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Xu Z, Khokhlova TD, Cho CS, Khokhlova VA. Histotripsy: A Method for Mechanical Tissue Ablation with Ultrasound. Annu Rev Biomed Eng 2024; 26:141-167. [PMID: 38346277 DOI: 10.1146/annurev-bioeng-073123-022334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Histotripsy is a relatively new therapeutic ultrasound technology to mechanically liquefy tissue into subcellular debris using high-amplitude focused ultrasound pulses. In contrast to conventional high-intensity focused ultrasound thermal therapy, histotripsy has specific clinical advantages: the capacity for real-time monitoring using ultrasound imaging, diminished heat sink effects resulting in lesions with sharp margins, effective removal of the treated tissue, a tissue-selective feature to preserve crucial structures, and immunostimulation. The technology is being evaluated in small and large animal models for treating cancer, thrombosis, hematomas, abscesses, and biofilms; enhancing tumor-specific immune response; and neurological applications. Histotripsy has been recently approved by the US Food and Drug Administration to treat liver tumors, with clinical trials undertaken for benign prostatic hyperplasia and renal tumors. This review outlines the physical principles of various types of histotripsy; presents major parameters of the technology and corresponding hardware and software, imaging methods, and bioeffects; and discusses the most promising preclinical and clinical applications.
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Affiliation(s)
- Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA;
| | - Tatiana D Khokhlova
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Clifford S Cho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Vera A Khokhlova
- Department of Acoustics, Lomonosov Moscow State University, Moscow, Russia
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2
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Sandilos G, Butchy MV, Koneru M, Gongalla S, Sensenig R, Hong YK. Histotripsy - hype or hope? Review of innovation and future implications. J Gastrointest Surg 2024:S1091-255X(24)00492-X. [PMID: 38862075 DOI: 10.1016/j.gassur.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Histotripsy is a novel, ultrasound-based ablative technique that was recently approved by the Food and Drug Administration for hepatic targets. It has several promising additional theoretical applications that need to be further investigated. Its basis as a nonthermal cavitational technology presents a unique advantage over existing thermal ablation techniques in maximizing local effects while minimizing adjacent tissue destruction. This review discusses the technical basis and current preclinical and clinical data surrounding histotripsy. METHODS This was a comprehensive review of the literature surrounding histotripsy and the clinical landscape of existing ablative techniques using the PubMed database. A technical summary of histotripsy's physics and cellular effect was described. Moreover, data from recent clinical trials, including Hope4Liver, and future implications regarding its application in various benign and malignant conditions were discussed. RESULTS Preclinical data demonstrated the efficacy of histotripsy ablation in various organ systems with minimal tissue destruction when examined at the histologic level. The first prospective clinical trial involving histotripsy in hepatocellular carcinoma and liver metastases, Hope4Liver, demonstrated a primary efficacy of 95.5% with minimal complications (6.8%). This efficacy was replicated in similar trials involving the treatment of benign prostatic hypertrophy. DISCUSSION In addition to the noninvasive ability to ablate lesions in the liver, histotripsy offers additional therapeutic potential. Early data suggest a potential complementary therapeutic effect when combining histotripsy with existing immunologic therapies because of the technology's theoretical ability to sensitize tumors to adaptive immunity. As with most novel therapies, the effect of histotripsy on the oncologic therapeutic landscape remains uncertain.
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Affiliation(s)
- Georgianna Sandilos
- Division of Surgical Oncology, Department of Surgery, Cooper University Hospital, Cooper University Health Care, Camden, NJ, United States
| | - Margaret Virginia Butchy
- Division of Surgical Oncology, Department of Surgery, Cooper University Hospital, Cooper University Health Care, Camden, NJ, United States
| | - Manisha Koneru
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Shivsai Gongalla
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Richard Sensenig
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Young Ki Hong
- Division of Surgical Oncology, Department of Surgery, Cooper University Hospital, Cooper University Health Care, Camden, NJ, United States.
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Verma Y, Perera Molligoda Arachchige AS. Advances in Tumor Management: Harnessing the Potential of Histotripsy. Radiol Imaging Cancer 2024; 6:e230159. [PMID: 38639585 PMCID: PMC11148838 DOI: 10.1148/rycan.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
Tissue ablation techniques have long been used in clinical settings to treat various oncologic diseases. However, many of these techniques are invasive and can cause substantial adverse effects. Histotripsy is a noninvasive, nonionizing, nonthermal tissue ablation technique that has the potential to replace surgical interventions in various clinical settings. Histotripsy works by delivering high-intensity focused ultrasound waves to target tissue. These waves create cavitation bubbles within tissues that rapidly expand and collapse, thereby mechanically fractionating the tissue into acellular debris that is subsequently absorbed by the body's immune system. Preclinical and clinical studies have demonstrated the efficacy of histotripsy in treating a range of diseases, including liver, pancreatic, renal, and prostate tumors. Safety outcomes of histotripsy have been generally favorable, with minimal adverse effects reported. However, further studies are needed to optimize the technique and understand its long-term effects. This review aims to discuss the importance of histotripsy as a noninvasive tissue ablation technique, the preclinical and clinical literature on histotripsy and its safety, and the potential applications of histotripsy in clinical practice. Keywords: Tumor Microenvironment, Ultrasound-High-Intensity Focused (HIFU), Ablation Techniques, Abdomen/GI, Genital/Reproductive, Nonthermal Tissue Ablation, Histotripsy, Clinical Trials, Preclinical Applications, Focused Ultrasound © RSNA, 2024.
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Iqbal MF, Shafique MA, Abdur Raqib M, Fadlalla Ahmad TK, Haseeb A, M. A. Mhjoob A, Raja A. Histotripsy: an innovative approach for minimally invasive tumour and disease treatment. Ann Med Surg (Lond) 2024; 86:2081-2087. [PMID: 38576932 PMCID: PMC10990312 DOI: 10.1097/ms9.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
Histotripsy is a noninvasive medical technique that uses high-intensity focused ultrasound (HIFU) to treat liver tumours. The two main histotripsy methods are boiling histotripsy and cavitation cloud histotripsy. Boiling histotripsy uses prolonged ultrasound pulses to create small boiling bubbles in the tissue, which leads to the breakdown of the tissue into smaller subcellular fragments. Cavitation cloud histotripsy uses the ultrasonic cavitation effect to disintegrate target tissue into precisely defined liquefied lesions. Both methods show similar treatment effectiveness; however, boiling histotripsy ensures treatment stability by producing a stable boiling bubble with each pulse. The therapeutic effect is ascribed to mechanical damage at the subcellular level rather than thermal damage. This article discusses the mechanisms, treatment parameters, and potential of histotripsy as a minimally invasive procedure that provides precise and controlled subcellular damage.
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Affiliation(s)
| | | | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University
| | | | - Adarsh Raja
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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Worlikar T, Hall T, Zhang M, Mendiratta-Lala M, Green M, Cho CS, Xu Z. Insights from in vivo preclinical cancer studies with histotripsy. Int J Hyperthermia 2024; 41:2297650. [PMID: 38214171 PMCID: PMC11102041 DOI: 10.1080/02656736.2023.2297650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024] Open
Abstract
Histotripsy is the first noninvasive, non-ionizing, and non-thermal ablation technique that mechanically fractionates target tissue into acellular homogenate via controlled acoustic cavitation. Histotripsy has been evaluated for various preclinical applications requiring noninvasive tissue removal including cancer, brain surgery, blood clot and hematoma liquefaction, and correction of neonatal congenital heart defects. Promising preclinical results including local tumor suppression, improved survival outcomes, local and systemic anti-tumor immune responses, and histotripsy-induced abscopal effects have been reported in various animal tumor models. Histotripsy is also being investigated in veterinary patients with spontaneously arising tumors. Research is underway to combine histotripsy with immunotherapy and chemotherapy to improve therapeutic outcomes. In addition to preclinical cancer research, human clinical trials are ongoing for the treatment of liver tumors and renal tumors. Histotripsy has been recently approved by the FDA for noninvasive treatment of liver tumors. This review highlights key learnings from in vivo shock-scattering histotripsy, intrinsic threshold histotripsy, and boiling histotripsy cancer studies treating cancers of different anatomic locations and discusses the major considerations in planning in vivo histotripsy studies regarding instrumentation, tumor model, study design, treatment dose, and post-treatment tumor monitoring.
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Affiliation(s)
- Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Man Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Michael Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Radiation Oncology, Ann Arbor VA Healthcare, Ann Arbor, Michigan, USA
| | - Clifford S. Cho
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, Michigan, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Qi T, Jing Y, Deng J, Chang J, Sun W, Yang R, Liu X, Zhang Q, Wan M, Lu M. Boiling Histotripsy Using Dual-Frequency Protocol on Murine Breast Tumor Model and Promotes Immune Activation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1773-1785. [PMID: 37871099 DOI: 10.1109/tuffc.2023.3326561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Histotripsy is an ultrasound-guided, noninvasive, nonthermal ablation therapy that can mechanically lyse target tissues. There have been no reports of enhanced histotripsy for large-volume triple-negative breast cancer (TNBC). This study aims to verify the ability of a novel approach of dual-frequency mode combined with two-stage millisecond-length ultrasound pulses (DF-TS) to accelerate the treatment of murine subcutaneous 4T1 tumors and determine immune changes after treatment. A custom-designed 1.1-/2.2-MHz two-element confocal-annular array was used to treat approximately 6-mm tumors under ultrasound guidance and real-time monitoring. Two-stage millisecond-length ultrasound pulses were used to generate approximate cuboid ablation volumes (diagonal 5-6 mm) within each tumor, with a dose of 100 pulses/point. Immune effects were characterized by changes of pro-inflammatory cytokine levels and infiltration levels of immune cells. In all targeted treatment areas, bubble cloud activity was visualized by ultrasound monitoring. The novel protocol resulted in elliptical and controllable sized lesions, reducing the number of scanning points, and was generally well tolerated. After treatment, tumor growth experienced a seven-day stagnation period, the survival period of mice was prolonged, and the levels of pro-inflammatory cytokines and immune cell infiltration increased. This study demonstrates that DF-TS boiling histotripsy (BH) has a noninvasive, efficient, and precise ablation ability for TNBC and potentially enhances immune responses.
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Couillard AB, Zlevor AM, Ziemlewicz TJ, Kisting MA, Knott E, Rossebo AE, White J, Lubner MG, Gettle LM, Hinshaw JL, Mao L, Stoffregen W, Swietlik JF, Knavel-Koepsel E, Stratchko L, Abel EJ, Xu Z, Lee FT, Laeseke PF. A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model. J Vasc Interv Radiol 2023; 34:1986-1996. [PMID: 37481064 DOI: 10.1016/j.jvir.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE To compare the safety and efficacy of histotripsy with cryoablation in a chronic human-scale normal porcine kidney model. MATERIALS AND METHODS Eighteen female domestic swine were divided evenly into histotripsy and cryoablation treatment arms. A planned 2-3 cm diameter treatment was performed under ultrasound (histotripsy) or ultrasound and computed tomography (CT) guidance (cryoablation). Contrast-enhanced CT and serum blood analysis were performed immediately postprocedure and on day 7, with either immediate killing (n = 3) or continued survival to day 30 (n = 6), at which time contrast-enhanced CT, serum blood analysis, and necropsy were performed. Animal welfare, treatment zone appearance, procedure-related adverse events, and histopathology of the treatment zones and surrounding tissues were assessed. RESULTS Histotripsy treatment zones (mean ±standard deviation diameters, 2.7 ± 0.12 × 2.4 ± 0.19 × 2.4 ± 0.26 cm; volume, 8.3 ± 1.9 cm3) were larger than cryoablation zones (mean diameters, 2.2 ± 0.19 × 1.9 ± 0.13 × 1.7 ± 0.19 cm; volume, 3.9 ± 0.8 cm3; P < .001). At 30 days, histotripsy and cryoablation treatment zone volumes decreased by 96% and 83% on CT, respectively (P < .001). Perirenal hematomas were present after 8 of 9 (89%) cryoablation (mean volume, 22.2 cm3) and 1 of 9 (11%, P < .001) histotripsy (volume, 0.4 cm3) procedures, with active arterial extravasation in 4 of 9 (44%) cryoablation and no histotripsy animals (P = .206). All 9 histotripsy animals and 5 of 9 (56%) cryoablation animals had collecting system debris (P = .042). Changes in serum creatinine were similar between the groups (P = .321). CONCLUSIONS Other than a higher rate of bleeding after cryoablation, the safety and early efficacy of histotripsy and cryoablation were comparable for creating treatment zones in a chronic normal porcine kidney model.
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Affiliation(s)
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Emily Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jim White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - John F Swietlik
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Lindsay Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Jason Abel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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Falk KL, Laeseke PF, Kisting MA, Zlevor AM, Knott EA, Smolock AR, Bradley C, Vlaisavljevich E, Lee FT, Ziemlewicz TJ. Clinical translation of abdominal histotripsy: a review of preclinical studies in large animal models. Int J Hyperthermia 2023; 40:2272065. [PMID: 37875279 PMCID: PMC10629829 DOI: 10.1080/02656736.2023.2272065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Histotripsy is an emerging noninvasive, non-thermal, and non-ionizing focused ultrasound (US) therapy that can be used to destroy targeted tissue. Histotripsy has evolved from early laboratory prototypes to clinical systems which have been comprehensively evaluated in the preclinical environment to ensure safe translation to human use. This review summarizes the observations and results from preclinical histotripsy studies in the liver, kidney, and pancreas. Key findings from these studies include the ability to make a clinically relevant treatment zone in each organ with maintained collagenous architecture, potentially allowing treatments in areas not currently amenable to thermal ablation. Treatments across organ capsules have proven safe, including in anticoagulated models which may expand patients eligible for treatment or eliminate the risk associated with taking patients off anti-coagulation. Treatment zones are well-defined with imaging and rapidly resorb, which may allow improved evaluation of treatment zones for residual or recurrent tumor. Understanding the effects of histotripsy in animal models will help inform physicians adopting histotripsy for human clinical use.
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Affiliation(s)
- Katrina L Falk
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Emily A Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Amanda R Smolock
- Department of Radiology, Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Charles Bradley
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Fred T Lee
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
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Kutlu AZ, Laeseke PF, Zeighami Salimabad M, Minesinger GM, Periyasamy S, Pieper AA, Hall TJ, Wagner MG. A Multimodal Phantom for Visualization and Assessment of Histotripsy Treatments on Ultrasound and X-Ray Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1401-1407. [PMID: 36878828 PMCID: PMC10106430 DOI: 10.1016/j.ultrasmedbio.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/09/2022] [Accepted: 01/23/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Histotripsy is an emerging non-invasive, non-ionizing and non-thermal focal tumor therapy. Although histotripsy targeting is currently based on ultrasound (US), other imaging modalities such as cone-beam computed tomography (CBCT) have recently been proposed to enable the treatment of tumors not visible on ultrasound. The objective of this study was to develop and evaluate a multi-modality phantom to facilitate the assessment of histotripsy treatment zones on both US and CBCT imaging. METHODS Fifteen red blood cell phantoms composed of alternating layers with and without barium were manufactured. Spherical 25-mm histotripsy treatments were performed, and treatment zone size and location were measured on CBCT and ultrasound. Sound speed, impedance and attenuation were measured for each layer type. RESULTS The average ± standard deviation signed difference between measured treatment diameters was 0.29 ± 1.25 mm. The Euclidean distance between measured treatment centers was 1.68 ± 0.63 mm. The sound speed in the different layers ranged from 1491 to 1514 m/s and was within typically reported soft tissue ranges (1480-1560 m/s). In all phantoms, histotripsy resulted in sharply delineated treatment zones, allowing segmentation in both modalities. CONCLUSION These phantoms will aid in the development and validation of X-ray-based histotripsy targeting techniques, which promise to expand the scope of treatable lesions beyond only those visible on ultrasound.
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Affiliation(s)
- Ayca Z Kutlu
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Grace M Minesinger
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander A Pieper
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Martin G Wagner
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
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Development of an ultrasound guided focused ultrasound system for 3D volumetric low energy nanodroplet-mediated histotripsy. Sci Rep 2022; 12:20664. [PMID: 36450815 PMCID: PMC9712369 DOI: 10.1038/s41598-022-25129-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Low pressure histotripsy is likely to facilitate current treatments that require extremely high pressures. An ultrasound guided focused ultrasound system was designed to accommodate a rotating imaging transducer within a low frequency therapeutic transducer that operates at a center frequency of 105 kHz. The implementation of this integrated system provides real-time therapeutic and volumetric imaging functions, that are used here for low-cost, low-energy 3D volumetric ultrasound histotripsy using nanodroplets. A two-step approach for low pressure histotripsy is implemented with this dual-array. Vaporization of nanodroplets into gaseous microbubbles was performed via the 1D rotating imaging probe. The therapeutic transducer is then used to detonate the vaporized nanodroplets and trigger potent mechanical effects in the surrounding tissue. Rotating the imaging transducer creates a circular vaporized nanodroplet shape which generates a round lesion upon detonation. This contrasts with the elongated lesion formed when using a standard 1D imaging transducer for nanodroplet activation. Optimization experiments show that maximal nanodroplet activation can be achieved with a 2-cycle excitation pulse at a center frequency of 3.5 MHz, and a peak negative pressure of 3.4 MPa (a mechanical index of 1.84). Vaporized nanodroplet detonation was achieved by applying a low frequency treatment at a center frequency of 105 kHz and mechanical index of 0.9. In ex-vivo samples, the rotated nanodroplet activation method yielded the largest lesion area, with a mean of 4.7 ± 0.5 mm2, and a rounded shape. In comparison, standard fixed transducer nanodroplet activation resulted in an average lesion area of 2.6 ± 0.4 mm2, and an elongated shape. This hybrid system enables to achieve volumetric low energy histotripsy, and thus facilitates the creation of precise, large-volume mechanical lesions in tissues, while reducing the pressure threshold required for standard histotripsy by over an order of magnitude.
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Landry TG, Gannon J, Vlaisavljevich E, Mallay MG, Woodacre JK, Croul S, Fawcett JP, Brown JA. Endoscopic Coregistered Ultrasound Imaging and Precision Histotripsy: Initial In Vivo Evaluation. BME FRONTIERS 2022; 2022:9794321. [PMID: 37850178 PMCID: PMC10521722 DOI: 10.34133/2022/9794321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/06/2022] [Indexed: 10/19/2023] Open
Abstract
Objective. Initial performance evaluation of a system for simultaneous high-resolution ultrasound imaging and focused mechanical submillimeter histotripsy ablation in rat brains. Impact Statement. This study used a novel combination of high-resolution imaging and histotripsy in an endoscopic form. This would provide neurosurgeons with unprecedented accuracy in targeting and executing nonthermal ablations in minimally invasive surgeries. Introduction. Histotripsy is a safe and effective nonthermal focused ablation technique. However, neurosurgical applications, such as brain tumor ablation, are difficult due to the presence of the skull. Current devices are too large to use in the minimally invasive approaches surgeons prefer. We have developed a combined imaging and histotripsy endoscope to provide neurosurgeons with a new tool for this application. Methods. The histotripsy component had a 10 mm diameter, operating at 6.3 MHz. Affixed within a cutout hole in its center was a 30 MHz ultrasound imaging array. This coregistered pair was used to ablate brain tissue of anesthetized rats while imaging. Histological sections were examined, and qualitative descriptions of ablations and basic shape descriptive statistics were generated. Results. Complete ablations with submillimeter area were produced in seconds, including with a moving device. Ablation progress could be monitored in real time using power Doppler imaging, and B-mode was effective for monitoring post-ablation bleeding. Collateral damage was minimal, with a 100 μm maximum distance of cellular damage from the ablation margin. Conclusion. The results demonstrate a promising hardware suite to enable precision ablations in endoscopic procedures or fundamental preclinical research in histotripsy, neuroscience, and cancer.
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Affiliation(s)
- Thomas G. Landry
- School of Biomedical Engineering, Dalhousie University, Canada
- Division of Surgery, Nova Scotia Health Authority, Canada
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Virginia, USA
| | | | | | - Sidney Croul
- Department of Pathology & Laboratory Medicine, Dalhousie University, Canada
| | - James P. Fawcett
- Department of Pharmacology, Dalhousie University, Canada
- Department of Surgery, Dalhousie University, Canada
| | - Jeremy A. Brown
- School of Biomedical Engineering, Dalhousie University, Canada
- Division of Surgery, Nova Scotia Health Authority, Canada
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Worlikar T, Zhang M, Ganguly A, Hall TL, Shi J, Zhao L, Lee FT, Mendiratta-Lala M, Cho CS, Xu Z. Impact of Histotripsy on Development of Intrahepatic Metastases in a Rodent Liver Tumor Model. Cancers (Basel) 2022; 14:1612. [PMID: 35406383 PMCID: PMC8996987 DOI: 10.3390/cancers14071612] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Histotripsy has been used for tumor ablation, through controlled, non-invasive acoustic cavitation. This is the first study to evaluate the impact of partial histotripsy ablation on immune infiltration, survival outcomes, and metastasis development, in an in vivo orthotopic, immunocompetent rat HCC model (McA-RH7777). At 7−9 days post-tumor inoculation, the tumor grew to 5−10 mm, and ~50−75% tumor volume was treated by ultrasound-guided histotripsy, by delivering 1−2 cycle histotripsy pulses at 100 Hz PRF (focal peak negative pressure P− >30 MPa), using a custom 1 MHz transducer. Complete local tumor regression was observed on MRI in 9/11 histotripsy-treated rats, with no local recurrence or metastasis up to the 12-week study end point, and only a <1 mm residual scar tissue observed on histology. In comparison, 100% of untreated control animals demonstrated local tumor progression, developed intrahepatic metastases, and were euthanized at 1−3 weeks. Survival outcomes in histotripsy-treated animals were significantly improved compared to controls (p-value < 0.0001). There was evidence of potentially epithelial-to-mesenchymal transition (EMT) in control tumor and tissue healing in histotripsy-treated tumors. At 2- and 7-days post-histotripsy, increased immune infiltration of CD11b+, CD8+ and NK cells was observed, as compared to controls, which may have contributed to the eventual regression of the untargeted tumor region in histotripsy-treated tumors.
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Affiliation(s)
- Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
| | - Man Zhang
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (M.Z.); (M.M.-L.)
| | - Anutosh Ganguly
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA; (A.G.); (C.S.C.)
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
| | - Jiaqi Shi
- Department of Pathology & Clinical Labs, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Fred T. Lee
- Department of Radiology, University of Wisconsin, Madison, WI 53705, USA;
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (M.Z.); (M.M.-L.)
| | - Clifford S. Cho
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA; (A.G.); (C.S.C.)
- Department of Surgery, Ann Arbor VA Healthcare, Ann Arbor, MI 48105, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (T.W.); (T.L.H.)
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13
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Hendricks-Wenger A, Arnold L, Gannon J, Simon A, Singh N, Sheppard H, Nagai-Singer MA, Imran KM, Lee K, Clark-Deener S, Byron C, Edwards MR, Larson MM, Rossmeisl JH, Coutermarsh-Ott SL, Eden K, Dervisis N, Klahn S, Tuohy J, Allen IC, Vlaisavljevich E. Histotripsy Ablation in Preclinical Animal Models of Cancer and Spontaneous Tumors in Veterinary Patients: A Review. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:5-26. [PMID: 34478363 PMCID: PMC9284566 DOI: 10.1109/tuffc.2021.3110083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
New therapeutic strategies are direly needed in the fight against cancer. Over the last decade, several tumor ablation strategies have emerged as stand-alone or combination therapies. Histotripsy is the first completely noninvasive, nonthermal, and nonionizing tumor ablation method. Histotripsy can produce consistent and rapid ablations, even near critical structures. Additional benefits include real-time image guidance, high precision, and the ability to treat tumors of any predetermined size and shape. Unfortunately, the lack of clinically and physiologically relevant preclinical cancer models is often a significant limitation with all focal tumor ablation strategies. The majority of studies testing histotripsy for cancer treatment have focused on small animal models, which have been critical in moving this field forward and will continue to be essential for providing mechanistic insight. While these small animal models have notable translational value, there are significant limitations in terms of scale and anatomical relevance. To address these limitations, a diverse range of large animal models and spontaneous tumor studies in veterinary patients have emerged to complement existing rodent models. These models and veterinary patients are excellent at providing realistic avenues for developing and testing histotripsy devices and techniques designed for future use in human patients. Here, we provide a review of animal models used in preclinical histotripsy studies and compare histotripsy ablation in these models using a series of original case reports across a broad spectrum of preclinical animal models and spontaneous tumors in veterinary patients.
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14
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Hendricks-Wenger A, Sereno J, Gannon J, Zeher A, Brock RM, Beitel-White N, Simon A, Davalos RV, Coutermarsh-Ott S, Vlaisavljevich E, Allen IC. Histotripsy Ablation Alters the Tumor Microenvironment and Promotes Immune System Activation in a Subcutaneous Model of Pancreatic Cancer. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2987-3000. [PMID: 33956631 PMCID: PMC9295194 DOI: 10.1109/tuffc.2021.3078094] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pancreatic cancer is a significant cause of cancer-related deaths in the United States with an abysmal five-year overall survival rate that is under 9%. Reasons for this mortality include the lack of late-stage treatment options and the immunosuppressive tumor microenvironment. Histotripsy is an ultrasound-guided, noninvasive, nonthermal tumor ablation therapy that mechanically lyses targeted cells. To study the effects of histotripsy on pancreatic cancer, we utilized an in vitro model of pancreatic adenocarcinoma and compared the release of potential antigens following histotripsy treatment to other ablation modalities. Histotripsy was found to release immune-stimulating molecules at magnitudes similar to other nonthermal ablation modalities and superior to thermal ablation modalities, which corresponded to increased innate immune system activation in vivo. In subsequent in vivo studies, murine Pan02 tumors were grown in mice and treated with histotripsy. Flow cytometry and rtPCR were used to determine changes in the tumor microenvironment over time compared to untreated animals. In mice with pancreatic tumors, we observed significantly increased tumor-progression-free and general survival, with increased activation of the innate immune system 24 h posttreatment and decreased tumor-associated immune cell populations within 14 days of treatment. This study demonstrates the feasibility of using histotripsy for pancreatic cancer ablation and provides mechanistic insight into the initial innate immune system activation following treatment. Further work is needed to establish the mechanisms behind the immunomodulation of the tumor microenvironment and immune effects.
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15
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Bader KB, Wallach EL, Shekhar H, Flores-Guzman F, Halpern HJ, Hernandez SL. Estimating the mechanical energy of histotripsy bubble clouds with high frame rate imaging. Phys Med Biol 2021; 66:10.1088/1361-6560/ac155d. [PMID: 34271560 PMCID: PMC10680990 DOI: 10.1088/1361-6560/ac155d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
Mechanical ablation with the focused ultrasound therapy histotripsy relies on the generation and action of bubble clouds. Despite its critical role for ablation, quantitative metrics of bubble activity to gauge treatment outcomes are still lacking. Here, plane wave imaging was used to track the dissolution of bubble clouds following initiation with the histotripsy pulse. Information about the rate of change in pixel intensity was coupled with an analytic diffusion model to estimate bubble size. Accuracy of the hybrid measurement/model was assessed by comparing the predicted and measured dissolution time of the bubble cloud. Good agreement was found between predictions and measurements of bubble cloud dissolution times in agarose phantoms and murine subcutaneous SCC VII tumors. The analytic diffusion model was extended to compute the maximum bubble size as well as energy imparted to the tissue due to bubble expansion. Regions within tumors predicted to have undergone strong bubble expansion were collocated with ablation. Further, the dissolution time was found to correlate with acoustic emissions generated by the bubble cloud during histotripsy insonation. Overall, these results indicate a combination of modeling and high frame rate imaging may provide means to quantify mechanical energy imparted to the tissue due to bubble expansion for histotripsy.
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Affiliation(s)
- Kenneth B Bader
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Emily L Wallach
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, Gujarat, India
| | | | - Howard J Halpern
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL United States of America
| | - Sonia L Hernandez
- Department of Surgery, University of Chicago, Chicago, IL, United States of America
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16
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Hendricks-Wenger A, Hutchison R, Vlaisavljevich E, Allen IC. Immunological Effects of Histotripsy for Cancer Therapy. Front Oncol 2021; 11:681629. [PMID: 34136405 PMCID: PMC8200675 DOI: 10.3389/fonc.2021.681629] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Cancer is the second leading cause of death worldwide despite major advancements in diagnosis and therapy over the past century. One of the most debilitating aspects of cancer is the burden brought on by metastatic disease. Therefore, an ideal treatment protocol would address not only debulking larger primary tumors but also circulating tumor cells and distant metastases. To address this need, the use of immune modulating therapies has become a pillar in the oncology armamentarium. A therapeutic option that has recently emerged is the use of focal ablation therapies that can destroy a tumor through various physical or mechanical mechanisms and release a cellular lysate with the potential to stimulate an immune response. Histotripsy is a non-invasive, non-ionizing, non-thermal, ultrasound guided ablation technology that has shown promise over the past decade as a debulking therapy. As histotripsy therapies have developed, the full picture of the accompanying immune response has revealed a wide range of immunogenic mechanisms that include DAMP and anti-tumor mediator release, changes in local cellular immune populations, development of a systemic immune response, and therapeutic synergism with the inclusion of checkpoint inhibitor therapies. These studies also suggest that there is an immune effect from histotripsy therapies across multiple murine tumor types that may be reproducible. Overall, the effects of histotripsy on tumors show a positive effect on immunomodulation.
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Affiliation(s)
- Alissa Hendricks-Wenger
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, United States
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Ruby Hutchison
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Eli Vlaisavljevich
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, United States
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
- Institute for Critical Technology and Applied Sciences Center for Engineered Health, Virginia Tech, Blacksburg, VA, United States
| | - Irving Coy Allen
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, VA, United States
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
- Institute for Critical Technology and Applied Sciences Center for Engineered Health, Virginia Tech, Blacksburg, VA, United States
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
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17
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Meng L, Shan H, He X, Zhou J, Huang J, Zhang X, Ma L, Xue X, Zhang Z, Xiao Y. Establishment of a modified percutaneous CT-guided paraspinal intramuscular VX-2 squamous cell carcinoma dual tumor model in rabbits. PeerJ 2021; 9:e11536. [PMID: 34123599 PMCID: PMC8166237 DOI: 10.7717/peerj.11536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background The rabbit VX-2 tumor model is a commonly used transplanted tumor model and is widely used in surgical, radiological, and interventional studies. Most of the known tumor models for each site are single solid tumors. This study aimed to establish an accurate and stable intramuscular dual tumor model guided by computed tomography (CT). Methods In this study, we compared three different inoculation methods to select the most appropriate dual tumor model. Six New Zealand White rabbits were used as tumor-carrying rabbits for tumor harvesting. Thirty rabbits were divided into three groups as experimental rabbits. Group A applied the tumor cell suspension method, in which the suspension was injected into the designated location with a syringe under CT guidance. Groups B and C used tumor tissue strips obtained in vivo or under direct in vitro vision. The tumor tissue strips were implanted into the designated locations using a guide needle under CT guidance. The differences in tumorigenic rate, the size difference between bilateral tumors, and metastasis between the three methods were compared. Results It was found that group A obtained a 100% tumor survival rate, but the size of the tumor was more variable, and needle tract implantation metastasis occurred in 5 cases. In group B, tumor tissue strips were taken in vivo for implantation, in which one case failed to survive. Tumor tissue strips in group C were obtained in vitro under direct vision. The tumor tissue strips obtained in vitro by puncture using a biopsy needle in group C had a 100% tumorigenicity rate and stable tumor size. No significant needle tract implantation metastases were found in either group B or C. The variance of tumor size obtained in group A was significantly higher than in groups B and C. The variance of tumor size in group C was the smallest. Group C had high tumorigenicity and a more stable size and morphology of the formed tumors. Conclusion The results showed that the method of obtaining tumor tissue strips using in vitro direct vision puncture and implanting them into the muscle with CT guidance and guide needles can establish an accurate and stable dual tumor model. This dual tumor model can provide substantial support for relevant preclinical studies.
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Affiliation(s)
- Liangliang Meng
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China.,Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Husheng Shan
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Xiaofeng He
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiantao Zhou
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Jingxiang Huang
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, Beijing, China
| | - Xin Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Li Ma
- Anesthesia and Surgery Center, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Xue
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhongliang Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
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18
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Xu Z, Hall TL, Vlaisavljevich E, Lee FT. Histotripsy: the first noninvasive, non-ionizing, non-thermal ablation technique based on ultrasound. Int J Hyperthermia 2021; 38:561-575. [PMID: 33827375 PMCID: PMC9404673 DOI: 10.1080/02656736.2021.1905189] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 01/09/2023] Open
Abstract
Histotripsy is the first noninvasive, non-ionizing, and non-thermal ablation technology guided by real-time imaging. Using focused ultrasound delivered from outside the body, histotripsy mechanically destroys tissue through cavitation, rendering the target into acellular debris. The material in the histotripsy ablation zone is absorbed by the body within 1-2 months, leaving a minimal remnant scar. Histotripsy has also been shown to stimulate an immune response and induce abscopal effects in animal models, which may have positive implications for future cancer treatment. Histotripsy has been investigated for a wide range of applications in preclinical studies, including the treatment of cancer, neurological diseases, and cardiovascular diseases. Three human clinical trials have been undertaken using histotripsy for the treatment of benign prostatic hyperplasia, liver cancer, and calcified valve stenosis. This review provides a comprehensive overview of histotripsy covering the origin, mechanism, bioeffects, parameters, instruments, and the latest results on preclinical and human studies.
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Affiliation(s)
- Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Fred T. Lee
- Departments of Radiology, Biomedical Engineering, and Urology, University of Wisconsin, Madison, WI, USA
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19
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Knott EA, Swietlik JF, Longo KC, Watson RF, Green CM, Abel EJ, Lubner MG, Hinshaw JL, Smolock AR, Xu Z, Lee FT, Ziemlewicz TJ. Robotically-Assisted Sonic Therapy for Renal Ablation in a Live Porcine Model: Initial Preclinical Results. J Vasc Interv Radiol 2019; 30:1293-1302. [PMID: 31130365 PMCID: PMC6925588 DOI: 10.1016/j.jvir.2019.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of Robotically Assisted Sonic Therapy (RAST)-a noninvasive and nonthermal focused ultrasound therapy based on histotripsy-for renal ablation in a live porcine model. MATERIALS AND METHODS RAST ablations (n = 11) were performed in 7 female swine: 3 evaluated at 1 week (acute) and 4 evaluated at 4 weeks (chronic). Treatment groups were acute bilateral (3 swine, 6 ablations with immediate computed tomography [CT] and sacrifice); chronic single kidney (3 swine, 3 ablations; CT at day 0, week 1, and week 4 after treatment, followed by sacrifice); and chronic bilateral (1 swine, 2 ablations). Treatments were performed using a prototype system (VortxRx; HistoSonics, Inc) and targeted a 2.5-cm-diameter sphere in the lower pole of each kidney, intentionally including the central collecting system. RESULTS Mean treatment time was 26.4 minutes. Ablations had a mean diameter of 2.4 ± 0.3 cm, volume of 8.5 ± 2.4 cm3, and sphericity index of 1.00. Median ablation volume decreased by 96.1% over 4 weeks. Histology demonstrated complete lysis with residual blood products inside the ablation zone. Temporary collecting system obstruction by thrombus was observed in 4/11 kidneys (2 acute and 2 chronic) and resolved by 1 week. There were no urinary leaks, main vessel thromboses, or adjacent organ injuries on imaging or necropsy. CONCLUSIONS In this normal porcine model, renal RAST demonstrated complete histologic destruction of the target renal tissue while sparing the urothelium.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024.
| | - John F Swietlik
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Katherine C Longo
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Rao F Watson
- Department of Pathology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Chelsey M Green
- Department of Statistics, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - E Jason Abel
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Amanda R Smolock
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024
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20
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Lundt J, Hall T, Rao A, Fowlkes JB, Cain C, Lee F, Xu Z. Coalescence of residual histotripsy cavitation nuclei using low-gain regions of the therapy beam during electronic focal steering. Phys Med Biol 2018; 63:225010. [PMID: 30418936 DOI: 10.1088/1361-6560/aaeaf3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Following collapse of a histotripsy cloud, residual microbubbles may persist for seconds, distributed throughout the focus. Their presence can attenuate and scatter subsequent pulses, hindering treatment speed and homogeneity. Previous studies have demonstrated use of separate low-amplitude (~1 MPa) pulses interleaved with histotripsy pulses to drive bubble coalescence (BC), significantly improving treatment speed without sacrificing homogeneity. We propose that by using electronic focal steering (EFS) to direct the therapy focus throughout specially-designed EFS sequences, it is possible to use low-gain regions of the therapy beam to accomplish BC during EFS without any additional acoustic sequence. First, to establish proof of principle for an isolated focus, a 50-foci EFS sequence was constructed with the first position isolated near the geometric focus and remaining positions distributed post-focally. EFS sequences were evaluated in tissue-mimicking phantoms with gas concentrations of 20% and 100% with respect to saturation. Results using an isolated focus demonstrated that at 20% gas concentration, 49 EFS pulses were sufficient to achieve BC in all samples for pulse repetition frequency (PRF) ⩽ 800 Hz and 84.1% ± 3.0% of samples at 5 kHz PRF. For phantoms prepared with 100% gas concentration, BC was achieved by 49 EFS pulses in 39.2% ± 4.7% of samples at 50 Hz PRF and 63.4% ± 15.3% of samples at 5 kHz. To show feasibility of using the EFS-BC method to ablate a large volume quickly, a 1000-foci EFS sequence covering a volume of approximately 27 ml was tested. Results indicate that the BC effect was similarly present. A treatment rate of 27 ± 6 ml min-1 was achieved, which is signficantly faster than standard histotripsy and ultrasound thermal ablation. This study demonstrates that histotripsy with EFS can achieve BC without employing a separate acoustic sequence which has the potential to accelerate large-volume ablation while minimizing energy deposition.
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Affiliation(s)
- Jonathan Lundt
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
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21
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Smolock AR, Cristescu MM, Vlaisavljevich E, Gendron-Fitzpatrick A, Green C, Cannata J, Ziemlewicz TJ, Lee FT. Robotically Assisted Sonic Therapy as a Noninvasive Nonthermal Ablation Modality: Proof of Concept in a Porcine Liver Model. Radiology 2018; 287:485-493. [DOI: 10.1148/radiol.2018171544] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda R. Smolock
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Mircea M. Cristescu
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Eli Vlaisavljevich
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Annette Gendron-Fitzpatrick
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Chelsey Green
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Jonathan Cannata
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Timothy J. Ziemlewicz
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
| | - Fred T. Lee
- From the Department of Radiology (A.R.S., M.M.C., T.J.Z., F.T.L.), Research Animal Resource Center (A.G.F.), Department of Statistics (C.G.), and Department of Biomedical Engineering (F.T.L.), University of Wisconsin, 600 Highland Ave, Madison, Wis 53792; Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, Va (E.V.); and HistoSonics, Ann Arbor, Mich (E.V., J.C.)
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22
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Zhang W, Tao H, Zeng J, Fang G, Liang B, Zhou L, Luo X, Shi J, Niu L. Laparotomy Cryoablation in Rabbit VX2 Pancreatic Carcinoma. Pancreas 2017; 46:288-295. [PMID: 28129233 DOI: 10.1097/mpa.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to establish a suitable rabbit model and select the optimal protocol for laparotomy cryoablation of pancreatic carcinoma. METHODS VX2 tumor tissues were inoculated into rabbit pancreases to build the pancreatic carcinoma model; then, the tumor-bearing rabbits were randomly divided into 4 groups: control, treatment A (the cryoablated-iceball diameter was bigger than the tumor), treatment B (iceball was as big as the tumor), and treatment C (iceball was smaller than the tumor). Related laboratory tests were conducted, and survival time was recorded. RESULTS The VX2 pancreatic carcinoma model was successfully established, and serum neuron-specific enolase levels increased continuously after inoculation. Compared with controls, rabbits in treatments A and C groups had no significant survival benefit (P > 0.05), but treatment B significantly prolonged the survival time (P < 0.01). CONCLUSIONS VX2 pancreatic cancer model was successfully established with neuron-specific enolase as biomarker. Treatment B may be the optimal protocol for pancreatic carcinoma and a new treatment option for patients with unresectable pancreatic cancer.
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Affiliation(s)
- Wenlong Zhang
- From the *Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun; and †Fuda Cancer Hospital, Jinan University School of Medicine (Guangzhou Fuda Cancer Hospital), and ‡Guangzhou Fuda Cancer Institute, Guangzhou, China
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Villemain O, Kwiecinski W, Bel A, Robin J, Bruneval P, Arnal B, Tanter M, Pernot M, Messas E. Pulsed cavitational ultrasound for non-invasive chordal cutting guided by real-time 3D echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1101-7. [DOI: 10.1093/ehjci/jew145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 04/10/2016] [Indexed: 01/12/2023] Open
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Wagstaff P, Ingels A, Zondervan P, de la Rosette JJMCH, Laguna MP. Thermal ablation in renal cell carcinoma management: a comprehensive review. Curr Opin Urol 2015; 24:474-82. [PMID: 25051022 DOI: 10.1097/mou.0000000000000084] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article provides an overview of recent developments in the field of thermal ablation for renal cell carcinoma and focuses on current standard techniques, new technologies, imaging for ablation guidance and evaluation, and future perspectives. RECENT FINDINGS Emerging long-term data on cryoablation and radiofrequency ablation (RFA) show marginally lower oncologic outcomes compared to surgical treatment, balanced by better functional and perioperative outcomes. Reports on residual disease vary widely, influenced by different definitions and strategies in determining ablation failure. Stratifying disease-free survival after RFA according to tumor size suggests 3 cm to be a reasonable cut off for RFA tumor selection. Microwave ablation and high-intensity focal ultrasound are modalities with the potential of creating localized high temperatures. However, difficulties in renal implementation are impairing sufficient ablation results. Irreversible electroporation, although not strictly thermal, is a new technology showing promising results in animal and early human research. SUMMARY Although high-level randomized controlled trials comparing thermal ablation techniques are lacking, evidence shows that thermal ablation for small renal masses is a safe procedure for both long-term oncologic and functional outcomes. Thermal ablation continues to be associated with a low risk of residual disease, for which candidates should be properly informed. RFA and cryoablation remain the standard techniques whereas alternative techniques require further studies.
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Affiliation(s)
- Peter Wagstaff
- Department of Urology, Academic Medical Center, Amsterdam, Netherlands *Peter Wagstaff and Alexandre Ingels contributed equally to the writing of this article
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Yuksel Durmaz Y, Vlaisavljevich E, Xu Z, ElSayed M. Development of Nanodroplets for Histotripsy-Mediated Cell Ablation. Mol Pharm 2014; 11:3684-95. [DOI: 10.1021/mp500419w] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Yasemin Yuksel Durmaz
- Department
of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Eli Vlaisavljevich
- Department
of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Zhen Xu
- Department
of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mohamed ElSayed
- Department
of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
- Macromolecular
Science and Engineering Program, University of Michigan, Ann Arbor, Michigan 48109, United States
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Abstract
PURPOSE OF REVIEW The aim of this article is to outline the initial development of histotripsy, a noninvasive image-guided focused ultrasound technology that mechanically homogenizes targeted tissues and to describe the results of preclinical translational research directed toward urologic applications. RECENT FINDINGS Histotripsy tissue ablation is based on initiation and control of acoustic cavitation at a target point within the body. This unique mechanical mechanism of action is distinct when compared with conventional thermal ablative modalities. Features of histotripsy (nonthermal, noninvasive, high precision, real-time monitoring/feedback, and tissue liquefaction) have prompted assessment of this technology as a potential ablative therapy for a number of organs and disease processes. SUMMARY Ongoing research efforts to apply histotripsy to preclinical models of benign prostatic hyperplasia, prostate cancer, renal masses, and renal calculi have resulted in enhanced understanding of cavitation bioeffects, refinement of treatment systems, strategies to enhance treatment efficiency, and initiation of a pilot human clinical trial to assess the safety of histotripsy for benign prostatic hyperplasia therapy.
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Wang TY, Hall TL, Xu Z, Fowlkes JB, Cain CA. Imaging feedback for histotripsy by characterizing dynamics of acoustic radiation force impulse (ARFI)-induced shear waves excited in a treated volume. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2014; 61:1137-1151. [PMID: 24960703 DOI: 10.1109/tuffc.2014.3013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Our previous study indicated that shear waves decay and propagate at a lower speed as they propagate into a tissue volume mechanically fractionated by histotripsy. In this paper, we hypothesize that the change in the shear dynamics is related to the degree of tissue fractionation, and can be used to predict histotripsy treatment outcomes. To test this hypothesis, lesions with different degrees of tissue fractionation were created in agar-graphite tissue phantoms and ex vivo kidneys with increasing numbers of therapy pulses, from 0 to 2000 pulses per treatment location. The therapy pulses were 3-cycle 750-kHz focused ultrasound delivered at a peak negative/positive pressure of 17/108 MPa and a repetition rate of 50 Hz. The shear waves were excited by acoustic radiation force impulse (ARFI) focused at the center of the lesion. The spatial and temporal behavior of the propagating shear waves was measured with ultrasound plane wave imaging. The temporal displacement profile at a lateral location 10 mm offset to the shear excitation region was detected with M-mode imaging. The decay and delay of the shear waves were quantitatively characterized on the temporal displacement profile. Results showed significant changes in two characteristics on the temporal displacement profile: the peak-to-peak displacement decayed exponentially with increasing numbers of therapy pulses; the relative time-to-peak displacement increased with increasing numbers of therapy pulses, and appeared to saturate at higher numbers of pulses. Correspondingly, the degree of tissues fractionation, as indicated by the percentage of structurally intact cell nuclei, decreased exponentially with increasing numbers of therapy pulses. Strong linear correlations were found between the two characteristics and the degree of tissue fractionation. These results suggest that the characteristics of the shear temporal displacement profile may provide useful feedback information regarding the treatment outcomes.
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