Magnetic resonance imaging for the exploitation of bubble-enhanced heating by high-intensity focused ultrasound: a feasibility study in ex vivo liver

Histotripsy: A Method for Mechanical Tissue Ablation with Ultrasound

Histotripsy is a relatively new therapeutic ultrasound technology to mechanically liquefy tissue into subcellular debris using high-amplitude focused ultrasound pulses. In contrast to conventional high-intensity focused ultrasound thermal therapy, histotripsy has specific clinical advantages: the capacity for real-time monitoring using ultrasound imaging, diminished heat sink effects resulting in lesions with sharp margins, effective removal of the treated tissue, a tissue-selective feature to preserve crucial structures, and immunostimulation. The technology is being evaluated in small and large animal models for treating cancer, thrombosis, hematomas, abscesses, and biofilms; enhancing tumor-specific immune response; and neurological applications. Histotripsy has been recently approved by the US Food and Drug Administration to treat liver tumors, with clinical trials undertaken for benign prostatic hyperplasia and renal tumors. This review outlines the physical principles of various types of histotripsy; presents major parameters of the technology and corresponding hardware and software, imaging methods, and bioeffects; and discusses the most promising preclinical and clinical applications.

Numerical Simulations of the Nonlinear Interaction of a Bubble Cloud and a High Intensity Focused Ultrasound Field

We studied the effects of a small bubble cloud located at the pre-focal area of a high-intensity focused ultrasound field. Our objective is to show that bubbles can modify the bioeffects of an ultrasound treatment in muscle tissue. We model a three-dimensional ultrasound field in an idealized configuration of real operating conditions. Simulations are performed using a combined method based on the Khokhlov-Zabolotskaya-Kuznetsov equation, describing the ultrasound propagation, and a Rayleigh-Plesset equation, modeling the bubble oscillations. The nonlinear interaction of the ultrasound field and the bubble oscillations is considered. Results with and without bubbles for different void fractions of the cloud and different acoustic powers are compared. The cloud induces scattering, nonlinear distortion, and shielding of ultrasound, which increase the mechanical index in the pre-focal zone, shift the location, reduce the size, and modify the shape of the volume of tissue of high mechanical index values, and lower the pressure at the intended focus considerably. Although some hypothesis and parameters used in the models do not fit the real HIFU situations, the simulation results suggest that the effects caused by a bubble cloud located in the pre-focal area should be considered and monitored to ensure the safety of high-intensity focused ultrasound treatments.