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Ponomarchuk E, Tsysar S, Kvashennikova A, Chupova D, Pestova P, Danilova N, Malkov P, Buravkov S, Khokhlova V. Pilot Study on Boiling Histotripsy Treatment of Human Leiomyoma Ex Vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1255-1261. [PMID: 38762389 DOI: 10.1016/j.ultrasmedbio.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE As an alternative to surgical excision and magnetic resonance-guided thermal high-intensity focused ultrasound ablation of uterine leiomyoma, this work was aimed at pilot feasibility demonstration of use of ultrasound-guided boiling histotripsy for non-invasive non-thermal fractionation of human uterine leiomyoma ex vivo. METHODS A custom-made sector ultrasound transducer of 1.5-MHz operating frequency and nominal f-number F# = 0.75 was used to produce a volumetric lesion (two layers of 5 × 5 foci with a 1 mm step) in surgically resected human leiomyoma ex vivo. A sequence of 10 ms pulses (P+/P-/As = 157/-25/170 MPa in situ) with 1% duty cycle was delivered N = 30 times per focus under B-mode guidance. The treatment outcome was evaluated via B-mode imaging and histologically with hematoxylin and eosin and Masson's trichrome staining. RESULTS The treatment was successfully performed in less than 30 min and resulted in formation of a rectangular lesion visualized on B-mode images during the sonication as an echogenic region, which sustained for about 10 min post-treatment. Histology revealed loss of cellular structure, necrotic debris and globules of degenerated collagen in the target volume surrounded by injured smooth muscle cells. CONCLUSION The pilot experiment described here indicates that boiling histotripsy is feasible for non-invasive mechanical disintegration of human uterine leiomyoma ex vivo under B-mode guidance, encouraging further investigation and optimization of this potential clinical application of boiling histotripsy.
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Affiliation(s)
| | - Sergey Tsysar
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
| | | | - Daria Chupova
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Polina Pestova
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Natalia Danilova
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - Pavel Malkov
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - Sergey Buravkov
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
| | - Vera Khokhlova
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
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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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Chu Kwan W, Partanen A, Narayanan U, Waspe AC, Drake JM. Biomechanical testing of ex vivo porcine tendons following high intensity focused ultrasound thermal ablation. PLoS One 2024; 19:e0302778. [PMID: 38713687 DOI: 10.1371/journal.pone.0302778] [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: 01/28/2024] [Accepted: 04/12/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) has been demonstrated to be able to thermally ablate tendons with the aim to non-invasively disrupt tendon contractures in the clinical setting. However, the biomechanical changes of tendons permitting this disrupting is poorly understood. We aim to obtain a dose-dependent biomechanical response of tendons following magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation. METHODS Ex vivo porcine tendons (n = 72) were embedded in an agar phantom and randomly assigned to 12 groups based on MRgFUS treatment. The treatment time was 10, 20, or 30s, and the applied acoustic power was 25, 50, 75, or 100W. Following each MRgFUS treatment, tendons underwent biomechanical tensile testing on an Instron machine, which calculated stress-strain curves during tendon elongation. Rupture rate, maximum treatment temperature, Young's modulus and ultimate strength were analyzed for each treatment energy. RESULTS The study revealed a dose-dependent response, with tendons rupturing in over 50% of cases when energy delivery exceeded 1000J and 100% disruption at energy levels beyond 2000J. The achieved temperatures during MRgFUS were directly proportional to energy delivery. The highest recorded temperature was 56.8°C ± 9.34 (3000J), while the lowest recorded temperate was 18.6°C ± 0.6 (control). The Young's modulus was highest in the control group (47.3 MPa ± 6.5) and lowest in the 3000J group (13.2 MPa ± 5.9). There was no statistically significant difference in ultimate strength between treatment groups. CONCLUSION This study establishes crucial thresholds for reliable and repeatable disruption of tendons, laying the groundwork for future in vivo optimization. The findings prompt further exploration of MRgFUS as a non-invasive modality for tendon disruption, offering hope for improved outcomes in patients with musculotendinous contractures.
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Affiliation(s)
| | | | - Unni Narayanan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam C Waspe
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Ponomarchuk E, Thomas G, Song M, Krokhmal A, Kvashennikova A, Wang YN, Khokhlova V, Khokhlova T. Histology-based quantification of boiling histotripsy outcomes via ResNet-18 network: Towards mechanical dose metrics. ULTRASONICS 2024; 138:107225. [PMID: 38141356 DOI: 10.1016/j.ultras.2023.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
This work was focused on the newly developed ultrasonic approach for non-invasive surgery - boiling histotripsy (BH) - recently proposed for mechanical ablation of tissues using pulsed high intensity focused ultrasound (HIFU). The BH lesion is known to depend in size and shape on exposure parameters and mechanical properties, structure and composition of tissue being treated. The aim of this work was to advance the concept of BH dose by investigating quantitative relationships between the parameters of the lesion, pulsing protocols, and targeted tissue properties. A HIFU focus of a 1.5 MHz 256-element array driven by power-enhanced Verasonics system was electronically steered along the grid within 12 × 4 × 12 mm volume to produce volumetric lesions in porcine liver (soft, with abundant collagenous structures) and bovine myocardium (stiff, homogenous cellular) ex vivo tissues with various pulsing protocols (1-10 ms pulses, 1-15 pulses per point). Quantification of the lesion size and completeness was performed through serial histological sectioning, and a computer vision approach using a combination of manual and automated detection of fully fractionated and residual tissue based on neural network ResNet-18 was developed. Histological sample fixation led to underestimation of BH ablation rate compared to the ultrasound-based estimations, and provided similar qualitative feedback as did gross inspection. This suggests that gross observation may be sufficient for qualitatively evaluating the BH treatment completeness. BH efficiency in liver tissue was shown to be insensitive to the changes in pulsing protocol within the tested parameter range, whereas in bovine myocardium the efficiency increased with either increasing pulse length or number of pulses per point or both. The results imply that one universal mechanical dose metric applicable to an arbitrary tissue type is unlikely to be established. The dose metric as a product of the BH pulse duration and the number of pulses per sonication point (BHD1) was shown to be more relevant for initial planning of fractionation of collagenous tissues. The dose metric as a number of pulses per point (BHD2) is more suitable for the treatment planning of softer targets primarily containing cellular tissue, allowing for significant acceleration of treatment using shorter pulses.
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Affiliation(s)
| | - Gilles Thomas
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle, USA
| | - Minho Song
- Department of Gastroenterology, University of Washington, Seattle, USA
| | - Alisa Krokhmal
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russian Federation
| | | | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle, USA
| | - Vera Khokhlova
- Physics Faculty, Lomonosov Moscow State University, Moscow, Russian Federation; Center for Industrial and Medical Ultrasound, University of Washington, Seattle, USA
| | - Tatiana Khokhlova
- Department of Gastroenterology, University of Washington, Seattle, USA
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Williams RP, Simon JC, Khokhlova VA, Sapozhnikov OA, Khokhlova TD. The histotripsy spectrum: differences and similarities in techniques and instrumentation. Int J Hyperthermia 2023; 40:2233720. [PMID: 37460101 PMCID: PMC10479943 DOI: 10.1080/02656736.2023.2233720] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
Since its inception about two decades ago, histotripsy - a non-thermal mechanical tissue ablation technique - has evolved into a spectrum of methods, each with distinct potentiating physical mechanisms: intrinsic threshold histotripsy, shock-scattering histotripsy, hybrid histotripsy, and boiling histotripsy. All methods utilize short, high-amplitude pulses of focused ultrasound delivered at a low duty cycle, and all involve excitation of violent bubble activity and acoustic streaming at the focus to fractionate tissue down to the subcellular level. The main differences are in pulse duration, which spans microseconds to milliseconds, and ultrasound waveform shape and corresponding peak acoustic pressures required to achieve the desired type of bubble activity. In addition, most types of histotripsy rely on the presence of high-amplitude shocks that develop in the pressure profile at the focus due to nonlinear propagation effects. Those requirements, in turn, dictate aspects of the instrument design, both in terms of driving electronics, transducer dimensions and intensity limitations at surface, shape (primarily, the F-number) and frequency. The combination of the optimized instrumentation and the bio-effects from bubble activity and streaming on different tissues, lead to target clinical applications for each histotripsy method. Here, the differences and similarities in the physical mechanisms and resulting bioeffects of each method are reviewed and tied to optimal instrumentation and clinical applications.
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Affiliation(s)
- Randall P Williams
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Julianna C Simon
- Graduate Program in Acoustics, The Pennsylvania State University, University Park, PA, USA
| | - Vera A Khokhlova
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
- Department of Acoustics, Physics Faculty, Moscow State University, Moscow, Russia
| | - Oleg A Sapozhnikov
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
- Department of Acoustics, Physics Faculty, Moscow State University, Moscow, Russia
| | - Tatiana D Khokhlova
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
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