In vivo feasibility of image-guided transvaginal focused ultrasound therapy for the treatment of intracavitary fibroids

Perfluorohexane-encapsulated fullerene nanospheres for dual-modality US/CT imaging and synergistic high-intensity focused ultrasound ablation

Purpose

The objective of this study was to develop a multifunctional contrast agent for bioimaging and synergistic high-intensity focused ultrasound (HIFU) therapy to achieve theranostic.

Materials and methods

A novel type of perfluorohexane-encapsulated fullerene (PFH-C₆₀) nanosphere was successfully developed via a vacuum ultrasonic emulsification and centrifugation method and subsequently used in ultrasound/computed tomography (CT) dual-modality and HIFU ablation of dissected bovine livers. In addition, transmission electron microscopic examination was employed to detect structural changes in the target tissue for HIFU ablation.

Results

The use of composite nanospheres effectively enhanced ultrasound and CT imaging. Moreover, the HIFU ablation of dissected bovine livers was also significantly enhanced.

Conclusion

Composite nanospheres demonstrate potential theranostic application as a multifunctional contrast agent for dual-modality biological imaging and highly efficient synergistic imaging-guided HIFU ablation.

Development of a spherically focused phased array transducer for ultrasonic image-guided hyperthermia

A 1.5 MHz prolate spheroidal therapeutic array with 128 circular elements was designed to accommodate standard imaging arrays for ultrasonic image-guided hyperthermia. The implementation of this dual-array system integrates real-time therapeutic and imaging functions with a single ultrasound system (Vantage 256, Verasonics). To facilitate applications involving small animal imaging and therapy the array was designed to have a beam depth of field smaller than 3.5 mm and to electronically steer over distances greater than 1 cm in both the axial and lateral directions. In order to achieve the required f number of 0.69, 1-3 piezocomposite modules were mated within the transducer housing. The performance of the prototype array was experimentally evaluated with excellent agreement with numerical simulation. A focal volume (2.70 mm (axial)  ×  0.65 mm (transverse)  ×  0.35 mm (transverse)) defined by the  -6 dB focal intensity was obtained to address the dimensions needed for small animal therapy. An electronic beam steering range defined by the  -3 dB focal peak intensity (17 mm (axial)  ×  14 mm (transverse)  ×  12 mm (transverse)) and  -8 dB lateral grating lobes (24 mm (axial)  ×  18 mm (transverse)  ×  16 mm (transverse)) was achieved. The combined testing of imaging and therapeutic functions confirmed well-controlled local heating generation and imaging in a tissue mimicking phantom. This dual-array implementation offers a practical means to achieve hyperthermia and ablation in small animal models and can be incorporated within protocols for ultrasound-mediated drug delivery.

Cranial nerve threshold for thermal injury induced by MRI-guided high-intensity focused ultrasound (MRgHIFU): preliminary results on an optic nerve model

Future clinical applications of magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) are moving toward the management of different intracranial pathologies. We sought to validate the production, safety, and efficacy of thermal injury to cranial nerves generated by MRgHIFU. In this study, five female domestic pigs underwent a standard bifrontal craniectomy under general anesthesia. Treatment was then given using an MRgHIFU system to induce hyperthermic ablative sonication (6 to 10 s; 50 to 2000 J.) Histological analyses were done to confirm nerve damage; temperature measured on the optic nerve was approximately 53.4°C (range: 39°C to 70°C.) Histology demonstrated a clear definition between a necrotic, transitional zone, and normal tissue. MRgHIFU induces targeted thermal injury to nervous tissue within a specific threshold of 50°C to 60°C with the tissue near the sonication center yielding the greatest effect; adjacent tissue showed minimal changes. Additional studies utilizing this technology are required to further establish accurate threshold parameters for optic nerve thermo-ablation.

Transmission electron microscopy of VX2 liver tumors after high-intensity focused ultrasound ablation enhanced with SonoVue

INTRODUCTION

The purpose of this study was to observe sequential changes in rabbit VX2 liver tumors using transmission electron microscopy after high-intensity focused ultrasound (HIFU) ablation enhanced with the contrast agent SonoVuer (Bracco, Milan, Italy).

METHODS

Thirty New Zealand rabbits with VX2 liver tumors were randomly divided into two groups. The liver tumors of rabbits in Group A underwent single HIFU ablation; those in Group B were given the ultrasound contrast agent SonoVue 0.2 mL/kg before HIFU exposure. Five rabbits from each of the two groups were killed at 0 hours, 6 days, and 14 days after HIFU ablation. Tissue samples that included targeted and untargeted tissue were observed using transmission electron microscopy.

RESULTS

Using transmission electron microscopy, it was evident that most of the cellular organs in the targeted areas of tumors in Groups A and B had disappeared early after HIFU, but the basic cell structure was seen in Group A. On the sixth day after HIFU ablation, all cells in the targeted areas were disrupted, and fibrous bands were detected in the rims of targeted areas in both groups. In the surrounding areas, cell swelling in Group B was more severe than in Group A, and a greater number of apoptotic bodies were found in Group B.

CONCLUSION

The use of an ultrasound contrast agent can enhance the effects of HIFU ablation on the destruction of cell ultrastructure and can enlarge the region of HIFU ablation; this provides experimental evidence for the use of contrast agents in controlling the effects of HIFU.

Focused ultrasound for treatment of uterine myoma: From experimental model to clinical practice

It is well known that focused ultrasound has a biologic effect on tissue. High intensity focused ultrasound (HIFU) on a small target area raises the temperature of the tissue enough to denaturate proteins and cause irreversible cell damage. The tight focus of the ultrasound energy allows delivery of the intended dose to a very precise location. The resulting coagulation necrosis is relatively painless. The application of this method in the human clinical setting has required pilot studies on an animal model. Although the treatment had a high success rate, there was a significant percentage of complications, mainly attributed to the technical drawbacks of the procedure. Therefore, this method has been modified for use in humans, and the HIFU is now guided, monitored and controlled by magnetic resonance imaging (MRI). In October 2004, Food and Drug Adiministration (FDA) approved MRI guided focused ultrasound treatment of uterine fibroids in humans. Since then, successful treatment of uterine myomas by HIFU has been performed in thousands of women.

Enhancing effects of SonoVue, a microbubble sonographic contrast agent, on high-intensity focused ultrasound ablation in rabbit livers in vivo

OBJECTIVE

The purpose of this study was to explore the enhancing biological effects of SonoVue (Bracco SpA, Milan, Italy), a sulfur hexafluoride sonographic contrast agent, on high-intensity focused ultrasound (HIFU) ablation in vivo.

METHODS

Forty-five rabbits were randomly divided into 3 groups and underwent laparotomy. Animals in group 1 were given injections of 0.2 mL of SonoVue intravenously; animals in group 2 were given physiologic saline; and those in group 3 were not given injections as control. The exposure time was set at 2 seconds with the acoustic power at 600 W. After HIFU ablations, volumes of coagulated regions were measured. Liver tissues were examined under light microscopy with hematoxylin-eosin staining and under transmission electron microscopy.

RESULTS

Coagulated volumes in group 1 (mean +/- SD, 2.41 +/- 0.44 cm(3)) were larger than those in group 2 (0.80 +/- 0.13 cm(3)) and group 3 (0.83 +/- 0.16 cm(3)) (P < .05). Separated from the surrounding area with a clear demarcation line, the targeted area in each group showed a few necrotic cells on light microscopy with the hematoxylin-eosin stain. More bubbles were observed under light microscopy in exposed areas in group 1 than in the other 2 groups (P < .05). Electron microscopy showed more severe cell ultrastructure disorder, including more interrupted cell nuclear membranes, in targeted areas in group 1 than in the other 2 groups. Conversely, in all the groups, untreated areas were not affected.

CONCLUSIONS

SonoVue can substantially enhance the ablation effects of HIFU, suggesting that microbubble contrast agents may be useful for improving HIFU efficiency.

Enhancement of ultrasound contrast agent in high-intensity focused ultrasound ablation

High-intensity focused ultrasound (HIFU) is becoming an increasingly attractive modality for ablation. Enhancement of HIFU is an important issue that has been discussed and investigated worldwide. Ultrasound contrast agents are considered to constitute an efficient medium for changing acoustic characteristics and improving energy deposition in the focal region. The role of microbubbles in inducing enhanced heating, cavitation, and other related events in HIFU ablation has been investigated, with the goal of improving coagulation necrosis volume or decreasing acoustic power and exposure duration. Consequently, with the use of ultrasound contrast agents, applications of HIFU are expected to become more efficient, safe, and accurate and to produce fewer adverse effects. This paper reviews studies that have been conducted to investigate the enhancement of ultrasound contrast agents in HIFU ablation through experiments that were carried out in vitro and in vivo; an analysis of results of this enhancement mechanism is provided.

Methods and application areas of endoscopic optical coherence tomography

We review the current state of research in endoscopic optical coherence tomography (OCT). We first survey the range of available endoscopic optical imaging techniques. We then discuss the various OCT-based endoscopic methods that have thus far been developed. We compare the different endoscopic OCT methods in terms of their scan performance. Next, we examine the application range of endoscopic OCT methods. In particular, we look at the reported utility of the methods in digestive, intravascular, respiratory, urinary and reproductive systems. We highlight two additional applications--biopsy procedures and neurosurgery--where sufficiently compact OCT-based endoscopes can have significant clinical impacts.

Image-Guided High-Intensity Focused Ultrasound for Conduction Block of Peripheral Nerves

The objective of our work has been to investigate the use of ultrasound image-guided high-intensity focused ultrasound (HIFU) to non-invasively produce conduction block in rabbit sciatic nerves in vivo, a technique that could become a treatment of spasticity and pain. The work reported here involved the investigation of the duration of such conduction blocks after HIFU treatment and whether they resulted in axon degeneration. The right sciatic nerves of 12 rabbits were treated, under guidance of ultrasound imaging, with repeated 5-s applications of 3.2 MHz HIFU with in situ intensity of 1930 W/cm(2) (spatial-average, temporal-average) until conduction block was achieved. Survival endpoints were 0, 7, or 14 days after HIFU treatment, at which point the nerve conduction was assessed. Qualitative and quantitative histological analysis of nerve sections proximal and distal to the HIFU site was performed. Conduction block of all 12 nerves was achieved with average HIFU treatment time of 10.5+/-4.9 s (mean+/-SD). The volume of necrosis of adjacent muscle was measured to be 1.59+/-1.1 cm(3) (mean+/-SD). For all nerves, conduction block remained at the survival endpoint and the block resulted in degeneration of axons distal to the HIFU site, as confirmed by electrophysiological and histological methods. Potential clinical applications include treatment of spasticity in patients with spinal cord injury or pain in cancer patients.

Annular phased-array high-intensity focused ultrasound device for image-guided therapy of uterine fibroids

An ultrasound (US), image-guided high-intensity focused ultrasound (HIFU) device was developed for noninvasive ablation of uterine fibroids. The HIFU device was an annular phased array, with a focal depth range of 30-60 mm, a natural focus of 50 mm, and a resonant frequency of 3 MHz. The in-house control software was developed to operate the HIFU electronics drive system for inducing tissue coagulation at different distances from the array. A novel imaging algorithm was developed to minimize the HIFU-induced noise in the US images. The device was able to produce lesions in bovine serum albumin-embedded polyacrylamide gels and excised pig liver. The lesions could be seen on the US images as hyperechoic regions. Depths ranging from 30 to 60 mm were sonicated at acoustic intensities of 4100 and 6100 W/cm2 for 15 s each, with the latter producing average lesion volumes at least 63% larger than the former. Tissue sonication patterns that began distal to the transducer produced longer lesions than those that began proximally. The variation in lesion dimensions indicates the possible development of HIFU protocols that increase HIFU throughput and shorten tumor treatment times.