Comparison of analytical and numerical approaches for CT-based aberration correction in transcranial passive acoustic imaging

An efficient method for transcranial ultrasound focus correction based on the coupling of boundary integrals and finite elements

Transcranial focused ultrasound is a novel technique for the noninvasive treatment of brain diseases. The success of the treatment greatly depends on achieving precise and efficient intraoperative focus. However, compensating for aberrated ultrasound waves caused by the skull through numerical simulation-based phase corrections is a challenging task due to the significant computational burden involved in solving the acoustic wave equation. In this article, we propose a promising strategy using the coupling of the boundary integral equation method (BIEM) and the finite element method (FEM) to overcome the above limitation. Specifically, we adopt the BIEM to obtain the Robin-to-Dirichlet maps on the boundaries of the skull and then couple the maps to the FEM matrices via a dual interpolation technique, resulting in a computational domain including only the skull. Three simulation experiments were conducted to evaluate the effectiveness of the proposed method, including a convergence test and two skull-induced aberration corrections in 2D and 3D ultrasound. The results show that the method's convergence is guaranteed as the element size decreases, leading to a decrease in pressure error. The computation times for simulating a 500 kHz ultrasound field on a regular desktop computer were found to be 0.47 ± 0.01 s in the 2D case and 43.72 ± 1.49 s in the 3D case, provided that lower-upper decomposition (approximately 13 s in 2D and 2.5 h in 3D) was implemented in advance. We also demonstrated that more accurate transcranial focusing can be achieved by phase correction compared to the noncorrected results (with errors of 1.02 mm vs. 6.45 mm in 2D and 0.28 mm vs. 3.07 mm in 3D). The proposed strategy is valuable for enabling online ultrasound simulations during treatment, facilitating real-time adjustments and interventions.

Improving Sonication Efficiency in Transcranial MR-Guided Focused Ultrasound Treatment: A Patient-Data Simulation Study

The potential improvement in sonication efficiency achieved by tilting the focused ultrasound (FUS) transducer of the transcranial MR-guided FUS system is presented. A total of 56 cases of patient treatment data were used. The relative position of the clinical FUS transducer to the patient's head was reconstructed, and region-specific skull density and porosity were calculated based on the patient's CT volume image. The total transmission coefficient of acoustic waves emitted from each channel was calculated. Then, the total energy penetrating the human skull-which represents the sonication efficiency-was estimated. As a result, improved sonication efficiency was by titling the FUS transducer to a more appropriate angle achieved in all 56 treatment cases. This simulation result suggests the potential improvement in transcranial-focused ultrasound treatment by simply adjusting the transducer angle.

Aberration correction in abdominal histotripsy

In transabdominal histotripsy, ultrasound pulses are focused on the body to noninvasively destroy soft tissues via cavitation. However, the ability to focus is limited by phase aberration, or decorrelation of the ultrasound pulses due to spatial variation in the speed of sound throughout heterogeneous tissue. Phase aberration shifts, broadens, and weakens the focus, thereby reducing the safety and efficacy of histotripsy therapy. This paper reviews and discusses aberration effects in histotripsy and in related therapeutic ultrasound techniques (e.g., high intensity focused ultrasound), with an emphasis on aberration by soft tissues. Methods for aberration correction are reviewed and can be classified into two groups: model-based methods, which use segmented images of the tissue as input to an acoustic propagation model to predict and compensate phase differences, and signal-based methods, which use a receive-capable therapy array to detect phase differences by sensing acoustic signals backpropagating from the focus. The relative advantages and disadvantages of both groups of methods are discussed. Importantly, model-based methods can correct focal shift, while signal-based methods can restore substantial focal pressure, suggesting that both methods should be combined in a 2-step approach. Aberration correction will be critical to improving histotripsy treatments and expanding the histotripsy treatment envelope to enable non-invasive, non-thermal histotripsy therapy for more patients.

Real-Time Passive Acoustic Mapping With Enhanced Spatial Resolution in Neuronavigation-Guided Focused Ultrasound for Blood-Brain Barrier Opening

OBJECTIVE

Passive acoustic mapping (PAM) provides the spatial information of acoustic energy emitted from microbubbles during focused ultrasound (FUS), which can be used for safety and efficacy monitoring of blood-brain barrier (BBB) opening. In our previous work with a neuronavigation-guided FUS system, only part of the cavitation signal could be monitored in real time due to the computational burden although full-burst analysis is required to detect transient and stochastic cavitation activity. In addition, the spatial resolution of PAM can be limited for a small-aperture receiving array transducer. For full-burst real-time PAM with enhanced resolution, we developed a parallel processing scheme for coherence-factor-based PAM (CF-PAM) and implemented it onto the neuronavigation-guided FUS system using a co-axial phased-array imaging transducer.

METHODS

Simulation and in-vitro human skull studies were conducted for the performance evaluation of the proposed method in terms of spatial resolution and processing speed. We also carried out real-time cavitation mapping during BBB opening in non-human primates (NHPs).

RESULTS

CF-PAM with the proposed processing scheme provided better resolution than that of traditional time-exposure-acoustics PAM with a higher processing speed than that of eigenspace-based robust Capon beamformer, which facilitated the full-burst PAM with the integration time of 10 ms at a rate of 2 Hz. In vivo feasibility of PAM with the co-axial imaging transducer was also demonstrated in two NHPs, showing the advantages of using real-time B-mode and full-burst PAM for accurate targeting and safe treatment monitoring.

SIGNIFICANCE

This full-burst PAM with enhanced resolution will facilitate the clinical translation of online cavitation monitoring for safe and efficient BBB opening.

Acoustoelectric Time-Reversal for Ultrasound Phase-Aberration Correction

Acoustoelectric imaging (AEI) is a technique that combines ultrasound (US) with radio frequency recording to detect and map local current source densities. This study demonstrates a new method called acoustoelectric time reversal (AETR), which uses AEI of a small current source to correct for phase aberrations through a skull or other US-aberrating layers with applications to brain imaging and therapy. Simulations conducted at three different US frequencies (0.5, 1.5, and 2.5 MHz) were performed through media layered with different sound speeds and geometries to induce aberrations of the US beam. Time delays of the acoustoelectric (AE) signal from a monopole within the medium were calculated for each element to enable corrections using AETR. Uncorrected aberrated beam profiles were compared with those after applying AETR corrections, which demonstrated a strong recovery (29%-100%) of lateral resolution and increases in focal pressure up to 283%. To further demonstrate the practical feasibility of AETR, we further conducted bench-top experiments using a 2.5 MHz linear US array to perform AETR through 3-D-printed aberrating objects. These experiments restored lost lateral restoration up to 100% for the different aberrators and increased focal pressure up to 230% after applying AETR corrections. Cumulatively, these results highlight AETR as a powerful tool for correcting focal aberrations in the presence of a local current source with applications to AEI, US imaging, neuromodulation, and therapy.

Optimizing transcranial ultrasound delivery at large incident angles by leveraging cranial leaky guided wave dispersion

We investigate the role of leaky guided waves in transcranial ultrasound transmission in temporal and parietal bones at large incidence angles. Our numerical and experimental results show that the dispersion characteristics of the fundamental leaky guided wave mode with longitudinal polarization can be leveraged to estimate the critical angle above which efficient shear mode conversion takes place, and below which major transmission drops can be expected. Simulations that employ a numerical propagator matrix and a Semi-Analytical approach establish the transcranial dispersion characteristics and transmission coefficients at different incident angles. Experimental transmission tests conducted at 500 kHz and radiation tests performed in the 200-800 kHz range confirm the numerical findings in terms of transmitted peak pressure and frequency-radiation angle spectra, based on which the connection between critical angles, dispersion and transmission is demonstrated. Our results support the identification of transcranial ultrasound strategies that leverage shear mode conversion, which is less sensitive to phase aberrations compared to normal incidence ultrasound. These findings can also enable higher transmission rates in cranial bones with low porosity by leveraging dispersion information extracted through signal processing, without requiring measurement of geometric and mechanical properties of the cranial bone.

Comparison between MR and CT imaging used to correct for skull-induced phase aberrations during transcranial focused ultrasound

Transcranial focused ultrasound with the InSightec Exablate system uses thermal ablation for the treatment of movement and mood disorders and blood brain barrier disruption for tumor therapy. The system uses computed tomography (CT) images to calculate phase corrections that account for aberrations caused by the human skull. This work investigates whether magnetic resonance (MR) images can be used as an alternative to CT images to calculate phase corrections. Phase corrections were calculated using the gold standard hydrophone method and the standard of care InSightec ray tracing method. MR binary image mask, MR-simulated-CT (MRsimCT), and CT images of three ex vivo human skulls were supplied as inputs to the InSightec ray tracing method. The degassed ex vivo human skulls were sonicated with a 670 kHz hemispherical phased array transducer (InSightec Exablate 4000). 3D raster scans of the beam profiles were acquired using a hydrophone mounted on a 3-axis positioner system. Focal spots were evaluated using six metrics: pressure at the target, peak pressure, intensity at the target, peak intensity, positioning error, and focal spot volume. Targets at the geometric focus and 5 mm lateral to the geometric focus were investigated. There was no statistical difference between any of the metrics at either target using either MRsimCT or CT for phase aberration correction. As opposed to the MRsimCT, the use of CT images for aberration correction requires registration to the treatment day MR images; CT misregistration within a range of ± 2 degrees of rotation error along three dimensions was shown to reduce focal spot intensity by up to 9.4%. MRsimCT images used for phase aberration correction for the skull produce similar results as CT-based correction, while avoiding both CT to MR registration errors and unnecessary patient exposure to ionizing radiation.

Effects of phase aberration on transabdominal focusing for a large aperture, lowf-number histotripsy transducer

Objective. Soft tissue phase aberration may be particularly severe for histotripsy due to large aperture and lowf-number transducer geometries. This study investigated how phase aberration from human abdominal tissue affects focusing of a large, strongly curved histotripsy transducer.Approach.A computational model (k-Wave) was experimentally validated withex vivoporcine abdominal tissue and used to simulate focusing a histotripsy transducer (radius: 14.2 cm,f-number: 0.62, central frequencyfc: 750 kHz) through the human abdomen. Abdominal computed tomography images from 10 human subjects were segmented to create three-dimensional acoustic property maps. Simulations were performed focusing at 3 target locations in the liver of each subject with ideal phase correction, without phase correction, and after separately matching the sound speed of water and fat to non-fat soft tissue.Main results.Experimental validation in porcine abdominal tissue showed that simulated and measured arrival time differences agreed well (average error, ∼0.10 acoustic cycles atfc). In simulations with human tissue, aberration created arrival time differences of 0.65μs (∼0.5 cycles) at the target and shifted the focus from the target by 6.8 mm (6.4 mm pre-focally along depth direction), on average. Ideal phase correction increased maximum pressure amplitude by 95%, on average. Matching the sound speed of water and fat to non-fat soft tissue decreased the average pre-focal shift by 3.6 and 0.5 mm and increased pressure amplitude by 2% and 69%, respectively.Significance.Soft tissue phase aberration of large aperture, lowf-number histotripsy transducers is substantial despite low therapeutic frequencies. Phase correction could potentially recover substantial pressure amplitude for transabdominal histotripsy. Additionally, different heterogeneity sources distinctly affect focusing quality. The water path strongly affects the focal shift, while irregular tissue boundaries (e.g. fat) dominate pressure loss.

Two-step aberration correction: application to transcranial histotripsy

Objective: Phase aberration correction is essential in transcranial histotripsy to compensate for focal distortion caused by the heterogeneity of the intact skull bone. This paper improves the 2-step aberration correction (AC) method that has been previously presented and develops an AC workflow that fits in the clinical environment, in which the computed tomography (CT)-based analytical approach was first implemented, followed by a cavitation-based approach using the shockwaves from the acoustic cavitation emission (ACE).Approach:A 700 kHz, 360-element hemispherical transducer array capable of transmit-and-receive on all channels was used to transcranially generate histotripsy-induced cavitation and acquire ACE shockwaves. For CT-AC, two ray-tracing models were investigated: a forward ray-tracing model (transducer-to-focus) in the open-source software Kranion, and an in-house backward ray-tracing model (focus-to-transducer) accounting for refraction and the sound speed variation in skulls. Co-registration was achieved by aligning the skull CT data to the skull surface map reconstructed using the acoustic pulse-echo method. For ACE-AC, the ACE signals from the collapses of generated bubbles were aligned by cross-correlation to estimate the corresponding time delays.Main results:The performance of the 2-step method was tested with 3 excised human calvariums placed at 2 different locations in the transducer array. Results showed that the 2-step AC achieved 90 ± 7% peak focal pressure compared to the gold standard hydrophone correction. It also reduced the focal shift from 0.84 to 0.30 mm and the focal volume from 10.6 to 2.0 mm3on average compared to the no AC cases.Significance:The 2-step AC yielded better refocusing compared to either CT-AC or ACE-AC alone and can be implemented in real-time for transcranial histotripsy brain therapy.

Ultrasound stimulation of the motor cortex during tonic muscle contraction

Transcranial ultrasound stimulation (tUS) shows potential as a noninvasive brain stimulation (NIBS) technique, offering increased spatial precision compared to other NIBS techniques. However, its reported effects on primary motor cortex (M1) are limited. We aimed to better understand tUS effects in human M1 by performing tUS of the hand area of M1 (M1hand) during tonic muscle contraction of the index finger. Stimulation during muscle contraction was chosen because of the transcranial magnetic stimulation-induced phenomenon known as cortical silent period (cSP), in which transcranial magnetic stimulation (TMS) of M1hand involuntarily suppresses voluntary motor activity. Since cSP is widely considered an inhibitory phenomenon, it presents an ideal parallel for tUS, which has often been proposed to preferentially influence inhibitory interneurons. Recording electromyography (EMG) of the first dorsal interosseous (FDI) muscle, we investigated effects on muscle activity both during and after tUS. We found no change in FDI EMG activity concurrent with tUS stimulation. Using single-pulse TMS, we found no difference in M1 excitability before versus after sparsely repetitive tUS exposure. Using acoustic simulations in models made from structural MRI of the participants that matched the experimental setups, we estimated in-brain pressures and generated an estimate of cumulative tUS exposure experienced by M1hand for each subject. We were unable to find any correlation between cumulative M1hand exposure and M1 excitability change. We also present data that suggest a TMS-induced MEP always preceded a near-threshold cSP.

Experimental Demonstration of Trans-Skull Volumetric Passive Acoustic Mapping With the Heterogeneous Angular Spectrum Approach

Real-time, 3-D, passive acoustic mapping (PAM) of microbubble dynamics during transcranial focused ultrasound (FUS) is essential for optimal treatment outcomes. The angular spectrum approach (ASA) potentially offers a very efficient method to perform PAM, as it can reconstruct specific frequency bands pertinent to microbubble dynamics and may be extended to correct aberrations caused by the skull. Here, we experimentally assess the abilities of heterogeneous ASA (HASA) to perform trans-skull PAM. Our experimental investigations demonstrate that the 3-D PAMs of a known 1-MHz source, constructed with HASA through an ex vivo human skull segment, reduced both the localization error (from 4.7 ± 2.3 to 2.3 ± 1.6 mm) and the number, size, and energy of spurious lobes caused by aberration, with the modest additional computational expense. While further improvements in the localization errors are expected with arrays with denser elements and larger aperture, our analysis revealed that experimental constraints associated with the array pitch and aperture (here, 1.8 mm and 2.5 cm, respectively) can be ameliorated by interpolation and peak finding techniques. Beyond the array characteristics, our analysis also indicated that errors in the registration (translation and rotation of ±5 mm and ±5°, respectively) of the skull segment to the array can lead to peak localization errors of the order of a few wavelengths. Interestingly, errors in the spatially dependent speed of sound in the skull (±20%) caused only subwavelength errors in the reconstructions, suggesting that registration is the most important determinant of point source localization accuracy. Collectively, our findings show that HASA can address source localization problems through the skull efficiently and accurately under realistic conditions, thereby creating unique opportunities for imaging and controlling the microbubble dynamics in the brain.

Transcranial Magnetic Resonance-Guided Histotripsy for Brain Surgery: Pre-clinical Investigation

Histotripsy has been previously applied to target various cranial locations in vitro through an excised human skull. Recently, a transcranial magnetic resonance (MR)-guided histotripsy (tcMRgHt) system was developed, enabling pre-clinical investigations of tcMRgHt for brain surgery. To determine the feasibility of in vivo transcranial histotripsy, tcMRgHt treatment was delivered to eight pigs using a 700-kHz, 128-element, MR-compatible phased-array transducer inside a 3-T magnetic resonance imaging (MRI) scanner. After craniotomy to open an acoustic window to the brain, histotripsy was applied through an excised human calvarium to target the inside of the pig brain based on pre-treatment MRI and fiducial markers. MR images were acquired pre-treatment, immediately post-treatment and 2-4 h post-treatment to evaluate the acute treatment outcome. Successful histotripsy ablation was observed in all pigs. The MR-evident lesions were well confined within the targeted volume, without evidence of excessive brain edema or hemorrhage outside of the target zone. Histology revealed tissue homogenization in the ablation zones with a sharp demarcation between destroyed and unaffected tissue, which correlated well with the radiographic treatment zones on MRI. These results are the first to support the in vivo feasibility of tcMRgHt in the pig brain, enabling further investigation of the use of tcMRgHt for brain surgery.

Towards controlled drug delivery in brain tumors with microbubble-enhanced focused ultrasound

Brain tumors are particularly challenging malignancies, due to their location in a structurally and functionally distinct part of the human body - the central nervous system (CNS). The CNS is separated and protected by a unique system of brain and blood vessel cells which together prevent most bloodborne therapeutics from entering the brain tumor microenvironment (TME). Recently, great strides have been made through microbubble (MB) ultrasound contrast agents in conjunction with ultrasound energy to locally increase the permeability of brain vessels and modulate the brain TME. As we elaborate in this review, this physical method can effectively deliver a wide range of anticancer agents, including chemotherapeutics, antibodies, and nanoparticle drug conjugates across a range of preclinical brain tumors, including high grade glioma (glioblastoma), diffuse intrinsic pontine gliomas, and brain metastasis. Moreover, recent evidence suggests that this technology can promote the effective delivery of novel immunotherapeutic agents, including immune check-point inhibitors and chimeric antigen receptor T cells, among others. With early clinical studies demonstrating safety, and several Phase I/II trials testing the preclinical findings underway, this technology is making firm steps towards shaping the future treatments of primary and metastatic brain cancer. By elaborating on its key components, including ultrasound systems and MB technology, along with methods for closed-loop spatial and temporal control of MB activity, we highlight how this technology can be tuned to enable new, personalized treatment strategies for primary brain malignancies and brain metastases.

Transcranial MR-Guided Histotripsy System

Histotripsy has been previously shown to treat a wide range of locations through excised human skulls in vitro. In this article, a transcranial magnetic resonance (MR)-guided histotripsy (tcMRgHt) system was developed, characterized, and tested in the in vivo pig brain through an excised human skull. A 700-kHz, 128-element MR-compatible phased-array ultrasound transducer with a focal depth of 15 cm was designed and fabricated in-house. Support structures were also constructed to facilitate transcranial treatment. The tcMRgHt array was acoustically characterized with a peak negative pressure up to 137 MPa in free field, 72 MPa through an excised human skull with aberration correction, and 48.4 MPa without aberration correction. The electronic focal steering range through the skull was 33.5 mm laterally and 50 mm axially, where a peak negative pressure above the 26-MPa cavitation intrinsic threshold can be achieved. The MR compatibility of the tcMRgHt system was assessed quantitatively using SNR, B0 field map, and B1 field map in a clinical 3T magnetic resonance imaging (MRI) scanner. Transcranial treatment using electronic focal steering was validated in red blood cell phantoms and in vivo pig brain through an excised human skull. In two pigs, targeted cerebral tissue was successfully treated through the human skull as confirmed by MRI. Excessive bleeding or edema was not observed in the peri-target zones by the time of pig euthanasia. These results demonstrated the feasibility of using this preclinical tcMRgHt system for in vivo transcranial treatment in a swine model.

Comparison Between Ray-Tracing and Full-Wave Simulation for Transcranial Ultrasound Focusing on a Clinical System Using the Transfer Matrix Formalism

Only one high-intensity focused ultrasound device has been clinically approved for transcranial brain surgery at the time of writing. The device operates within 650 and 720 kHz and corrects the phase distortions induced by the skull of each patient using a multielement phased array. Phase correction is estimated adaptively using a proprietary algorithm based on computed-tomography (CT) images of the patient's skull. In this article, we assess the performance of the phase correction computed by the clinical device and compare it to: 1) the correction obtained with a previously validated full-wave simulation algorithm using an open-source pseudo-spectral toolbox and 2) a hydrophone-based correction performed invasively to measure the aberrations induced by the skull at 650 kHz. For the full-wave simulation, three different mappings between CT Hounsfield units and the longitudinal speed of sound inside the skull were tested. All methods are compared with the exact same setup due to transfer matrices acquired with the clinical system for N = 5 skulls and T = 2 different targets for each skull. We show that the clinical ray-tracing software and the full-wave simulation restore, respectively, 84% ± 5% and 86% ± 5% of the pressure obtained with hydrophone-based correction for targets located in central brain regions. On the second target (off-center), we also report that the performance of both algorithms degrades when the average incident angles of the acoustic beam at the skull surface increase. When incident angles are higher than 20°, the restored pressure drops below 75% of the pressure restored with hydrophone-based correction.

Transcranial focused ultrasound phase correction using the hybrid angular spectrum method

The InSightec Exablate system is the standard of care used for transcranial focused ultrasound ablation treatments in the United States. The system calculates phase corrections that account for aberrations caused by the human skull. This work investigates whether skull aberration correction can be improved by comparing the standard of care InSightec ray tracing method with the hybrid angular spectrum (HAS) method and the gold standard hydrophone method. Three degassed ex vivo human skulls were sonicated with a 670 kHz hemispherical phased array transducer (InSightec Exablate 4000). Phase corrections were calculated using four different methods (straight ray tracing, InSightec ray tracing, HAS, and hydrophone) and were used to drive the transducer. 3D raster scans of the beam profiles were acquired using a hydrophone mounted on a 3-axis positioner system. Focal spots were evaluated using six metrics: pressure at the target, peak pressure, intensity at the target, peak intensity, positioning error, and focal spot volume. For three skulls, the InSightec ray tracing method achieved 52 ± 21% normalized target intensity (normalized to hydrophone), 76 ± 17% normalized peak intensity, and 0.72 ± 0.47 mm positioning error. The HAS method achieved 74 ± 9% normalized target intensity, 81 ± 9% normalized peak intensity, and 0.35 ± 0.09 mm positioning error. The InSightec-to-HAS improvement in focal spot targeting provides promise in improving treatment outcomes. These improvements to skull aberration correction are also highly relevant for the applications of focused ultrasound neuromodulation and blood brain barrier opening, which are currently being translated for human use.

Design of a Versatile Angle-Rotatable Skull-Shaped Conformal Transcranial Focused Ultrasound Transducer for Noninvasive Brain Therapy

Phase-controlled focused ultrasound transducers have opened up a new way to noninvasively treat brain diseases. However, due to the geometry and the heterogeneous medium of the human skull, the currently used hemispherical transducers cannot guarantee that the ultrasound emitted by the transducer penetrates the skull normally; consequently, the impact of the shear wave on the treatment area has to be considered. The usual approach is to turn off elements in the transducer with excessively large incident angles, but this approach reduces the efficiency of the transducer. This article presents the design of a novel transducer that can be rotated according to the different geometric shapes of the skull. The incident angles of the elements in the transducer are modified so that the effect of the shear wave on the treatment area can be ignored and the efficiency of the transducer is improved. The results of computed tomography (CT) model simulation of nine skulls verify the versatility and feasibility of the new transducer. We believe that this kind of rotatable transducer has clinical and engineering significance.

Real-Time Passive Acoustic Mapping Using Sparse Matrix Multiplication

Passive acoustic mapping enables the spatiotemporal monitoring of cavitation with circulating microbubbles during focused ultrasound (FUS)-mediated blood-brain barrier opening. However, the computational load for processing large data sets of cavitation maps or more complex algorithms limit the visualization in real-time for treatment monitoring and adjustment. In this study, we implemented a graphical processing unit (GPU)-accelerated sparse matrix-based beamforming and time exposure acoustics in a neuronavigation-guided ultrasound system for real-time spatiotemporal monitoring of cavitation. The system performance was tested in silico through benchmarking, in vitro using nonhuman primate (NHP) and human skull specimens, and demonstrated in vivo in NHPs. We demonstrated the stability of the cavitation map for integration times longer than 62.5 [Formula: see text]. A compromise between real-time displaying and cavitation map quality obtained from beamformed RF data sets with a size of 2000 ×128 ×30 (axial [Formula: see text]) was achieved for an integration time of [Formula: see text], which required a computational time of 0.27 s (frame rate of 3.7 Hz) and could be displayed in real-time between pulses at PRF = 2 Hz. Our benchmarking tests show that the GPU sparse-matrix algorithm processed the RF data set at a computational rate of [Formula: see text]/pixel/sample, which enables adjusting the frame rate and the integration time as needed. The neuronavigation system with real-time implementation of cavitation mapping facilitated the localization of the cavitation activity and helped to identify distortions due to FUS phase aberration. The in vivo test of the method demonstrated the feasibility of GPU-accelerated sparse matrix computing in a close to a clinical condition, where focus distortions exemplify problems during treatment. These experimental conditions show the need for spatiotemporal monitoring of cavitation with real-time capability that enables the operator to correct or halt the sonication in case substantial aberrations are observed.

An efficient and accurate parallel hybrid acoustic signal correction method for transcranial ultrasound

Phased-control focused ultrasound transducers provide a new and noninvasive treatment method for brain disease. However, improving the accuracy of phase correction and reducing the calculation time during treatment have always been contradictory constraints. In this paper, a hybrid acoustic signal correction (HASC) method combined with k-Wave stage and holography stage was introduced for phase correction and simulation of transcranial focused ultrasound. The k-Wave stage is mainly used to calculate the sound field in a heterogeneous medium (skull), which divides the sound field calculation process into paths that can be calculated in parallel, and the transcranial correction phase can also be obtained during the calculation. The holography stage is sufficient to simulate the acoustic field in the homogenous intracranial medium after ultrasound transmitting through the skull. The agreement of the k-space corrected pseudospectral time domain method and HASC method was assessed by statistical methods: linear regression between the two methods provided a slope of 0.9735, intercept of 0.0078, and R ² of 0.9982. The Bland-Altman method provided a bias of 0.0015 and 95% limits of agreement 0.065 apart. We demonstrated that the difference in sound intensity at the focal point corrected by HASC and time reversal phase correction method was 0.2% and 0.5% in the results of simulation and experiment, respectively. Not only that, the phase calculation time by the HASC phase correction method can be reduced to 11 min on a multi GPU array, which has clinical potential for ultrasound treatment of brain therapy.

Echo-Focusing in Transcranial Focused Ultrasound Thalamotomy for Essential Tremor: A Feasibility Study

BACKGROUND

Transcranial magnetic resonance-guided focused ultrasound (TcMRgFUS) systems currently employ computed tomography (CT)-based aberration corrections, which may provide suboptimal trans-skull focusing.

OBJECTIVES

The objective of this study was to evaluate a contrast agent microbubble imaging-based transcranial focusing method, echo-focusing (EF), during TcMRgFUS for essential tremor.

METHODS

A clinical trial of TcMRgFUS thalamotomy using EF for the treatment of essential tremor was conducted (NCT03935581; funded by InSightec [Tirat Carmel, Israel]). Patients (n = 12) were injected with Definity (Lantheus Medical Imaging, North Billerica, MA) microbubbles, and EF was performed using a research feature add-on to a commercial TcMRgFUS system (ExAblate Neuro, InSightec). Subablative thermal sonications carried out using (1) EF and (2) CT-based aberration corrections were compared via magnetic resonance thermometry, and the optimal focusing method for each patient was employed for TcMRgFUS thalamotomy.

RESULTS

EF aberration corrections provided increased sonication efficiency, decreased focal size, and equivalent targeting accuracy relative to CT-based focusing. EF aberration corrections were employed successfully for lesion formation in all 12 patients, 3 of whom had previously undergone unsuccessful TcMRgFUS thalamotomy via CT-based focusing. There were no adverse events related directly to the EF procedure.

CONCLUSIONS

EF is feasible and appears safe during TcMRgFUS thalamotomy for essential tremor and improves on the trans-skull focal quality provided by existing CT-based focusing methods. © 2020 International Parkinson and Movement Disorder Society.

An open-source phase correction toolkit for transcranial focused ultrasound

BACKGROUND

The phase correction on transcranial focused ultrasound is essential to regulate unwanted focal point shift caused by skull bone aberration. The aim of the current study was to design and investigate the feasibility of a ray-based phase correction toolkit for transcranial focused ultrasound.

RESULTS

The peak pressure at focal area was improved by 140.5 ± 7.0% on target I and 134.8 ± 19.1% on target II using proposed phase correction toolkit, respectively. A total computation time of 402.1 ± 24.5 milliseconds was achieved for each sonication.

CONCLUSION

The designed ray-based phase correction software can be used as a lightweight toolkit to compensate aberrated phase within clinical environment.

Heterogeneous Angular Spectrum Method for Trans-Skull Imaging and Focusing

Ultrasound, alone or in concert with circulating microbubble contrast agents, has emerged as a promising modality for therapy and imaging of brain diseases. While this has become possible due to advancements in aberration correction methods, a range of applications, including adaptive focusing and tracking of the microbubble dynamics through the human skull, may benefit from even more computationally efficient methods to account for skull aberrations. Here, we derive a general method for the angular spectrum approach (ASA) in a heterogeneous medium, based on a numerical marching scheme to approximate the full implicit solution. We then demonstrate its functionality with simulations for (human) skull-related aberration correction and trans-skull passive acoustic mapping. Our simulations show that the general solution provides accurate trans-skull focusing as compared to the uncorrected case (error in focal point location of 1.0 ± 0.4 mm vs 2.2 ± 0.7 mm) for clinically relevant frequencies (0.25-1.5MHz), apertures (50-100 mm), and targets, with peak focal pressures approximately 30 ± 17% of the free field case, with the effects of skull attenuation and amplitude shading included. In the case of source localization, our method leads to an average of 75% error reduction (from 2.9 ± 1.8 mm to 0.7 ± 0.5 mm) and 40-60% increase in peak intensity, evaluated over the range of frequencies (0.4-1.2 MHz), apertures (50-100 mm), and point source locations (40 mm by 50 mm grid) as compared to the homogeneous medium ASA. Overall, total computation times for both focusing and point source localization of the order milliseconds (166 ± 37 ms, compared with 44 ± 4 ms for the homogeneous ASA formulation) can be attained with this approach. Collectively our findings indicate that the proposed phase correction method based on the ASA could provide a computationally efficient and accurate method for trans-skull transmit focusing and imaging of point scatterers, potentially opening new possibilities for treatment and diagnosis of brain diseases.

A Noninvasive Ultrasound Resonance Method for Detecting Skull Induced Phase Shifts May Provide a Signal for Adaptive Focusing

OBJECTIVE

There may be a need to perform dynamic skull aberration corrections during the non-invasive high-intensity transcranial treatment with magnetic resonance imaging (MRI) -guided focused ultrasound in order to accurately and rapidly restore the focus in the brain.

METHODS

This could possibly be accomplished by using an ultrasound-based correction method based on the skulls' thickness resonance frequencies. The focus of a 500 kHz transducer was centered in the ex vivo human skull caps at different temperatures. The pulse-echoed signals reflected from the skulls were analyzed in the frequency domain to reveal the resonance frequencies for the phase shift calculation. The accuracy was compared to both hydrophone and computed tomography (CT) based analytical methods.

RESULTS

Around 73% of the measurements (n = 784) were in the optimal constructive interference region, with a 15° decrease in the average phase error compared to the previous study. In the best implementation, it performed approximately the same or better than the CT based analytical method currently in clinical use. Linear correlation was found between the resonance frequencies or skull induced phase shifts and the skull temperature with an average rate of -0.4 kHz/°C and 2.6 deg/°C, respectively.

CONCLUSION

The ultrasound based resonance method has shown the feasibility of detecting heating-induced changes of skull phase shift non-invasively and accurately.

SIGNIFICANCE

Since the technique can be made MRI compatible and integrated in the therapy arrays, it may enable temperature tracking and adaptive focusing during high-intensity transcranial ultrasound treatments, to prevent skull overheating and preserve the transcranial focusing integrity.

A rapid beam simulation framework for transcranial focused ultrasound

Transcranial focused ultrasound is a non-invasive therapeutic modality that can be used to treat essential tremor. Beams of energy are focused into a small spot in the thalamus, resulting in tissue heating and ablation. Here, we report on a rapid 3D numeric simulation framework that can be used to predict focal spot characteristics prior to the application of ultrasound. By comparing with magnetic resonance proton resonance frequency shift thermometry (MR thermometry) data acquired during treatments of essential tremor, we verified that our simulation framework can be used to predict focal spot position, and with patient-specific calibration, predict focal spot temperature rise. Preliminary data suggests that lateral smearing of the focal spot can be simulated. The framework may also be relevant for other therapeutic ultrasound applications such as blood brain barrier opening and neuromodulation.

Advances in acoustic monitoring and control of focused ultrasound-mediated increases in blood-brain barrier permeability

Transcranial focused ultrasound (FUS) combined with intravenously circulating microbubbles can transiently and selectively increase blood-brain barrier permeability to enable targeted drug delivery to the central nervous system, and is a technique that has the potential to revolutionize the way neurological diseases are managed in medical practice. Clinical testing of this approach is currently underway in patients with brain tumors, early Alzheimer's disease, and amyotrophic lateral sclerosis. A major challenge that needs to be addressed in order for widespread clinical adoption of FUS-mediated blood-brain barrier permeabilization to occur is the development of systems and methods for real-time treatment monitoring and control, to ensure that safe and effective acoustic exposure levels are maintained throughout the procedures. This review gives a basic overview of the oscillation dynamics, acoustic emissions, and biological effects associated with ultrasound-stimulated microbubbles in vivo, and provides a summary of recent advances in acoustic-based strategies for detecting, controlling, and mapping microbubble activity in the brain. Further development of next-generation clinical FUS brain devices tailored towards microbubble-mediated applications is warranted and required for translation of this potentially disruptive technology into routine clinical practice.

Receiver array design for sonothrombolysis treatment monitoring in deep vein thrombosis

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.

Simulating transvertebral ultrasound propagation with a multi-layered ray acoustics model

The simulation accuracy of transvertebral ultrasound propagation using a multi-layered ray acoustics model based on CT-derived vertebral geometry was investigated through comparison with experimental measurements of pressure fields in ex vivo human vertebral foramen. A spherically focused transducer (5 cm diameter, f-number 1.2, 514 kHz) was geometrically focused to the centre of individual thoracic vertebral foramen, through the posterior bony elements. Transducer propagation paths through the laminae and the spinous processes were tested. Simulation transducer-vertebra configurations were registered to experiment transducer-vertebra configurations, and simulation accuracy of the simulation model was evaluated for predicting maximum transmitted pressure to the canal, voxel pressure in the canal, and focal distortion. Accuracy in predicting maximum transmitted pressure was calculated by vertebra, and it is shown that simulation predicts maximum pressure with a greater degree of accuracy than a vertebra-specific insertion loss. Simulation error in voxel pressure was evaluated using root-mean-square error and cross-correlation, and found to be similar to the water-only case. Simulation accuracy in predicting focal distortion was evaluated by comparing experiment and simulation maximum pressure location and weighted  >50% focal volume location. Average simulation error across all measurements and simulations in maximum pressure location and weighted  >50% focal volume location were 2.3 mm and 1.5 mm, respectively. These errors are small relative to the dimensions of the transducer focus (4.9 mm full width half maximum), the spinal cord (10 mm diameter), and vertebral canal diameter (15-20 mm diameter). These results suggest that ray acoustics can be applied to simulating transvertebral ultrasound propagation.

Three-dimensional transcranial microbubble imaging for guiding volumetric ultrasound-mediated blood-brain barrier opening

Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening recently entered clinical testing for targeted drug delivery to the brain. Sources of variability exist in the current procedures, motivating the development of real-time monitoring and control techniques to improve treatment safety and efficacy. Here we used three-dimensional (3D) transcranial microbubble imaging to calibrate FUS exposure levels for volumetric BBB opening.

Methods: Using a sparse hemispherical transmit/receive ultrasound phased array, pulsed ultrasound was focused transcranially into the thalamus of rabbits during microbubble infusion and multi-channel 3D beamforming was performed online with receiver signals captured at the subharmonic frequency. Pressures were increased pulse-by-pulse until subharmonic activity was detected on acoustic imaging (p_sub), and tissue volumes surrounding the calibration point were exposed at 50-100%p_sub via rapid electronic beam steering.

Results: Spatially-coherent subharmonic microbubble activity was successfully reconstructed transcranially in vivo during calibration sonications. Multi-point exposures induced volumetric regions of elevated BBB permeability assessed via contrast-enhanced magnetic resonance imaging (MRI). At exposure levels ≥75%p_sub, MRI and histological examination occasionally revealed tissue damage, whereas sonications at 50%p_sub were performed safely. Substantial intra-grid variability of FUS-induced bioeffects was observed via MRI, prompting future development of multi-point calibration schemes for improved treatment consistency. Receiver array sparsity and sensor configuration had substantial impacts on subharmonic detection sensitivity, and are factors that should be considered when designing next-generation clinical FUS brain therapy systems.

Conclusion: Our findings suggest that 3D subharmonic imaging can be used to calibrate exposure levels for safe FUS-induced volumetric BBB opening, and should be explored further as a method for cavitation-mediated treatment guidance.

Catheter Hydrophone Aberration Correction for Transcranial Histotripsy Treatment of Intracerebral Hemorrhage: Proof-of-Concept

Histotripsy is a minimally invasive ultrasound therapy that has shown rapid liquefaction of blood clots through human skullcaps in an in vitro intracerebral hemorrhage model. However, the efficiency of these treatments can be compromised if the skull-induced aberrations are uncorrected. We have developed a catheter hydrophone which can perform aberration correction (AC) and drain the liquefied clot following histotripsy treatment. Histotripsy pulses were delivered through an excised human skullcap using a 256-element, 500-kHz hemisphere array transducer with a 15-cm focal distance. A custom hydrophone was fabricated using a mm PZT-5h crystal interfaced to a coaxial cable and integrated into a drainage catheter. An AC algorithm was developed to correct the aberrations introduced between histotripsy pulses from each array element. An increase in focal pressure of up to 60% was achieved at the geometric focus and 27%-62% across a range of electronic steering locations. The sagittal and axial -6-dB beam widths decreased from 4.6 to 2.2 mm in the sagittal direction and 8 to 4.4 mm in the axial direction, compared to 1.5 and 3 mm in the absence of aberration. After performing AC, lesions with diameters ranging from 0.24 to 1.35 mm were generated using electronic steering over a mm grid in a tissue-mimicking phantom. An average volume of 4.07 ± 0.91 mL was liquefied and drained after using electronic steering to treat a 4.2-mL spherical volume in in vitro bovine clots through the skullcap.

Accurate simulation of transcranial ultrasound propagation for ultrasonic neuromodulation and stimulation

Non-invasive, focal neurostimulation with ultrasound is a potentially powerful neuroscientific tool that requires effective transcranial focusing of ultrasound to develop. Time-reversal (TR) focusing using numerical simulations of transcranial ultrasound propagation can correct for the effect of the skull, but relies on accurate simulations. Here, focusing requirements for ultrasonic neurostimulation are established through a review of previously employed ultrasonic parameters, and consideration of deep brain targets. The specific limitations of finite-difference time domain (FDTD) and k-space corrected pseudospectral time domain (PSTD) schemes are tested numerically to establish the spatial points per wavelength and temporal points per period needed to achieve the desired accuracy while minimizing the computational burden. These criteria are confirmed through convergence testing of a fully simulated TR protocol using a virtual skull. The k-space PSTD scheme performed as well as, or better than, the widely used FDTD scheme across all individual error tests and in the convergence of large scale models, recommending it for use in simulated TR. Staircasing was shown to be the most serious source of error. Convergence testing indicated that higher sampling is required to achieve fine control of the pressure amplitude at the target than is needed for accurate spatial targeting.

Quantitative Frequency-Domain Passive Cavitation Imaging

Passive cavitation detection has been an instrumental technique for measuring cavitation dynamics, elucidating concomitant bioeffects, and guiding ultrasound therapies. Recently, techniques have been developed to create images of cavitation activity to provide investigators with a more complete set of information. These techniques use arrays to record and subsequently beamform received cavitation emissions, rather than processing emissions received on a single-element transducer. In this paper, the methods for performing frequency-domain delay, sum, and integrate passive imaging are outlined. The method can be applied to any passively acquired acoustic scattering or emissions, including cavitation emissions. To compare data across different systems, techniques for normalizing Fourier transformed data and converting the data to the acoustic energy received by the array are described. A discussion of hardware requirements and alternative imaging approaches is additionally outlined. Examples are provided in MATLAB.

Rapid full-wave phase aberration correction method for transcranial high-intensity focused ultrasound therapies

Background

Non-invasive high-intensity focused ultrasound (HIFU) can be used to treat a variety of disorders, including those in the brain. However, the differences in acoustic properties between the skull and the surrounding soft tissue cause aberrations in the path of the ultrasonic beam, hindering or preventing treatment.

Methods

We present a method for correcting these aberrations that is fast, full-wave, and allows for corrections at multiple treatment locations. The method is simulation-based: an acoustic model is built based on high-resolution CT scans, and simulations are performed using the hybrid angular spectrum (HAS) method to determine the phases needed for correction.

Results

Computation of corrections for clinically applicable resolutions can be achieved in approximately 15 min. Experimental results with a plastic model designed to mimic the aberrations caused by the skull show that the method can recover 95 % of the peak pressure obtained using hydrophone-based time-reversal methods. Testing using an ex vivo human skull flap resulted in recovering up to 70 % of the peak pressure at the focus and 61 % when steering (representing, respectively, a 1.52- and 1.19-fold increase in the peak pressure over the uncorrected case). Additionally, combining the phase correction method with rapid HAS simulations allows evaluation of such treatment metrics as the effect of misregistration on resulting pressure levels.

Conclusions

The method presented here is able to rapidly compute phases required to improve ultrasound focusing through the skull at multiple treatment locations. Combining phase correction with rapid simulation techniques allows for evaluation of various treatment metrics such as the effect of steering on pressure levels. Since the method computes 3D pressure patterns, it may also be suitable for predicting off-focus hot spots during treatments—a primary concern for transcranial HIFU. Additionally, the plastic-skull method presented here may be a useful tool in evaluating the effectiveness of phase correction methods.

A multi-frequency sparse hemispherical ultrasound phased array for microbubble-mediated transcranial therapy and simultaneous cavitation mapping

Focused ultrasound (FUS) phased arrays show promise for non-invasive brain therapy. However, the majority of them are limited to a single transmit/receive frequency and therefore lack the versatility to expose and monitor the treatment volume. Multi-frequency arrays could offer variable transmit focal sizes under a fixed aperture, and detect different spectral content on receive for imaging purposes. Here, a three-frequency (306, 612, and 1224 kHz) sparse hemispherical ultrasound phased array (31.8 cm aperture; 128 transducer modules) was constructed and evaluated for microbubble-mediated transcranial therapy and simultaneous cavitation mapping. The array is able to perform effective electronic beam steering over a volume spanning (-40, 40) and (-30, 50) mm in the lateral and axial directions, respectively. The focal size at the geometric center is approximately 0.9 (2.1) mm, 1.7 (3.9) mm, and 3.1 (6.5) mm in lateral (axial) pressure full width at half maximum (FWHM) at 1224, 612, and 306 kHz, respectively. The array was also found capable of dual-frequency excitation and simultaneous multi-foci sonication, which enables the future exploration of more complex exposure strategies. Passive acoustic mapping of dilute microbubble clouds demonstrated that the point spread function of the receive array has a lateral (axial) intensity FWHM between 0.8-3.5 mm (1.7-11.7 mm) over a volume spanning (-25, 25) mm in both the lateral and axial directions, depending on the transmit/receive frequency combination and the imaging location. The device enabled both half and second harmonic imaging through the intact skull, which may be useful for improving the contrast-to-tissue ratio or imaging resolution, respectively. Preliminary in vivo experiments demonstrated the system's ability to induce blood-brain barrier opening and simultaneously spatially map microbubble cavitation activity in a rat model. This work presents a tool to investigate optimal strategies for non-thermal FUS brain therapy and concurrent microbubble cavitation monitoring through the availability of multiple frequencies.

Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy

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.