOI: 10.1186/s40349-017-0099-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/15/2017] [Indexed: 04/12/2023] Open
Abstract
Background High intensity focused ultrasound (HIFU) has gained clinical interest as a non-invasive local tumour therapy in many organs. In addition, it has been shown that lung cancer can be targeted by HIFU using One-Lung Flooding (OLF). OLF generates a gas free saline-lung compound in one lung wing and therefore acoustic access to central lung tumours. It can be assumed that lung parenchyma is exposed to ultrasound intensities in the pre-focal path and in cases of misguiding. If so, cavitation might be induced in the saline fraction of flooded lung and cause tissue damage. Therefore this study was aimed to determine the thresholds of HIFU induced cavitation and tissue erosion in flooded lung. Methods Resected human lung lobes were flooded ex-vivo. HIFU (1,1 MHz) was targeted under sonographic guidance into flooded lung parenchyma. Cavitation events were counted using subharmonic passive cavitation detection (PCD). B-Mode imaging was used to detect cavitation and erosion sonographically. Tissue samples out of the focal zone were analysed histologically. Results In flooded lung, a PCD and a sonographic cavitation detection threshold of 625 Wcm− 2(pr = 4, 3 MPa) and 3.600 Wcm− 2(pr = 8, 3 MPa) was found. Cavitation in flooded lung appears as blurred hyperechoic focal region, which enhances echogenity with insonation time. Lung parenchyma erosion was detected at intensities above 7.200 Wcm− 2(pr = 10, 9 MPa). Conclusions Cavitation occurs in flooded lung parenchyma, which can be detected passively and by B-Mode imaging. Focal intensities required for lung tumour ablation are below levels where erosive events occur. Therefore focal cavitation events can be monitored and potential risk from tissue erosion in flooded lung avoided. Electronic supplementary material The online version of this article (doi:10.1186/s40349-017-0099-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frank Wolfram
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Gera, Germany
| | | | - Carsten Boltze
- Institute of Pathology, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University Jena, Gera, Germany
| | - Klaus Vitold Jenderka
- Institute of Physics and Ultrasound, University of applied science HOME, Merseburg, Germany
| | - Thomas Günther Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Gera, Germany
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19
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Kim Y, Nabili M, Acharya P, Lopez A, Myers MR. Microvessel rupture induced by high-intensity therapeutic ultrasound-a study of parameter sensitivity in a simple in vivo model. J Ther Ultrasound 2017; 5:5. [PMID: 28265413 PMCID: PMC5333438 DOI: 10.1186/s40349-017-0082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Safety analyses of transcranial therapeutic ultrasound procedures require knowledge of the dependence of the rupture probability and rupture time upon sonication parameters. As previous vessel-rupture studies have concentrated on a specific set of exposure conditions, there is a need for more comprehensive parametric studies. METHODS Probability of rupture and rupture times were measured by exposing the large blood vessel of a live earthworm to high-intensity focused ultrasound pulse trains of various characteristics. Pressures generated by the ultrasound transducers were estimated through numerical solutions to the KZK (Khokhlov-Zabolotskaya-Kuznetsov) equation. Three ultrasound frequencies (1.1, 2.5, and 3.3 MHz) were considered, as were three pulse repetition frequencies (1, 3, and 10 Hz), and two duty factors (0.0001, 0.001). The pressures produced ranged from 4 to 18 MPa. Exposures of up to 10 min in duration were employed. Trials were repeated an average of 11 times. RESULTS No trends as a function of pulse repetition rate were identifiable, for either probability of rupture or rupture time. Rupture time was found to be a strong function of duty factor at the lower pressures; at 1.1 MHz the rupture time was an order of magnitude lower for the 0.001 duty factor than the 0.0001. At moderate pressures, the difference between the duty factors was less, and there was essentially no difference between duty factors at the highest pressure. Probability of rupture was not found to be a strong function of duty factor. Rupture thresholds were about 4 MPa for the 1.1 MHz frequency, 7 MPa at 3.3 MHz, and 11 MPa for the 2.5 MHz, though the pressure value at 2.5 MHz frequency will likely be reduced when steep-angle corrections are accounted for in the KZK model used to estimate pressures. Mechanical index provided a better collapse of the data (less separation of the curves pertaining to the different frequencies) than peak negative pressure, for both probability of rupture and rupture time. CONCLUSION The results provide a database with which investigations in more complex animal models can be compared, potentially establishing trends by which bioeffects in human vessels can be estimated.
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Affiliation(s)
- Yeonho Kim
- Preclinical Studies Core, Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Marjan Nabili
- Division of Radiological Health, Office of In-Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U. S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 66, Room 4311, Silver Spring, MD 20993 USA
| | - Priyanka Acharya
- Department of Chemical and Biomolecular Engineering, University of Maryland College Park, 4418 Stadium Drive, College Park, MD 20742 USA
| | - Asis Lopez
- Bioinnovation PhD Program, School of Science and Engineering, Tulane University, 6823 St. Charles Avenue, Lindy Boggs Center, Room 440, New Orleans, LA 70118 USA
| | - Matthew R Myers
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U. S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 62, Room 2231, Silver Spring, MD 20993 USA
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20
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Staruch RM, Nofiele J, Walker J, Bing C, Madhuranthakam AJ, Bailey A, Kim YS, Chhabra A, Burns D, Chopra R. Assessment of acute thermal damage volumes in muscle using magnetization-prepared 3D T 2 -weighted imaging following MRI-guided high-intensity focused ultrasound therapy. J Magn Reson Imaging 2017; 46:354-364. [PMID: 28067975 DOI: 10.1002/jmri.25605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/05/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate magnetization-prepared 3D T2 -weighted magnetic resonance imaging (MRI) measurements of acute tissue changes produced during ablative MR high-intensity focused ultrasound (MR-HIFU) exposures. MATERIALS AND METHODS A clinical MR-HIFU system (3T) was used to generate thermal lesions (n = 24) in the skeletal muscles of three pigs. T1 -weighted, 2D T2 -weighted, and magnetization-prepared 3D T2 -weighted sequences were acquired before and after therapy to evaluate tissue changes following ablation. Tissues were harvested shortly after imaging, fixed in formalin, and gross-sectioned. Select lesions were processed into whole-mount sections. Lesion dimensions for each imaging sequence (length, width) and for gross sections (diameter of lesion core and rim) were assessed by three physicists. Contrast-to-background ratio between lesions and surrounding muscle was compared. RESULTS Lesion dimensions on T1 and 2D T2 -weighted imaging sequences were well correlated (R2 ∼0.7). The contrast-to-background ratio between lesion and surrounding muscle was 7.4 ± 2.4 for the magnetization-prepared sequence versus 1.7 ± 0.5 for a conventional 2D T2 -weighted acquisition, and 7.0 ± 2.9 for a contrast-enhanced T1 -weighted sequence. Compared with diameter measured on gross pathology, all imaging sequences overestimated the lesion core by 22-33%, and underestimated the lesion rim by 6-13%. CONCLUSION After MR-HIFU exposures, measurements of the acute thermal damage patterns in muscle using a magnetization-prepared 3D T2 -weighted imaging sequence correlate with 2D T2 -weighted and contrast-enhanced T1 -weighted imaging, and all agree well with histology. The magnetization-prepared sequence offers positive tissue contrast and does not require IV contrast agents, and may provide a noninvasive imaging evaluation of the region of acute thermal injury at multiple times during HIFU procedures. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:354-364.
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Affiliation(s)
- Robert M Staruch
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Clinical Sites Research Program, Philips Research North America, Cambridge, Massachusetts, USA
| | - Joris Nofiele
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jamie Walker
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Chenchen Bing
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - April Bailey
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Young-Sun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dennis Burns
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rajiv Chopra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
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21
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Hynynen K, Jones RM. Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy. Phys Med Biol 2016; 61:R206-48. [PMID: 27494561 PMCID: PMC5022373 DOI: 10.1088/0031-9155/61/17/r206] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Focused ultrasound offers a non-invasive way of depositing acoustic energy deep into the body, which can be harnessed for a broad spectrum of therapeutic purposes, including tissue ablation, the targeting of therapeutic agents, and stem cell delivery. Phased array transducers enable electronic control over the beam geometry and direction, and can be tailored to provide optimal energy deposition patterns for a given therapeutic application. Their use in combination with modern medical imaging for therapy guidance allows precise targeting, online monitoring, and post-treatment evaluation of the ultrasound-mediated bioeffects. In the past there have been some technical obstacles hindering the construction of large aperture, high-power, densely-populated phased arrays and, as a result, they have not been fully exploited for therapy delivery to date. However, recent research has made the construction of such arrays feasible, and it is expected that their continued development will both greatly improve the safety and efficacy of existing ultrasound therapies as well as enable treatments that are not currently possible with existing technology. This review will summarize the basic principles, current statures, and future potential of image-guided ultrasound phased arrays for therapy.
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Affiliation(s)
- Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada. Department of Medical Biophysics, University of Toronto, Toronto, Canada. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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22
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Shaw CJ, Civale J, Botting KJ, Niu Y, Ter Haar G, Rivens I, Giussani DA, Lees CC. Noninvasive high-intensity focused ultrasound treatment of twin-twin transfusion syndrome: A preliminary in vivo study. Sci Transl Med 2016; 8:347ra95. [PMID: 27412787 DOI: 10.1126/scitranslmed.aaf2135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/13/2016] [Indexed: 02/11/2024]
Abstract
We investigated the efficacy, maternofetal responses, and safety of using high-intensity focused ultrasound (HIFU) for noninvasive occlusion of placental vasculature compared to sham treatment in anesthetized pregnant sheep. This technique for noninvasive occlusion of placental vasculature may be translatable to the treatment of conditions arising from abnormal placental vasculature, such as twin-twin transfusion syndrome (TTTS). Eleven pregnant sheep were instrumented with maternal and fetal arterial catheters and time-transit flow probes to monitor cardiovascular, acid-base, and metabolic status, and then exposed to HIFU (n = 5) or sham (n = 6) ablation of placental vasculature through the exposed uterine surface. Placental vascular flow was occluded in 28 of 30 targets, and histological examination confirmed occlusion in 24 of 30 targets. In both HIFU and sham exposures, uterine contact reduced maternal uterine artery flow, but delivery of oxygen and glucose to the fetal brain remained normal. HIFU can consistently occlude in vivo placental vessels and ablate blood flow in a pregnant sheep model. Cardiovascular and metabolic fetal responses suggest that the technique is safe in the short term and potentially translatable to human pregnancy.
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Affiliation(s)
- Caroline J Shaw
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK. Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
| | - John Civale
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Kimberley J Botting
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Youguo Niu
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Gail Ter Haar
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Ian Rivens
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Christoph C Lees
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK. Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium.
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Horodyckid C, Canney M, Vignot A, Boisgard R, Drier A, Huberfeld G, François C, Prigent A, Santin MD, Adam C, Willer JC, Lafon C, Chapelon JY, Carpentier A. Safe long-term repeated disruption of the blood-brain barrier using an implantable ultrasound device: a multiparametric study in a primate model. J Neurosurg 2016; 126:1351-1361. [PMID: 27285538 DOI: 10.3171/2016.3.jns151635] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The main limitation to the efficacy of chemotherapy for brain tumors is the restricted access to the brain because of the limited permeability of the blood-brain barrier (BBB). Previous animal studies have shown that the application of pulsed ultrasound (US), in combination with the intravenous injection of microbubbles, can temporarily disrupt the BBB to deliver drugs that normally cannot reach brain tissue. Although many previous studies have been performed with external focused US transducers, the device described in the current work emits US energy using an unfocused transducer implanted in the skull thickness. This method avoids distortion of the US energy by the skull bone and allows for simple, repetitive, and broad disruption of the BBB without the need for MRI monitoring. The purpose of the present study was to determine if the BBB can be safely and repeatedly disrupted using such an implantable unfocused US device in a primate model. METHODS An 11.5-mm-diameter, 1-MHz, planar US device was implanted via a bur hole into the skull of 3 primates (2 Papio anubis [olive] baboons and 1 Macaca fascicularis [macaque]) for 4 months. Pulsed US sonications were applied together with the simultaneous intravenous injection of sulfur hexafluoride microbubbles (SonoVue) every 2 weeks to temporarily disrupt the BBB. In each primate, a total of 7 sonications were performed with a 23.2-msec burst length (25,000 cycles) and a 1-Hz pulse repetition frequency at acoustic pressure levels of 0.6-0.8 MPa. Potential toxicity induced by repeated BBB opening was analyzed using MRI, PET, electroencephalography (EEG), somatosensory evoked potential (SSEP) monitoring, behavioral scales, and histopathological analysis. RESULTS The T1-weighted contrast-enhanced MR images acquired after each sonication exhibited a zone of hypersignal underneath the transducer that persisted for more than 4 hours, indicating a broad region of BBB opening in the acoustic field of the implant. Positron emission tomography images with fluorine-18-labeled fluorodeoxyglucose (FDG) did not indicate any changes in the cerebral metabolism of glucose. Neither epileptic signs nor pathological central nerve conduction was observed on EEG and SSEP recordings, respectively. Behavior in all animals remained normal. Histological analysis showed no hemorrhagic processes, no petechia, and extravasation of only a few erythrocytes. CONCLUSIONS The studies performed confirm that an implantable, 1-MHz US device can be used to repeatedly open the BBB broadly in a large-animal model without inducing any acute, subacute, or chronic lesions.
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Affiliation(s)
- Catherine Horodyckid
- CarThera Research Team, Brain and Spine Institute, Paris;,Departments of 2 Neurosurgery and
| | - Michael Canney
- CarThera Research Team, Brain and Spine Institute, Paris
| | | | | | | | - Gilles Huberfeld
- Paris VI Sorbonne University, School of Medicine, Paris.,INSERM U1129 "Infantile Epilepsies and Brain Plasticity," Paris.,Paris Descartes University, PRES Sorbonne Paris Cité.,CEA, Gif sur Yvette
| | - Chantal François
- Sorbonne Universités, UPMC Univ Paris 06, UMRS 1127, ICM, F-75013 Paris
| | - Annick Prigent
- Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris
| | - Mathieu D Santin
- Centre de NeuroImagerie de Recherche-CENIR, Paris.,Institut du Cerveau et de la Moelle épinière - ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMRS 1127, Paris
| | - Clovis Adam
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pathology Department, Le Kremlin-Bicêtre, Paris; and
| | - Jean-Claude Willer
- Physiologie, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris.,Paris VI Sorbonne University, School of Medicine, Paris
| | - Cyril Lafon
- INSERM U1032, LabTau, University of Lyon, France
| | | | - Alexandre Carpentier
- Departments of 2 Neurosurgery and.,Paris VI Sorbonne University, School of Medicine, Paris
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24
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Guan L, Xu G. Damage effect of high-intensity focused ultrasound on breast cancer tissues and their vascularities. World J Surg Oncol 2016; 14:153. [PMID: 27230124 PMCID: PMC4882851 DOI: 10.1186/s12957-016-0908-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/20/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a noninvasive therapy that makes entire coagulative necrosis of a tumor in deep tissue through the intact skin. There are many reports about the HIFU's efficacy in the treatment of patients with breast cancer, but randomized clinical trials are rare which emphasize on the systematic assessment of histological changes in the ablated tumor vascularities, while clinical trials utilizing bevacizumab and other anti-angiogenic drugs in breast cancer have not demonstrated overall survival benefit. The purpose of this study is to evaluate the damage effect of HIFU on breast cancer tissues and their vascularities. METHODS Randomized clinical trials and the modality of treat-and-resect protocols were adopted. The treated outcome of all patients was followed up in this study. The target lesions of 25 breast cancer patients treated by HIFU were observed after autopsy. One slide was used for hematoxylin-eosin (HE) staining, one slide was used for elastic fiber staining by Victoria blue and Ponceau's histochemical staining, and one slide was used for vascular endothelial cell immunohistochemical staining with biotinylated-ulex europaeus agglutinin I (UEAI); all three slides were observed under an optical microscopic. One additional slide was systematically observed by electron microscopy. RESULTS The average follow-up time was 12 months; no local recurrence or a distant metastatic lesion was detected among treated patients. Histological examination of the HE slides indicated that HIFU caused coagulative necrosis in the tumor tissues and their vascularities: all feeder vessels less than 2 mm in diameter in the insonated tumor were occluded, the vascular elasticity provided by fibrin was lost, the cells were disordered and delaminated, and UEAI staining of the target lesions was negative. Immediately after HIFU irradiation, the tumor capillary ultrastructure was destroyed, the capillary endothelium was disintegrated, the peritubular cells were cavitated, and the plasma membrane was incomplete. CONCLUSIONS HIFU ablation can destroy all proliferating tumor cells and their growing vascularities simultaneously; this may break interdependent vicious cycle of tumor angiogenesis and neoplastic cell growth that results in infinite proliferation. While it cannot cause tumor resistance to HIFU ablation, it may be a new anti-angiogenic strategy that needs further clinical observation and exploration. Furthermore, the treatment indications of HIFU ablation were reviewed and discussed in this manuscript.
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MESH Headings
- Adult
- Aged
- Angiogenesis Inhibitors/therapeutic use
- Breast Neoplasms/blood supply
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/blood supply
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/blood supply
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/therapy
- Case-Control Studies
- Female
- Follow-Up Studies
- High-Intensity Focused Ultrasound Ablation/adverse effects
- Humans
- Lymphatic Metastasis
- Mastectomy
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/blood supply
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Neovascularization, Pathologic/pathology
- Prognosis
- Young Adult
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Affiliation(s)
- Liming Guan
- Department of Obstetrics and Gynaecology, Zhabei District Central Hospital, No. 619, Zhonghuaxin Road, Zhabei District, Shanghai, 200000, China.
| | - Gang Xu
- Department of Radiotherapy, Tumor Hospital, Peking University, No. 69, Wanfeng Road, Fengtai District, Beijing, 100000, China
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Lv W, Yan T, Wang G, Zhao W, Zhang T, Zhou D. High-intensity focused ultrasound therapy in combination with gemcitabine for unresectable pancreatic carcinoma. Ther Clin Risk Manag 2016; 12:687-91. [PMID: 27194912 PMCID: PMC4859417 DOI: 10.2147/tcrm.s90567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate the therapeutic effect and safety of high-intensity focused ultrasound (HIFU) therapy combined with gemcitabine in treating unresectable pancreatic carcinoma. Methods The 45 patients suffering from pancreatic carcinoma were randomized into two groups. The patients in the experimental group (n=23) received HIFU in combination with gemcitabine and those in the control group (n=22) received gemcitabine alone. The effect and clinical benefit rates in the two groups were compared. The median survival time and 6-month and 12-month survival rates were calculated by Kaplan–Meier method and log-rank test. Results The median survival time and 6-month survival rate were significantly higher in the experimental group than in the control group (8.91 months vs 5.53 months, 73.9% vs 40.9%, respectively P<0.05), but 12-month survival rate was not statistically different between the two groups (13.0% vs 4.5%, P>0.05). The clinical benefit rates in the experimental group and the control group were 69.6% and 36.3%, respectively (P<0.05). The pain remission rate in the experimental group was significantly higher than that in the control group (65.2% vs 31.8%, P<0.05). Conclusion HIFU in combination with gemcitabine is better than gemcitabine alone. This combinatorial therapy may become a better and effective treatment for unresectable pancreatic carcinoma.
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Affiliation(s)
- Wei Lv
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Tao Yan
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Guojin Wang
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Wei Zhao
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Tao Zhang
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Dinghua Zhou
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
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26
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Jones RM, O'Reilly MA, Hynynen K. Experimental demonstration of passive acoustic imaging in the human skull cavity using CT-based aberration corrections. Med Phys 2016; 42:4385-400. [PMID: 26133635 DOI: 10.1118/1.4922677] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Experimentally verify a previously described technique for performing passive acoustic imaging through an intact human skull using noninvasive, computed tomography (CT)-based aberration corrections Jones et al. [Phys. Med. Biol. 58, 4981-5005 (2013)]. METHODS A sparse hemispherical receiver array (30 cm diameter) consisting of 128 piezoceramic discs (2.5 mm diameter, 612 kHz center frequency) was used to passively listen through ex vivo human skullcaps (n = 4) to acoustic emissions from a narrow-band fixed source (1 mm diameter, 516 kHz center frequency) and from ultrasound-stimulated (5 cycle bursts, 1 Hz pulse repetition frequency, estimated in situ peak negative pressure 0.11-0.33 MPa, 306 kHz driving frequency) Definity™ microbubbles flowing through a thin-walled tube phantom. Initial in vivo feasibility testing of the method was performed. The performance of the method was assessed through comparisons to images generated without skull corrections, with invasive source-based corrections, and with water-path control images. RESULTS For source locations at least 25 mm from the inner skull surface, the modified reconstruction algorithm successfully restored a single focus within the skull cavity at a location within 1.25 mm from the true position of the narrow-band source. The results obtained from imaging single bubbles are in good agreement with numerical simulations of point source emitters and the authors' previous experimental measurements using source-based skull corrections O'Reilly et al. [IEEE Trans. Biomed. Eng. 61, 1285-1294 (2014)]. In a rat model, microbubble activity was mapped through an intact human skull at pressure levels below and above the threshold for focused ultrasound-induced blood-brain barrier opening. During bursts that led to coherent bubble activity, the location of maximum intensity in images generated with CT-based skull corrections was found to deviate by less than 1 mm, on average, from the position obtained using source-based corrections. CONCLUSIONS Taken together, these results demonstrate the feasibility of using the method to guide bubble-mediated ultrasound therapies in the brain. The technique may also have application in ultrasound-based cerebral angiography.
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Affiliation(s)
- Ryan M Jones
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada and Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Meaghan A O'Reilly
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada; and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
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27
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Monteith S, Snell J, Eames M, Kassell NF, Kelly E, Gwinn R. Transcranial magnetic resonance-guided focused ultrasound for temporal lobe epilepsy: a laboratory feasibility study. J Neurosurg 2016; 125:1557-1564. [PMID: 26871207 DOI: 10.3171/2015.10.jns1542] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In appropriate candidates, the treatment of medication-refractory mesial temporal lobe epilepsy (MTLE) is primarily surgical. Traditional anterior temporal lobectomy yields seizure-free rates of 60%-70% and possibly higher. The field of magnetic resonance-guided focused ultrasound (MRgFUS) is an evolving field in neurosurgery. There is potential to treat MTLE with MRgFUS; however, it has appeared that the temporal lobe structures were beyond the existing treatment envelope of currently available clinical systems. The purpose of this study was to determine whether lesional temperatures can be achieved in the target tissue and to assess potential safety concerns. METHODS Cadaveric skulls with tissue-mimicking gels were used as phantom targets. An ablative volume was then mapped out for a "virtual temporal lobectomy." These data were then used to create a target volume on the InSightec ExAblate Neuro system. The target was the amygdala, uncus, anterior 20 mm of hippocampus, and adjacent parahippocampal gyrus. This volume was approximately 5cm3. Thermocouples were placed on critical skull base structures to monitor skull base heating. RESULTS Adequate focusing of the ultrasound energy was possible in the temporal lobe structures. Using clinically relevant ultrasound parameters (power 900 W, duration 10 sec, frequency 650 kHz), ablative temperatures were not achieved (maximum temperature 46.1°C). Increasing sonication duration to 30 sec demonstrated lesional temperatures in the mesial temporal lobe structures of interest (up to 60.5°C). Heating of the skull base of up to 24.7°C occurred with 30-sec sonications. CONCLUSIONS MRgFUS thermal ablation of the mesial temporal lobe structures relevant in temporal lobe epilepsy is feasible in a laboratory model. Longer sonications were required to achieve temperatures that would create permanent lesions in brain tissue. Heating of the skull base occurred with longer sonications. Blocking algorithms would be required to restrict ultrasound beams causing skull base heating. In the future, MRgFUS may present a minimally invasive, non-ionizing treatment of MTLE.
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Affiliation(s)
- Stephen Monteith
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington
| | - John Snell
- Focused Ultrasound Foundation, Charlottesville; and
| | - Mathew Eames
- Focused Ultrasound Foundation, Charlottesville; and
| | - Neal F Kassell
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Edward Kelly
- Focused Ultrasound Foundation, Charlottesville; and
| | - Ryder Gwinn
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington
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Jacobs I, Hectors SJCG, Schabel MC, Grüll H, Strijkers GJ, Nicolay K. Cluster analysis of DCE-MRI data identifies regional tracer-kinetic changes after tumor treatment with high intensity focused ultrasound. NMR IN BIOMEDICINE 2015; 28:1443-1454. [PMID: 26390040 DOI: 10.1002/nbm.3406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/27/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Evaluation of high intensity focused ultrasound (HIFU) treatment with MRI is generally based on assessment of the non-perfused volume from contrast-enhanced T1-weighted images. However, the vascular status of tissue surrounding the non-perfused volume has not been extensively investigated with MRI. In this study, cluster analysis of the transfer constant K(trans) and extravascular extracellular volume fraction ve , derived from dynamic contrast-enhanced MRI (DCE-MRI) data, was performed in tumor tissue surrounding the non-perfused volume to identify tumor subregions with distinct contrast agent uptake kinetics. DCE-MRI was performed in CT26.WT colon carcinoma-bearing BALB/c mice before (n = 12), directly after (n = 12) and 3 days after (n = 6) partial tumor treatment with HIFU. In addition, a non-treated control group (n = 6) was included. The non-perfused volume was identified based on the level of contrast enhancement. Quantitative comparison between non-perfused tumor fractions and non-viable tumor fractions derived from NADH-diaphorase histology showed a stronger agreement between these fractions 3 days after treatment (R(2) to line of identity = 0.91) compared with directly after treatment (R(2) = 0.74). Next, k-means clustering with four clusters was applied to K(trans) and ve parameter values of all significantly enhanced pixels. The fraction of pixels within two clusters, characterized by a low K(trans) and either a low or high ve , significantly increased after HIFU. Changes in composition of these clusters were considered to be HIFU induced. Qualitative H&E histology showed that HIFU-induced alterations in these clusters may be associated with hemorrhage and structural tissue disruption. Combined microvasculature and hypoxia staining suggested that these tissue changes may affect blood vessel functionality and thereby tumor oxygenation. In conclusion, it was demonstrated that, in addition to assessment of the non-perfused tumor volume, the presented methodology gives further insight into HIFU-induced effects on tumor vascular status. This method may aid in assessment of the consequences of vascular alterations for the fate of the tissue.
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Affiliation(s)
- Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthias C Schabel
- Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | - Holger Grüll
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Oncology solutions, Philips Research, Eindhoven, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Hectors SJCG, Jacobs I, Moonen CTW, Strijkers GJ, Nicolay K. MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs. Magn Reson Med 2015; 75:302-17. [PMID: 26096859 DOI: 10.1002/mrm.25758] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 01/17/2023]
Abstract
Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-guided HIFU system. The MR-based evaluation of HIFU treatment is most often restricted to contrast-enhanced T1 -weighted imaging, while it has been shown that the non-perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU-induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been-or could be-used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI-based evaluation of HIFU treatment.
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Affiliation(s)
- Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Chrit T W Moonen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Shoji S, Hashimoto A, Nakamoto M, Fukuda N, Fujikawa H, Endo K, Tomonaga T, Nakano M, Terachi T, Uchida T. Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high-intensity focused ultrasound for localized prostate cancer. Int J Urol 2015; 22:563-71. [DOI: 10.1111/iju.12747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sunao Shoji
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Akio Hashimoto
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Masahiko Nakamoto
- Department of Radiology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Norio Fukuda
- Department of Radiology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Hiroshi Fujikawa
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Kazuyuki Endo
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Tetsuro Tomonaga
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Mayura Nakano
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Isehara Kanagawa Japan
| | - Toyoaki Uchida
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo Japan
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Goertz DE. An overview of the influence of therapeutic ultrasound exposures on the vasculature: high intensity ultrasound and microbubble-mediated bioeffects. Int J Hyperthermia 2015; 31:134-44. [PMID: 25716770 DOI: 10.3109/02656736.2015.1009179] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
It is well established that the interaction of ultrasound with soft tissues can induce a wide range of bioeffects. One of the most important and complex of these interactions in the context of therapeutic ultrasound is with the vasculature. Potential vascular effects range from enhancing microvascular permeability to inducing vascular damage and vessel occlusion. While aspects of these effects are broadly understood, the development of improved approaches to exploit these effects and gain a more detailed mechanistic understanding is ongoing and largely anchored in preclinical research. Here a general overview of this established yet rapidly evolving topic is provided, with a particular emphasis on effects arising from high-intensity focused ultrasound and microbubble-mediated exposures.
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Affiliation(s)
- David E Goertz
- Department of Physical Sciences, Sunnybrook Health Sciences Center , Toronto, Ontario , Canada
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32
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Wu F. High intensity focused ultrasound: A noninvasive therapy for locally advanced pancreatic cancer. World J Gastroenterol 2014; 20:16480-16488. [PMID: 25469016 PMCID: PMC4248191 DOI: 10.3748/wjg.v20.i44.16480] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/08/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
The noninvasive ablation of pancreatic cancer with high intensity focused ultrasound (HIFU) energy is received increasingly widespread interest. With rapidly temperature rise to cytotoxic levels within the focal volume of ultrasound beams, HIFU can selectively ablate a targeted lesion of the pancreas without any damage to surrounding or overlying tissues. Preliminary studies suggest that this approach is technical safe and feasible, and can be used alone or in combination with systemic chemotherapy for the treatment of patients with locally advanced pancreatic cancer. It can effectively alleviate cancer-related abdominal pain, and may confer an additional survival benefit with few significant complications. This review provides a brief overview of HIFU, describes current clinical applications, summarizes characteristics of continuous and pulsed HIFU, and discusses future applications and challenges in the treatment of pancreatic cancer.
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Hoerig CL, Serrone JC, Burgess MT, Zuccarello M, Mast TD. Prediction and suppression of HIFU-induced vessel rupture using passive cavitation detection in an ex vivo model. J Ther Ultrasound 2014; 2:14. [PMID: 25232483 PMCID: PMC4159109 DOI: 10.1186/2050-5736-2-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/15/2014] [Indexed: 12/28/2022] Open
Abstract
Background Occlusion of blood vessels using high-intensity focused ultrasound (HIFU) is a potential treatment for arteriovenous malformations and other neurovascular disorders. However, attempting HIFU-induced vessel occlusion can also cause vessel rupture, resulting in hemorrhage. Possible rupture mechanisms include mechanical effects of acoustic cavitation and heating of the vessel wall. Methods HIFU exposures were performed on 18 ex vivo porcine femoral arteries with simultaneous passive cavitation detection. Vessels were insonified by a 3.3-MHz focused source with spatial-peak, temporal-peak focal intensity of 15,690–24,430 W/cm2 (peak negative-pressure range 10.92–12.52 MPa) and a 50% duty cycle for durations up to 5 min. Time-dependent acoustic emissions were recorded by an unfocused passive cavitation detector and quantified within low-frequency (10–30 kHz), broadband (0.3–1.1 MHz), and subharmonic (1.65 MHz) bands. Vessel rupture was detected by inline metering of saline flow, recorded throughout each treatment. Recorded emissions were grouped into ‘pre-rupture’ (0–10 s prior to measured point of vessel rupture) and ‘intact-vessel’ (>10 s prior to measured point of vessel rupture) emissions. Receiver operating characteristic curve analysis was used to assess the ability of emissions within each frequency band to predict vessel rupture. Based on these measurements associating acoustic emissions with vessel rupture, a real-time feedback control module was implemented to monitor acoustic emissions during HIFU treatment and adjust the ultrasound intensity, with the goal of maximizing acoustic power delivered to the vessel while avoiding rupture. This feedback control approach was tested on 10 paired HIFU exposures of porcine femoral and subclavian arteries, in which the focal intensity was stepwise increased from 9,117 W/cm2 spatial-peak temporal-peak (SPTP) to a maximum of 21,980 W/cm2, with power modulated based on the measured subharmonic emission amplitude. Time to rupture was compared between these feedback-controlled trials and paired controller-inactive trials using a paired Wilcoxon signed-rank test. Results Subharmonic emissions were found to be the most predictive of vessel rupture (areas under the receiver operating characteristic curve (AUROC) = 0.757, p < 10-16) compared to low-frequency (AUROC = 0.657, p < 10-11) and broadband (AUROC = 0.729, p < 10-16) emissions. An independent-sample t test comparing pre-rupture to intact-vessel emissions revealed a statistically significant difference between the two groups for broadband and subharmonic emissions (p < 10-3), but not for low-frequency emissions (p = 0.058). In a one-sided paired Wilcoxon signed-rank test, activation of the control module was shown to increase the time to vessel rupture (T- = 8, p = 0.0244, N = 10). In one-sided paired t tests, activation of the control module was shown to cause no significant difference in time-averaged focal intensity (t = 0.362, p = 0.363, N = 10), but was shown to cause delivery of significantly greater total acoustic energy (t = 2.037, p = 0.0361, N = 10). Conclusions These results suggest that acoustic cavitation plays an important role in HIFU-induced vessel rupture. In HIFU treatments for vessel occlusion, passive monitoring of acoustic emissions may be useful in avoiding hemorrhage due to vessel rupture, as shown in the rupture suppression experiments.
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Affiliation(s)
| | | | - Mark T Burgess
- University of Cincinnati, Cincinnati, OH 45267-0586, USA
| | | | - T Douglas Mast
- University of Cincinnati, Cincinnati, OH 45267-0586, USA
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O'Reilly MA, Jones RM, Hynynen K. Three-dimensional transcranial ultrasound imaging of microbubble clouds using a sparse hemispherical array. IEEE Trans Biomed Eng 2014; 61:1285-94. [PMID: 24658252 DOI: 10.1109/tbme.2014.2300838] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is an increasing interest in bubble-mediated focused ultrasound (FUS) interventions in the brain. However, current technology lacks the ability to spatially monitor the interaction of the microbubbles with the applied acoustic field, something which is critical for safe clinical translation of these treatments. Passive acoustic mapping could offer a means for spatially monitoring microbubble emissions that relate to bubble activity and associated bioeffects. In this study, a hemispherical receiver array was integrated within an existing transcranial therapy array to create a device capable of both delivering therapy and monitoring the process via passive imaging of bubble clouds. A 128-element receiver array was constructed and characterized for varying bubble concentrations and source spacings. Initial in vivo feasibility testing was performed. The system was found to be capable of monitoring bubble emissions down to single bubble events through an ex vivo human skull. The lateral resolution of the system was found to be between 1.25 and 2 mm and the axial resolution between 2 and 3.5 mm, comparable to the resolution of MRI-based temperature monitoring during thermal FUS treatments in the brain. The results of initial in vivo experiments show that bubble activity can be mapped starting at pressure levels below the threshold for blood-brain barrier disruption. This study presents a feasible solution for imaging bubble activity during cavitation-mediated FUS treatments in the brain.
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Lipsman N, Mainprize TG, Schwartz ML, Hynynen K, Lozano AM. Intracranial applications of magnetic resonance-guided focused ultrasound. Neurotherapeutics 2014; 11:593-605. [PMID: 24850310 PMCID: PMC4121456 DOI: 10.1007/s13311-014-0281-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The ability to focus acoustic energy through the intact skull on to targets millimeters in size represents an important milestone in the development of neurotherapeutics. Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel, noninvasive method, which--under real-time imaging and thermographic guidance--can be used to generate focal intracranial thermal ablative lesions and disrupt the blood-brain barrier. An established treatment for bone metastases, uterine fibroids, and breast lesions, MRgFUS has now been proposed as an alternative to open neurosurgical procedures for a wide variety of indications. Studies investigating intracranial MRgFUS range from small animal preclinical experiments to large, late-phase randomized trials that span the clinical spectrum from movement disorders, to vascular, oncologic, and psychiatric applications. We review the principles of MRgFUS and its use for brain-based disorders, and outline future directions for this promising technology.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, University Health Network, University of Toronto, 399 Bathurst Street, 4W-431, Toronoto, M5T 2S8, Canada,
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Shoji S, Tonooka A, Hashimoto A, Nakamoto M, Tomonaga T, Nakano M, Sato H, Terachi T, Koike J, Uchida T. Time-dependent change of blood flow in the prostate treated with high-intensity focused ultrasound. Int J Urol 2014; 21:942-5. [DOI: 10.1111/iju.12515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/01/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Sunao Shoji
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo
| | - Akiko Tonooka
- Department of Surgical Pathology; Japan Labor Health and Welfare Organization; Kanto Rosai Hospital; Kawasaki Kanagawa
| | - Akio Hashimoto
- Department of Radiology; Tokai University Hachioji Hospital; Hachioji Tokyo
| | - Masahiko Nakamoto
- Department of Radiology; Osaka University Graduate School of Medicine; Suita Osaka
| | - Tetsuro Tomonaga
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo
| | - Mayura Nakano
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo
| | - Haruhiro Sato
- Department of Internal Medicine; Tokai University School of Medicine; Isehara Kanagawa
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Isehara Kanagawa
| | - Junki Koike
- Department of Pathology; St. Marianna University School of Medicine; Kawasaki Kanagawa Japan
| | - Toyoaki Uchida
- Department of Urology; Tokai University Hachioji Hospital; Hachioji Tokyo
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Shaw CJ, ter Haar GR, Rivens IH, Giussani DA, Lees CC. Pathophysiological mechanisms of high-intensity focused ultrasound-mediated vascular occlusion and relevance to non-invasive fetal surgery. J R Soc Interface 2014; 11:20140029. [PMID: 24671935 PMCID: PMC4006242 DOI: 10.1098/rsif.2014.0029] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/06/2014] [Indexed: 12/27/2022] Open
Abstract
High-intensity focused ultrasound (HIFU) is a non-invasive technology, which can be used occlude blood vessels in the body. Both the theory underlying and practical process of blood vessel occlusion are still under development and relatively sparse in vivo experimental and therapeutic data exist. HIFU would however provide an alternative to surgery, particularly in circumstances where serious complications inherent to surgery outweigh the potential benefits. Accordingly, the HIFU technique would be of particular utility for fetal and placental interventions, where open or endoscopic surgery is fraught with difficulty and likelihood of complications including premature delivery. This assumes that HIFU could be shown to safely and effectively occlude blood vessels in utero. To understand these mechanisms more fully, we present a review of relevant cross-specialty literature on the topic of vascular HIFU and suggest an integrative mechanism taking into account clinical, physical and engineering considerations through which HIFU may produce vascular occlusion. This model may aid in the design of HIFU protocols to further develop this area, and might be adapted to provide a non-invasive therapy for conditions in fetal medicine where vascular occlusion is beneficial.
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Affiliation(s)
- C. J. Shaw
- Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - G. R. ter Haar
- Joint Department of Physics, Institute of Cancer Research: Royal Marsden NHSF Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - I. H. Rivens
- Joint Department of Physics, Institute of Cancer Research: Royal Marsden NHSF Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - D. A. Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - C. C. Lees
- Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg, KU Leuven, Belgium
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Wu F, ter Haar G, Chen WR. High-intensity focused ultrasound ablation of breast cancer. Expert Rev Anticancer Ther 2014; 7:823-31. [PMID: 17555392 DOI: 10.1586/14737140.7.6.823] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The noninvasive ablation of tumors with high-intensity focused ultrasound (HIFU) energy has received increasingly widespread interest. The temperature within the focal volume of an ultrasound beam is rapidly raised to cytotoxic levels. HIFU can selectively ablate a targeted tumor at depth without any damage to surrounding or overlying tissues. Animal studies have shown that HIFU ablation is safe and effective for the treatment of implanted breast malignancies. The results from early clinical trials (Phase I and II) are encouraging, suggesting that HIFU is a promising treatment for small breast cancer. Once oncologic efficacy data from large-scale randomized clinical trials are available, HIFU ablation may become an attractive treatment option for patients with small breast cancer, especially the elderly.
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Affiliation(s)
- Feng Wu
- Clinical Center for Tumor Therapy of 2nd Affiliated Hospital, and Institute of Ultrasonic Engineering in Medicine, Chongqing Medical University, Chongqing, PR China.
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Häcker A, Dinter D, Michel MS, Alken P. High-intensity focused ultrasound as a treatment option in renal cell carcinoma. Expert Rev Anticancer Ther 2014; 5:1053-9. [PMID: 16336096 DOI: 10.1586/14737140.5.6.1053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Due to the widespread use of modern imaging modalities, small renal masses are discovered incidentally at increasing rates. Advances in minimally invasive technologies have changed the treatment options for renal cell carcinoma. High-intensity focused ultrasound aims to completely ablate renal tumors in a noninvasive manner. Experimental studies have demonstrated principle feasibility and safety of the technology. However, clinical studies on renal cell carcinoma are very limited and no substantial oncologic results are available to date. Major technical improvements are mandatory to enable high-intensity focused ultrasound as an effective treatment option for patients with small renal masses.
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Affiliation(s)
- Axel Häcker
- Department of Urology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
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Alkins R, Huang Y, Pajek D, Hynynen K. Cavitation-based third ventriculostomy using MRI-guided focused ultrasound. J Neurosurg 2013; 119:1520-9. [PMID: 24074494 DOI: 10.3171/2013.8.jns13969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Transcranial focused ultrasound is increasingly being investigated as a minimally invasive treatment for a range of intracranial pathologies. At higher peak rarefaction pressures than those used for thermal ablation, focused ultrasound can initiate inertial cavitation and create holes in the brain by fractionation of the tissue elements. The authors investigated the technical feasibility of using MRI-guided focused ultrasound to perform a third ventriculostomy as a possible noninvasive alternative to endoscopic third ventriculostomy for hydrocephalus. METHODS A craniectomy was performed in male pigs weighing 13-19 kg to expose the supratentorial brain, leaving the dura mater intact. Seven pigs were treated through the craniectomy, while 2 pigs were treated through ex vivo human skulls placed in the beam path. Registration and targeting was done using T2-weighted MRI sequences. For transcranial treatments a CT scan was used to correct the beam from aberrations due to the skull and maintain a small, high-intensity focus. Sonications were performed at both 650 kHz and 230 kHz at a range of intensities, and the in situ pressures were estimated both from simulations and experimental data to establish a threshold for tissue fractionation in the brain. RESULTS In craniectomized animals at 650 kHz, a peak pressure ≥ 22.7 MPa for 1 second was needed to reliably create a ventriculostomy. Transcranially at this frequency the ExAblate 4000 was unable to generate the required intensity to fractionate tissue, although cavitation was initiated. At 230 kHz, ventriculostomy was successful through the skull with a peak pressure of 8.8 MPa. CONCLUSIONS This is the first study to suggest that it is possible to perform a completely noninvasive third ventriculostomy using ultrasound. This may pave the way for future studies and eventually provide an alternative means for the creation of CSF communications in the brain, including perforation of the septum pellucidum or intraventricular membranes.
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Affiliation(s)
- Ryan Alkins
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto; and
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Sun Y, O'Neill B. Imaging high-intensity focused ultrasound-induced tissue denaturation by multispectral photoacoustic method: an ex vivo study. APPLIED OPTICS 2013; 52:1764-1770. [PMID: 23478783 DOI: 10.1364/ao.52.001764] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
We present an ex vivo study for the first time, to the best of our knowledge, in multispectral photoacoustic imaging (PAI) of tissue denaturation induced by high-intensity focused ultrasound (HIFU) in this paper. Tissue of bovine muscle was thermally treated in a heated water bath and by HIFU, and then was imaged using a multispectral photoacoustic approach. Light at multiple optical wavelengths between 700 and 900 nm was delivered to the treated bovine muscle tissue to excite the photoacoustic signal. Apparent tissue denaturation has been observed in multispectral photoacoustic images after being treated in a water bath and by HIFU. It is interesting that the denaturation is more striking at shorter optical wavelength photoacoustic images than at longer optical wavelength photoacoustic images. Multispectral photoacoustic images of the tissue denaturation were further analyzed and the photoacoustic spectrums of the denaturized tissue were calculated in this paper. This study suggests that a multispectral PAI approach might be a promising tool to evaluate tissue denaturation induced by HIFU treatment.
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Affiliation(s)
- Yao Sun
- Department of Radiology, Methodist Hospital Research Institute, Weill Medical College of Cornell University, Houston, Texas 77030, USA.
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Todorova M, Agache V, Mortazavi O, Chen B, Karshafian R, Hynynen K, Man S, Kerbel RS, Goertz DE. Antitumor effects of combining metronomic chemotherapy with the antivascular action of ultrasound stimulated microbubbles. Int J Cancer 2013; 132:2956-66. [DOI: 10.1002/ijc.27977] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/22/2012] [Indexed: 01/20/2023]
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Jiang F, He M, Liu YJ, Wang ZB, Zhang L, Bai J. High intensity focused ultrasound ablation of goat liver in vivo: Pathologic changes of portal vein and the "heat-sink" effect. ULTRASONICS 2013; 53:77-83. [PMID: 22583752 DOI: 10.1016/j.ultras.2012.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 04/08/2012] [Accepted: 04/08/2012] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to evaluate pathological changes of the portal vein (PV) and the effects on main branches of the hepatic PV during HIFU (high-intensity focused ultrasound) sonication when liver tissue adjacent to the main branches of hepatic PV was ablated. Normal liver tissue at 0mm, 5mm, 10mm away from the hepatic portal vein in 50 healthy goats was ablated with magnetic resonance image-guided HIFU (MRgHIFU). MRI showed a non-perfusion region at the target area but did not show any significant changes of the PV immediately after HIFU. The histological examination 1 day after HIFU showed coagulative necrosis at the target area, revealed deep-dyed swelling collagen (CS) fibers and vessel wall fracture (VWF) in the PV adjacent to the target area; however, no CS or VWF was observed in the PV 1 week after HIFU ablation. The energy required to ablate the foci at 0mm was 21% more than that at 10mm from the PV (p<0.05); the energy needed to ablate foci 5mm away from the PV was 10% more than that at 10mm from the PV (p<0.05). We concluded that minor injury of the hepatic portal vein may occur when ablating the adjacent liver tissue, and the acoustic energy deposition is related to the distance to the portal vein.
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Affiliation(s)
- F Jiang
- State Key Laboratory of Ultrasound Engineering in Medicine, Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
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Goertz DE, Todorova M, Mortazavi O, Agache V, Chen B, Karshafian R, Hynynen K. Antitumor effects of combining docetaxel (taxotere) with the antivascular action of ultrasound stimulated microbubbles. PLoS One 2012; 7:e52307. [PMID: 23284980 PMCID: PMC3527530 DOI: 10.1371/journal.pone.0052307] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022] Open
Abstract
Ultrasound stimulated microbubbles (USMB) are being investigated for their potential to promote the uptake of anticancer agents into tumor tissue by exploiting their ability to enhance microvascular permeability. At sufficiently high ultrasound transmit amplitudes it has also recently been shown that USMB treatments can, on their own, induce vascular damage, shutdown blood flow, and inhibit tumor growth. The objective of this study is to examine the antitumor effects of ‘antivascular’ USMB treatments in conjunction with chemotherapy, which differs from previous work which has sought to enhance drug uptake with USMBs by increasing vascular permeability. Conceptually this is a strategy similar to combining vascular disrupting agents with a chemotherapy, and we have selected the taxane docetaxel (Taxotere) for evaluating this approach as it has previously been shown to have potent antitumor effects when combined with small molecule vascular disrupting agents. Experiments were conducted on PC3 tumors implanted in athymic mice. USMB treatments were performed at a frequency of 1 MHz employing sequences of 50 ms bursts (0.00024 duty cycle) at 1.65 MPa. USMB treatments were administered on a weekly basis for 4 weeks with docetaxel (DTX) being given intravenously at a dose level of 5 mg/kg. The USMB treatments, either alone or in combination with DTX, induced an acute reduction in tumor perfusion which was accompanied at the 24 hour point by significantly enhanced necrosis and apoptosis. Longitudinal experiments showed a modest prolongation in survival but no significant growth inhibition occurred in DTX–only and USMB-only treatment groups relative to control tumors. The combined USMB-DTX treatment group produced tumor shrinkage in weeks 4–6, and significant growth inhibition and survival prolongation relative to the control (p<0.001), USMB-only (p<0.01) and DTX-only treatment groups (p<0.01). These results suggest the potential of enhancing the antitumor activity of docetaxel by combining it with antivascular USMB effects.
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Affiliation(s)
- David E Goertz
- Department of Medical Biophysics, University of Toronto, Toronto, Canada.
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Abstract
High-intensity focused ultrasound (HIFU) provides focal delivery of mechanical energy deep into the body. This energy can be used to elevate the tissue temperature to such a degree that ablation is achieved. The elevated temperature can also be used to release drugs from temperature-sensitive carriers or activate therapeutic molecules using mechanical or thermal energy. Lower dose exposures modify the vasculature to allow large molecules to diffuse from blood in the surrounding tissue for local drug delivery. The energy delivery can be targeted and monitored using magnetic resonance imaging (MRI). The online image guidance and monitoring provides treatment delivery that is customized to each patient such that optimal, effective treatment can be achieved. This ability to localize and customize treatment delivery may further enhance the future potential of targeted drugs that are personalized for each patient. This review examines the rapid development of MRI-guided HIFU (MRIgHIFU) methods over the past few years and discuss their future potential.
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Affiliation(s)
- Kullervo Hynynen
- Imaging Research, Sunnybrook Health Sciences Centre, and Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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WANG SHUWEN, HE XINYING, LI MINGZHONG. High-intensity focused ultrasound compared with irradiation for ovarian castration in premenopausal females with hormone receptor-positive breast cancer after radical mastectomy. Oncol Lett 2012; 4:1087-1091. [PMID: 23162657 PMCID: PMC3499595 DOI: 10.3892/ol.2012.860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
The aim of the current study was to determine the feasibility, efficacy and safety of ovarian castration by high-intensity focused ultrasound (HIFU) in premenopausal patients with estrogen receptor (ER)(+)/progesterone receptor (PR)(+) breast cancer subsequent to radical mastectomy. A total of 88 premenopausal females with pathologically confirmed ER(+)/PR(+) breast cancer following radical mastectomy were randomly and equally divided into two groups that received HIFU therapy or radiation treatment. HIFU therapy was applied twice at an interval of three days and radiotherapy was administered to a total prescribed dose of D(T) 18 Gy in nine fractions over 11 days. Outcome measures included serum levels of estradiol and estrone, the Kupperman index and the incidence of secondary amenorrhea. Adverse events were monitored and recorded. All patients were followed up for 12 months. Serum levels of estradiol and estrone were comparable prior to treatment between the HIFU and radiation treatment groups. One month following treatment, serum levels of estradiol and estrone were significantly decreased in the two groups, but a greater decline was observed in the HIFU treatment group (P<0.01 and 0.05, respectively). In addition, more patients developed severe menopausal symptoms and amenorrhea in the HIFU therapy group compared with the radiotherapy group (P<0.01 for the two groups). A total of 3 months following treatment, serum levels of estradiol and estrone and the distribution of patients with severe, moderate and mild menopausal symptoms were comparable between the two groups. Following nine menstrual cycles, the incidence of amenorrhea reached 100% in the two groups. HIFU therapy is superior to radiotherapy for ovarian castration in premenopausal females with ER(+)/PR(+) breast cancer subsequent to radical mastectomy in terms of its minimal invasiveness and faster efficacy. HIFU represents a feasible non-surgical approach for ovarian castration.
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Affiliation(s)
- SHU-WEN WANG
- Correspondence to: Dr Shu-Wen Wang, Department of Radiation Oncology, The First Affiliated Hospital of Medical College of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an, Shaanxi 710061, P.R. China, E-mail:
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Abstract
OBJECTIVES To characterize the ability of high-intensity focused ultrasound to achieve thrombolysis in vitro and investigate the feasibility of this approach as a means of restoring blood flow in thrombus-occluded arteries in vivo. MATERIALS AND METHODS All experiments were approved by the Institutional Animal Care Committee. Thrombolysis was performed with a 1.51-MHz focused ultrasound transducer with pulse lengths of 0.1 to 10 milliseconds and acoustic powers up to 300 W. In vitro experiments were performed with blood clots formed from rabbit arterial blood and situated in 2-mm diameter tubing. Both single location and flow bypass recanalization experiments were conducted. In vitro clot erosion was assessed with 30-MHz ultrasound, with debris size measured with filters and a Coulter counter. In vivo clots were initiated in the femoral arteries of rabbits (n = 26). Cavitation signals from bubbles formed during exposure were monitored. In vivo flow restoration was assessed with 23-MHz Doppler ultrasound. RESULTS At a single location, in vitro clot erosion volumes increased with exposure power and pulse length, with debris size reducing with increasing pulse length. Flow bypass experiments achieved 99.2% clot erosion with 1.1% of debris above 0.5 mm in size. In vivo, 10 milliseconds pulses were associated with bleeding, but at 1 millisecond, it was feasible to achieve partial flow restoration in 6 of the 10 clots with only 1 of the 10 showing evidence of bleeding. In all cases, thrombolysis occurred only in the presence of cavitation. CONCLUSION High-intensity focused ultrasound thrombolysis is feasible as a means of restoring partial blood flow in thrombus-occluded arteries in the absence of thrombolytic agents. The potential for bleeding with this approach requires further investigation.
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Miller DL, Smith NB, Bailey MR, Czarnota GJ, Hynynen K, Makin IRS. Overview of therapeutic ultrasound applications and safety considerations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:623-34. [PMID: 22441920 PMCID: PMC3810427 DOI: 10.7863/jum.2012.31.4.623] [Citation(s) in RCA: 331] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Applications of ultrasound in medicine for therapeutic purposes have been accepted and beneficial uses of ultrasonic biological effects for many years. Low-power ultrasound of about 1 MHz has been widely applied since the 1950s for physical therapy in conditions such as tendinitis and bursitis. In the 1980s, high-pressure-amplitude shock waves came into use for mechanically resolving kidney stones, and "lithotripsy" rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur, including burns from thermal-based therapies and severe hemorrhage from mechanical-based therapies (eg, lithotripsy). In all of these therapeutic applications of ultrasound bioeffects, standardization, ultrasound dosimetry, benefits assurance, and side-effect risk minimization must be carefully considered to ensure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks and therefore presents a manageable safety problem to the clinician. However, safety information can be scattered, confusing, or subject to commercial conflicts of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the American Institute of Ultrasound in Medicine, to the medical ultrasound community. In this overview, the Bioeffects Committee of the American Institute of Ultrasound in Medicine outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for ensuring therapeutic ultrasound safety.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan, 3240A Medical Science Building I, 1301 Catherine St, Ann Arbor, MI 48109-5667, USA.
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Serrone J, Kocaeli H, Douglas Mast T, Burgess MT, Zuccarello M. The potential applications of high-intensity focused ultrasound (HIFU) in vascular neurosurgery. J Clin Neurosci 2012; 19:214-21. [DOI: 10.1016/j.jocn.2011.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 11/25/2022]
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Gao Y, Gao S, Zhao B, Zhao Y, Hua X, Tan K, Liu Z. Vascular effects of microbubble-enhanced, pulsed, focused ultrasound on liver blood perfusion. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:91-98. [PMID: 22104531 DOI: 10.1016/j.ultrasmedbio.2011.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 09/23/2011] [Accepted: 09/29/2011] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to investigate the vascular effects of microbubble-enhanced pulsed high-pressure ultrasound on liver blood perfusion. In the presence of circulating lipid-shell microbubbles, a focused ultrasound transducer was used to transcutaneously treat eight livers of healthy rabbits for perfusion analysis and to treat three livers with the abdomen open for histologic analysis. Twenty-two livers treated with the ultrasound only (n = 11) or microbubbles only (n = 11) served as the controls. The focused ultrasound was operated at a frequency of 1.22 MHz with a peak negative pressure of 4.6 MPa. The liver blood perfusion was estimated by performing contrast-enhanced ultrasound and gray-scale quantification on the livers before and after treatment. A temporary, nonenhanced region occurred in all of the experimental livers. The regional contrast gray-scale values of the experimental group dropped significantly from 88.4 before treatment to 2.7 after treatment. The liver perfusion also demonstrated a gradual recovery over a 60-min period. The liver perfusion of the control groups remained the same after treatment. We found microvascular rupture, hemorrhage and swelling hepatocytes upon histologic examination of the experimental group. Regional liver blood perfusion can be temporarily blocked by microbubble-enhanced focused ultrasound with high-pressure amplitude. These vascular effects can be explained as acute microvascular injury of the liver and may have clinical implications.
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Affiliation(s)
- Yuejuan Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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