Enhanced heat deposition using ultrasound contrast agent--modeling and experimental observations

Real-time assessment of high-intensity focused ultrasound heating and cavitation with hybrid optoacoustic ultrasound imaging

High-intensity focused ultrasound (HIFU) enables localized ablation of biological tissues by capitalizing on the synergistic effects of heating and cavitation. Monitoring of those effects is essential for improving the efficacy and safety of HIFU interventions. Herein, we suggest a hybrid optoacoustic-ultrasound (OPUS) approach for real-time assessment of heating and cavitation processes while providing an essential anatomical reference for accurate localization of the HIFU-induced lesion. Both effects could clearly be observed by exploiting the temperature dependence of optoacoustic (OA) signals and the strong contrast of gas bubbles in pulse-echo ultrasound (US) images. The differences in temperature increase and its rate, as recorded with a thermal camera for different HIFU pressures, evinced the onset of cavitation at the expected pressure threshold. The estimated temperatures based on OA signal variations were also within 10-20 % agreement with the camera readings for temperatures below the coagulation threshold (∼50 °C). Experiments performed in excised tissues as well as in a post-mortem mouse demonstrate that both heating and cavitation effects can be effectively visualized and tracked using the OPUS approach. The good sensitivity of the suggested method for HIFU monitoring purposes was manifested by a significant increase in contrast-to-noise ratio within the ablated region by > 10 dB and > 5 dB for the OA and US images, respectively. The hybrid OPUS-based monitoring approach offers the ease of handheld operation thus can readily be implemented in a bedside setting to benefit several types of HIFU treatments used in the clinics.

Contrast agent shell properties effects on heat deposition in bubble enhanced high intensity focused ultrasound

The effects of the viscoelastic shell properties of ultrasound contrast agents on heat deposition in bubble enhanced high intensity focused ultrasound (HIFU) are studied numerically using a model that solves the ultrasound acoustic field and the multi-bubble dynamics. The propagation of the nonlinear acoustic waves in the test medium is modeled using the compressible Navier-Stokes equations in a fixed Eulerian grid, while the microbubbles are modeled as discrete flow singularities, which are tracked in a Lagrangian fashion. These two models are intimately coupled such that both the acoustic field and the bubbles influence each other at each time step. The resulting temperature rise in the field is then calculated by solving a heat transfer equation applied over a much longer time scale than the computed high frequency dynamics. Three shell models for the contrast agent are considered, and the effect of each of these models on the heat deposition at the focus is studied. The differences obtained in the bubble dynamics results between the shell models are discussed. The importance of modeling the elasticity of the shell is addressed by comparing the results between Newtonian and non-Newtonian shell models. Next, a parametric study varying the shell properties is carried out, and the relative roles of the shell viscosity and elasticity in affecting the heat deposition are discussed. These observations are then used to give recommendations for the design of innovative contrast agents, specifically for the purpose of obtaining higher heat deposition in bubble enhanced HIFU.

Modeling of Microbubble-Enhanced High-Intensity Focused Ultrasound

Heat enhancement at the target in a high intensity focused ultrasound (HIFU) field is investigated by considering the effects of the injection of microbubbles in the vicinity of the tumor to be ablated. The interaction between the bubble cloud and the HIFU field is investigated using a 3-D numerical model. The propagation of non-linear ultrasonic waves in the tissue or in a phantom medium is modeled using the compressible Navier-Stokes equations on a fixed Eulerian grid, while the microbubbles dynamics and motion are modeled as discrete singularities, which are tracked in a Lagrangian framework. These two models are coupled to each other such that both the acoustic field and the bubbles influence each other. The resulting temperature rise in the field is calculated by solving a heat transfer equation applied over a much longer time scale. The compressible continuum part of the model is validated by conducting axisymmetric HIFU simulations without microbubbles and comparing the pressure and temperature fields against available experiments. The coupled Eulerian-Lagrangian approach is then validated against existing experiments conducted with a phantom tissue. The bubbles are distributed randomly in a 3-D fashion inside a cylindrical volume, while the background acoustic field is assumed axisymmetric. The presence of microbubbles modifies the ultrasound field in the focal region and significantly enhances heat deposition. The various mechanisms through which heat deposition is increased are then examined. Among these effects, viscous damping of the bubble oscillations is found to be the main contributor to the enhanced heat deposition. The effects of the initial void fraction in the cloud are then sought by considering the changes in the attenuation of the primary ultrasonic wave and the modifications of the enhanced heat deposition in the focal region. It is observed that although high bubble void fractions lead to increased heat deposition, they also cause significant pre-focal heating because of acoustic shielding. The effects of the microbubble cloud size and its location in the focal region are studied, and the effects of these parameters in altering the temperature rise and the location of the temperature peak are discussed. It is found that concentrating the bubbles adjacent to the focus and farther away from the acoustic source leads to effective heat deposition. Finally, the presence of a shell at the bubble surface, as in contrast agents, is seen to reduce heat deposition by restraining bubble oscillations.

The enhanced HIFU-induced thermal effect via magnetic ultrasound contrast agent microbubbles

High intensity focused ultrasound (HIFU) has been regarded as a promising technology for treating cancer and other severe diseases noninvasively. In the present study, dual modality magnetic ultrasound contrast agent microbubbles (MBs) were synthesized by loading the super paramagnetic iron oxide nanoparticles (SPIOs) into the albumin-shelled MBs (referred as SPIO-albumin MBs). Then, both experimental measurements and numerical simulations were performed to evaluate the ability of SPIO-albumin MBs of enhancing HIFU-induced thermal effect. The results indicated that, comparing with regular albumin-shelled MBs, the SPIO-albumin MBs would lead to quicker temperature elevation rate and higher peak temperature. This phenomenon could be explained by the changes in MBs' physical and thermal properties induced by the integration of SPIOs into MB shell materials. In addition, more experimental results demonstrated that the enhancement effect on HIFU-induced temperature elevation could be further strengthened with more SPIOs combined with albumin-shell MBs. These observations suggested that more violent cavitation behaviors might be activated by ultrasound exposures with the presence of SPIOs, which in turn amplified ultrasound-stimulated thermal effect. Based on the present studies, it is reasonable to expect that, with the help of properly designed dual-modality magnetic MBs, the efficiency of HIFU-induced thermal effect could be further improved to achieve better therapeutic outcomes.

Inverse effects of flowing phase-shift nanodroplets and lipid-shelled microbubbles on subsequent cavitation during focused ultrasound exposures

This paper compared the effects of flowing phase-shift nanodroplets (NDs) and lipid-shelled microbubbles (MBs) on subsequent cavitation during focused ultrasound (FUS) exposures. The cavitation activity was monitored using a passive cavitation detection method as solutions of either phase-shift NDs or lipid-shelled MBs flowed at varying velocities through a 5-mm diameter wall-less vessel in a transparent tissue-mimicking phantom when exposed to FUS. The intensity of cavitation for the phase-shift NDs showed an upward trend with time and cavitation for the lipid-shelled MBs grew to a maximum at the outset of the FUS exposure followed by a trend of decreases when they were static in the vessel. Meanwhile, the increase of cavitation for the phase-shift NDs and decrease of cavitation for the lipid-shelled MBs had slowed down when they flowed through the vessel. During two discrete identical FUS exposures, while the normalized inertial cavitation dose (ICD) value for the lipid-shelled MB solution was higher than that for the saline in the first exposure (p-value <0.05), it decreased to almost the same level in the second exposure. For the phase-shift NDs, the normalized ICD was 0.71 in the first exposure and increased to 0.97 in the second exposure. At a low acoustic power, the normalized ICD values for the lipid-shelled MBs tended to increase with increasing velocities from 5 to 30cm/s (r>0.95). Meanwhile, the normalized ICD value for the phase-shift NDs was 0.182 at a flow velocity of 5cm/s and increased to 0.188 at a flow velocity of 15cm/s. As the flow velocity increased to 20cm/s, the normalized ICD was 0.185 and decreased to 0.178 at a flow velocity of 30cm/s. At high acoustic power, the normalized ICD values for both the lipid-shelled MBs and the phase-shift NDs increased with increasing flow velocities from 5 to 30cm/s (r>0.95). The effects of the flowing phase-shift NDs vaporized into gas bubbles as cavitation nuclei on the subsequent cavitation were inverse to those of the flowing lipid-shelled MBs destroyed after focused ultrasound exposures.

Tumor growth suppression by the combination of nanobubbles and ultrasound

We previously developed novel liposomal nanobubbles (Bubble liposomes [BL]) that oscillate and collapse in an ultrasound field, generating heat and shock waves. We aimed to investigate the feasibility of cancer therapy using the combination of BL and ultrasound. In addition, we investigated the anti-tumor mechanism of this cancer therapy. Colon-26 cells were inoculated into the flank of BALB/c mice to induce tumors. After 8 days, BL or saline was intratumorally injected, followed by transdermal ultrasound exposure of tumor tissue (1 MHz, 0-4 W/cm2 , 2 min). The anti-tumor effects were evaluated by histology (necrosis) and tumor growth. In vivo cell depletion assays were performed to identify the immune cells responsible for anti-tumor effects. Tumor temperatures were significantly higher when treated with BL + ultrasound than ultrasound alone. Intratumoral BL caused extensive tissue necrosis at 3-4 W/cm2 of ultrasound exposure. In addition, BL + ultrasound significantly suppressed tumor growth at 2-4 W/cm2 . In vivo depletion of CD8+ T cells (not NK or CD4+ T cells) completely blocked the effect of BL + ultrasound on tumor growth. These data suggest that CD8+ T cells play a critical role in tumor growth suppression. Finally, we concluded that BL + ultrasound, which can prime the anti-tumor cellular immune system, may be an effective hyperthermia strategy for cancer treatment.

A review of low-intensity ultrasound for cancer therapy

The literature describing the use of low-intensity ultrasound in four major areas of cancer therapy-sonodynamic therapy, ultrasound-mediated chemotherapy, ultrasound-mediated gene delivery and anti-vascular ultrasound therapy-was reviewed. Each technique consistently resulted in the death of cancer cells, and the bio-effects of ultrasound were attributed primarily to thermal actions and inertial cavitation. In each therapeutic modality, theranostic contrast agents composed of microbubbles played a role in both therapy and vascular imaging. The development of these agents is important as it establishes a therapeutic-diagnostic platform that can monitor the success of anti-cancer therapy. Little attention, however, has been given either to the direct assessment of the mechanisms underlying the observed bio-effects or to the viability of these therapies in naturally occurring cancers in larger mammals; if such investigations provided encouraging data, there could be prompt application of a therapy technique in the treatment of cancer patients.

High-speed observation of bubble cloud generation near a rigid wall by second-harmonic superimposed ultrasound

Cavitation bubbles are known to accelerate therapeutic effects of ultrasound. Although negative acoustic pressure is the principle factor of cavitation, positive acoustic pressure has a role for bubble cloud formation at a high intensity of focused ultrasound when cavitation bubbles provide pressure release surfaces converting the pressure from highly positive to negative. In this study, the second-harmonic was superimposed onto the fundamental acoustic pressure to emphasize either peak positive or negative pressure. The peak negative and positive pressure emphasized waves were focused on a surface of an aluminum block. Cavitation bubbles induced near the block were observed with a high-speed camera by backlight and the size of the cavitation generation region was measured from the high-speed images. The negative pressure emphasized waves showed an advantage in cavitation inception over the positive pressure emphasized waves. In the sequence of the negative pressure emphasized waves immediately followed by the positive pressure emphasized waves, cavitation bubbles were generated on the block by the former waves and the cavitation region were expanded toward the transducer in the latter waves with high reproducibility. The sequence demonstrated its potential usefulness in enhancing the effects of therapeutic ultrasound at a high acoustic intensity.

Modeling of thermal effects in antivascular ultrasound therapy

Antivascular ultrasound consisting of low-intensity sonication in the presence of circulating microbubbles of an ultrasound contrast agent has been demonstrated to disrupt blood flow in solid cancers. In this study a mathematical framework is described for the microbubble-induced heating that occurs during antivascular ultrasound. Biological tissues are modeled as a continuum of microbubble-filled vasculature, cells, and interstitial fluids with compressibility equal to the sum of the compressibility of each component. The mathematical simulations show that the absorption of ultrasound waves by viscous damping of the microbubble oscillations induced significant local heating of the tissue vasculature. The extent and the rate of temperature increase not only depends on the properties of the microbubbles and the sonication parameters but is also influenced markedly by the blood flow. Slow flow conditions lead to higher tissue temperatures due to a stronger interaction between microbubbles and ultrasound and reduced heat dissipation. Because tumors have slower blood flow than healthy tissue, the microbubble-induced ultrasound antivascular therapy is likely to affect cancerous tissue more extensively than healthy tissue, providing a way to selectively target the vasculature of cancers.

Premature cardiac contractions produced efficiently by external high-intensity focused ultrasound

Exposure of myocardium to a mechanical impact may produce premature ventricular contractions (PVCs). High-intensity focused ultrasound was reported to generate PVCs, while microbubbles at the target increased absorption, thus, promoting energy localization and decreased PVC threshold. The objective was to investigate the benefit of a two-stage ultrasonic transmission: (1) asymmetric mostly negative waveform at the focus (microbubbles generation) and (2) asymmetric mostly positive waveform at the microbubbles (impact generation). Optimization of transmission parameters was performed by measuring passive cavitation and attenuation. In vivo intact rat studies were performed while measuring electrocardiograph (ECG) and blood pressure. Most PVCs with blood injection were created while applying 3.06 MPa peak negative pressure during 1 ms, followed by 5.1 MPa peak positive pressure during 50 ms. Increasing the second stage from 5 ms to 50 ms increased the occurrence of PVCs. This study demonstrates that creation of localized microbubble population at the target promotes generation of PVCs without the need to inject contrast agents.

Minimizing the thermal losses from perfusion during focused ultrasound exposures with flowing microbubbles

This paper demonstrated the use of flowing microbubbles (MBs) to minimize thermal losses from perfusion during focused ultrasound exposures due to acoustic cavitation. Temperature and cavitation were simultaneously investigated as MBs flowing through a wall-less flow phantom with varying flow velocities (2-55 cm/s) and concentrations (0%-0.1%) when exposed at different acoustic power levels (5-120 W). The peak temperature at the end of ultrasonic exposures in the flow and in the outer of the vessel as well as the cavitation were higher than those pure controls measured at the same exposure parameters and flow velocities but without MBs. All the peak temperatures initially increased with increasing flow velocities of MBs, followed by a decrease of the peak temperatures with increasing flow velocities when the velocity was higher than the inflection velocity. Meanwhile, cavitation showed a trend of increases with increasing flow velocity. The inflection velocity and cavitation increased with increasing acoustic power and MBs concentration. Thermal lesion appeared around the vessel as MBs flow through the vessel, at which lesion was not observed originally without MBs. These results suggested that this may provide an effective way to minimize thermal losses from perfusion during focused ultrasound exposures.

Temperature change near microbubbles within a capillary network during focused ultrasound

Preformed gas bubbles can increase energy absorption from an ultrasound beam and therefore they have been proposed for an enhancer of ultrasound treatments. Although tissue temperature measurements performed in vivo using invasive thermocouple probes and MRI thermometry have demonstrated increased tissue temperature, the microscopic temperature distribution has not been investigated so far. In this study the transfer of heat between bubbles and tissue during focused ultrasound was simulated. Microbubble oscillations were simulated within a rat cortical microvascular network reconstructed from in vivo dual-photon microscopy images and the power density of these oscillations was used as an input term in the Pennes bioheat transfer equation. The temperature solution from the bioheat transfer equation was mapped onto vascular data to produce a three-dimensional temperature map. The results showed high temperatures near the bubbles and slow temperature rise in the tissue. Heating was shown to increase with increasing bubble frequency and insonation pressure, and showed a frequency-dependent peak. The goal of this research is to characterize the effect of various parameters on bubble-enhanced therapeutic ultrasound to allow better treatment planning. These results show that the induced temperature elevations have nonuniformities which may have a significant impact on the bio-effects of the exposure.

The correlation between bubble-enhanced HIFU heating and cavitation power

It has been established that while the inherent presence of bubbles increases heat generation due to scattering and absorption, inertial cavitation is responsible for elevated heating during high-intensity focused ultrasound (HIFU) application. The contribution of bubble-induced heating can be an important factor to consider, as it can be several times greater than the expected heat deposition from absorption of energy from the primary ultrasound field. The temperature and cavitation signal near the focus were measured for 5.5-s continuous-wave 1.1-MHz HIFU sonications in tissue mimicking phantoms. The measured temperature was corrected for heating predicted from the primary ultrasound absorption to isolate the temperature rise from the bubble activity. The temperature rise induced from cavitation correlates well with a measurement of the instantaneous "cavitation power" as indicated by the mean square voltage output of a 15-MHz passive cavitation detector. The results suggest that careful processing of the cavitation signals can serve as a proxy for measuring the heating contribution from inertial cavitation.

Sonoporation by ultrasound-activated microbubble contrast agents: effect of acoustic exposure parameters on cell membrane permeability and cell viability

This work investigates the effect of ultrasound exposure parameters on the sonoporation of KHT-C cells in suspension by perflutren microbubbles. Variations in insonating acoustic pressure (0.05 to 3.5 MPa), pulse frequency (0.5 to 5.0 MHz), pulse repetition frequency (10 to 3000 Hz), pulse duration (4 to 32 micros) and insonation time (0.1 to 900 s) were studied. The number of cells permeabilised to a fluorescent tracer molecule (70 kDa FITC-dextran) and the number of viable cells were measured using flow cytometry. The effect of exposure on the microbubble population was measured using a Coulter counter. Cell viability and membrane permeability were found to depend strongly on the acoustic exposure conditions. Cell permeability increased and viability decreased with increasing peak negative pressure, pulse repetition frequency, pulse duration and insonation time and with decreasing pulse centre frequency. The highest therapeutic ratio (defined as the ratio of permeabilised to nonviable cells) achieved was 8.8 with 32 +/- 4% permeabilization and 96 +/- 1% viability at 570 kPa peak negative pressure, 8 micros pulse duration, 3 kHz pulse repetition frequency, 500 kHz centre frequency and 12 s insonation time with microbubbles at 3.3% volume concentration. These settings correspond to an acoustic energy density (E(SPPA)) of 3.12 J/cm(2). Cell permeability and viability did not correlate with bubble disruption. The results indicate that ultrasound exposure parameters can be optimized for therapeutic sonoporation and that bubble disruption is a necessary but insufficient indicator of ultrasound-induced permeabilization.

Feasibility of using ultrasound contrast agents to increase the size of thermal lesions induced by non-focused transducers: in vitro demonstration in tissue mimicking phantom

Miniature flat ultrasound transducers have shown to be effective for a large variety of thermal therapies, but the associated superficial heating implicates developing original strategies in order to extend therapeutic depth. The goal of the present paper is to use ultrasound contrast agents (UCA) to increase remote attenuation and heating. Theoretical simulations demonstrated that increasing attenuation from 0.27 to 0.8 Np/cm at 10 MHz beyond a distance of 18 mm from the transducer should result in longer thermal damages due to protein coagulation in a tissue mimicking phantom. Contrast agents (BR14, Bracco, Plan-les-Ouates, Switzerland) were embedded in thermo-sensitive gel and attenuations ranging from 0.27 to 1.33 Np/cm were measured at 10 MHz for concentrations of BR14 between 0 and 4.8%. Thermal damages were then induced in several gels, which had different layering configurations. Thermal damages, 12.8mm in length, were obtained in homogeneous gels. When mixing contrast agents at a concentration of 3.2% beyond a first 18 mm-thick layer of homogeneous gel, the thermal damages reached 21.5mm in length. This work demonstrated that contrast agents can be used for increasing attenuation remotely and extending therapeutic depth induced by a non-focused transducer. Additional work must be done in vivo in order to verify the remote-only distribution of bubbles and associated increase in attenuation.

The disruption of murine tumor neovasculature by low-intensity ultrasound-comparison between 1- and 3-MHz sonication frequencies

RATIONALE AND OBJECTIVES

The goal was to determine whether the tumor vascular disrupting actions of low-intensity ultrasound were frequency dependent.

MATERIALS AND METHODS

The effect of the frequency (1 MHz at 2.2 W/cm2 or 3 MHz at 2.4 W/cm2) of low-intensity ultrasound as a neovascular disrupting modality was investigated in 15 murine melanomas (K1735(22)) insonated for 3 minutes after the intravenous injection of a microbubble contrast agent (Definity). In contrast-enhanced power Doppler observations of each tumor (before and after treatment), measurements were made of the size of the area of the tumor that was perfused with blood containing the ultrasound contrast agent (percentage area of flow [PAF]), and the volume of contrast agent flowing through the unit volume of the tumor (color-weighted fractional area [CWFA]). During insonation of the tumor, the temperature was measured with a fine wire thermocouple in an additional eight mice.

RESULTS

The antivascular action of low-intensity ultrasound was significantly enhanced (PAF by 64%; CWFA by 106%) when the tumor was treated with 3-MHz ultrasound rather than 1 MHz (analysis of variance: PAF, P=.02; CWFA, P=.04). The average rate of tumor temperature increase was 2.6+/-1.3 degrees C/min for 1 MHz and 5.0+/-1.7 degrees C/min for 3 MHz; these increases were significantly different (P=.04).

CONCLUSIONS

Insonation of the tumor at a higher frequency amplified the heating of the neoplasm and led to greater disruption of the tumor vasculature; 3-MHz ultrasound was more efficacious than 1 MHz for antivascular cancer therapy.

Hyperecho as the indicator of tissue necrosis during microbubble-assisted high intensity focused ultrasound: sensitivity, specificity and predictive value

The purpose of this study was to determine the sensitivity, specificity and predictive values of hyperecho in grayscale ultrasonic images as the indicator of tissue necrosis in microbubble-assisted high-intensity focused ultrasound (HIFU) exposure in vivo. Livers and kidneys of the rabbit were exposed to HIFU (control group) or microbubble-assisted HIFU (experimental group); a continuous line of ablation, viz. linear scan, was performed to destruct tissues. Tissue responses were evaluated macroscopically and microscopically 24 h after HIFU. The cases of positive (hyperecho occurred and tissue necrotized), false positive (tissue was unaffected although hyperecho appeared), negative (echo was not changed and tissue was intact) and false negative (tissue was destructed despite the lack of hyperecho) were counted, and then the sensitivity, specificity and positive and negative predictive values of hyperecho were calculated. The sensitivity, specificity, positive predictive value and negative predictive value were 49.25% vs. 79.63% (p < 0.001), 45.45% vs. 30.00%, 84.62% vs. 86.00% and 12.82% vs. 21.43% for liver and 76.06% vs. 81.25%, 26.53% vs. 41.67%, 60.00% vs. 82.28% (p = 0.002) and 43.33% vs. 40.00% for kidney, in control and experimental groups, respectively. Rates varied between tissue types in control group. These findings indicated that the use of microbubble during HIFU improved the sensitivity in liver and the positive predictive value in kidney. The specificity and negative predictive value were poor. Hyperecho could only be used as the indicator of tissue necrosis in some tissue types.

Needle size and injection rate impact microbubble contrast agent population

The most common type of ultrasound contrast agents are encapsulated microbubbles, typically 1 to 5 microns in diameter. These microbubbles are injected into the bloodstream to provide image enhancement during an ultrasound examination. Because of their compressibility, these microbubbles are inherently sensitive to changes in pressure. For imaging, this is beneficial in that these microbubbles oscillate in an acoustic field and allow imaging systems to detect their response uniquely from tissue. However, this sensitivity also means that microbubbles can be readily destroyed by significant hydrostatic pressure. Injection of these microbubbles through a small-gauge catheter, such as is sometimes performed in small animal imaging studies, can result in microbubble destruction. In this manuscript, the effects of microbubble injection through catheters of varying diameter are examined. Our results indicate that the concentration and size distribution of microbubbles can be substantially altered in cases of rapid injection through small-gauge needles.

Modeling photothermal and acoustical induced microbubble generation and growth

Previous experimental studies showed that powerful heating of nanoparticles by a laser pulse using energy density greater than 100 mJ/cm(2), could induce vaporization and generate microbubbles. When ultrasound is introduced at the same time as the laser pulse, much less laser power is required. For therapeutic applications, generation of microbubbles on demand at target locations, e.g. cells or bacteria can be used to induce hyperthermia or to facilitate drug delivery. The objective of this work is to develop a method capable of predicting photothermal and acoustic parameters in terms of laser power and acoustic pressure amplitude that are needed to produce stable microbubbles; and investigate the influence of bubble coalescence on the thresholds when the microbubbles are generated around nanoparticles that appear in clusters. We develop and solve here a combined problem of momentum, heat and mass transfer which is associated with generation and growth of a microbubble, filled with a mixture of non-vaporized gas (air) and water vapor. The microbubble's size and gas content vary as a result of three mechanisms: gas expansion or compression, evaporation or condensation on the bubble boundary, and diffusion of dissolved air in the surrounding water. The simulations predict that when ultrasound is applied relatively low threshold values of laser and ultrasound power are required to obtain a stable microbubble from a single nanoparticle. Even lower power is required when microbubbles are formed by coalescence around a cluster of 10 nanoparticles. Laser pulse energy density of 21 mJ/cm(2) is predicted for instance together with acoustic pressure of 0.1 MPa for a cluster of 10 or 62 mJ/cm(2) for a single nanoparticle. Those values are well within the safety limits, and as such are most appealing for targeted therapeutic purposes.

The antivascular action of physiotherapy ultrasound on a murine tumor: role of a microbubble contrast agent

This study investigated whether a microbubble-containing ultrasound contrast agent had a role in the antivascular action of physiotherapy ultrasound on tumor neovasculature. Ultrasound images (B-mode and contrast-enhanced power Doppler [0.02 mL Definity]) were made of 22 murine melanomas (K1735(22)). The tumor was insonated (I(SATA) = 1.7 W cm(-2), 1 MHz, continuous output) for 3 min and the power Doppler observations of the pre- and postinsonation tumor vascularities were analyzed. Significant reductions (p = 0.005 for analyses of color-weighted fractional area) in vascularity occurred when a contrast-enhanced power Doppler study occurred before insonation. Vascularity was unchanged in tumors without a pretherapy Doppler study. Histologic studies revealed tissue structural changes that correlated with the ultrasound findings. The underlying etiology of the interaction between the physiotherapy ultrasound beam, the microbubble-containing contrast agent and the tumor neovasculature is unknown. It was concluded that contrast agents play an important role in the antivascular effects induced by physiotherapy ultrasound.

Spatio-temporal analysis of molecular delivery through the blood-brain barrier using focused ultrasound

The deposition of gadolinium through ultrasound-induced blood-brain barrier (BBB) openings in the murine hippocampus was investigated. First, wave propagation simulations through the intact mouse skull revealed minimal beam distortion while thermal deposition simulations, at the same sonication parameters used to induce BBB opening in vivo, revealed temperature increases lower than 0.5 degrees C. The simulation results were validated experimentally in ex vivo skulls (m = 6) and in vitro tissue specimens. Then, in vivo mice (n = 9) were injected with microbubbles (Optison; 25-50 microl) and sonicated (frequency: 1.525 MHz, pressure amplitudes: 0.5-1.1 MPa, burst duration: 20 ms, duty cycle: 20%, durations: 2-4 shots, 30 s per shot, 30 s interval) at the left hippocampus, through intact skin and skull. Sequential, high-resolution, T1-weighted MRI (9.4 Tesla, in-plane resolution: 75 microm, scan time: 45-180 min) with gadolinium (Omniscan; 0.5 ml) injected intraperitoneally revealed a threshold of the BBB opening at 0.67 MPa and BBB closing within 28 h from opening. The contrast-enhancement area and gadolinium deposition path were monitored over time and the influence of vessel density, size and location was determined. Sonicated arteries, or their immediate surroundings, depicted greater contrast enhancement than sonicated homogeneous brain tissue regions. In conclusion, gadolinium was delivered through a transiently opened BBB and contained to a specific brain region (i.e., the hippocampus) using a single-element focused ultrasound transducer. It was also found that the amount of gadolinium deposited in the hippocampal region increased with the acoustic pressure and that the spatial distribution of the BBB opening was determined not only by the ultrasound beam, but also by the vasculature of the targeted brain region.

Lesions of ultrasound-induced lung hemorrhage are not consistent with thermal injury

Thermal injury, a potential mechanism of ultrasound-induced lung hemorrhage, was studied by comparing lesions induced by an infrared laser (a tissue-heating source) with those induced by pulsed ultrasound. A 600-mW continuous-wave CO2 laser (wavelength approximately 10.6 microm) was focused (680-microm beamwidth) on the surface of the lungs of rats for a duration between 10 to 40 s; ultrasound beamwidths were between 310 and 930 microm. After exposure, lungs were examined grossly and then processed for microscopic evaluation. Grossly, lesions induced by laser were somewhat similar to those induced by ultrasound; however, microscopically, they were dissimilar. Grossly, lesions were oval, red to dark red and extended into subjacent tissue to form a cone. The surface was elevated, but the center of the laser-induced lesions was often depressed. Microscopically, the laser-induced injury consisted of coagulation of tissue, cells and fluids, whereas injury induced by ultrasound consisted solely of alveolar hemorrhage. These results suggest that ultrasound-induced lung injury is most likely not caused by a thermal mechanism.