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Zhong X, Zhang X, Cao Y, Zhou P. Interaction Between Microbubbles and Microwave Ablation: A Phantom and Rabbit Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1143-1151. [PMID: 38469913 DOI: 10.1002/jum.16443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES This study aimed to explore the interactions between microbubbles and microwave ablation (MWA). METHODS The study employed custom-made phantoms (in vitro) and white New Zealand rabbits (in vivo). MWA was performed with or without microbubbles in the phantoms (2 × 105 particles mL-1) and rabbit livers (intravenous injection of 0.05 mL/kg SonoVue). During the MWA, K-type thermocouple probes were used to monitor the MWA-induced temperature increase. Contrast-enhanced ultrasound imaging (CEUS) was used to monitor and analyze the microbubbles signal intensity. After MWA, the ablation-zone volumes were evaluated and compared between the groups with and without microbubbles. RESULTS In both the phantom models and rabbits, microbubbles showed no significant influence on MWA, including the ablation range and MWA-induced temperature increase. In phantoms and rabbit livers filled with microbubbles, MWA caused the formation of a gradually expanding microbubble-defect region over the ablation time. An increase in the temperature caused microbubble destruction. CONCLUSIONS Microbubbles had no significant influence on MWA. However, MWA induced the destruction of microbubbles in a temperature-dependent manner. Thus, the poor thermotolerance of microbubbles is a non-negligible barrier when using CEUS to monitor the ablation range during MWA in real-time.
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Affiliation(s)
- Xinyu Zhong
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xinghao Zhang
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuting Cao
- Institute of Ultrasound Imaging and Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
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Jeong DY, Kang TW, Min JH, Song KD, Lee MW, Rhim H, Lim HK, Sinn DH, Han H. Effect of Perfluorobutane Microbubbles on Radiofrequency Ablation for Hepatocellular Carcinoma: Suppression of Steam Popping and Its Clinical Implication. Korean J Radiol 2020; 21:1077-1086. [PMID: 32691543 PMCID: PMC7371616 DOI: 10.3348/kjr.2019.0910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the effect of perfluorobutane microbubbles (Sonazoid®, GE Healthcare) on steam popping during radiofrequency (RF) ablation for treating hepatocellular carcinoma (HCC), and to assess whether popping affects treatment outcomes. Materials and Methods The institutional review board approved this retrospective study, which included 90 consecutive patients with single HCC, who received percutaneous RF ablation as the first-line treatment. The patients were divided into two groups, based on the presence or absence of the popping phenomenon, which was defined as an audible sound with a simultaneous sudden explosion within the ablation zone as detected via ultrasonography during the procedure. The factors contributing to the popping phenomenon were identified using multivariable logistic regression analysis. Local tumor progression (LTP) and disease-free survival (DFS) were assessed using the Kaplan-Meier method with the log-rank test for performing comparisons between the two groups. Results The overall incidence of the popping phenomenon was 25.8% (24/93). Sonazoid® was used in 1 patient (4.2%) in the popping group (n = 24), while it was used in 15 patients (21.7%) in the non-popping group (n = 69). Multivariable analysis revealed that the use of Sonazoid® was the only significant factor for absence of the popping phenomenon (odds ratio = 0.10, p = 0.048). There were no significant differences in cumulative LTP and DFS between the two groups (p = 0.479 and p = 0.424, respectively). Conclusion The use of Sonazoid® has a suppressive effect on the popping phenomenon during RF ablation in patients with HCC. However, the presence of the popping phenomenon may not affect clinical outcomes.
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Affiliation(s)
- Dong Young Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heewon Han
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
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Chen W, Cai H, Zhang X, Huang D, Yang J, Chen C, Qian Q, He Y, Chen Z. Physiologic Factors Affecting the Circulatory Persistence of Copolymer Microbubbles and Comparison of Contrast-Enhanced Effects between Copolymer Microbubbles and Sonovue. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:721-734. [PMID: 31899039 DOI: 10.1016/j.ultrasmedbio.2019.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/21/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
Ultrasound contrast agents have been widely used in clinical diagnosis. Knowledge of the physiologic factors affecting circulatory persistence is helpful in preparing long-lasting microbubbles (MBs) for blood perfusion and drug delivery research. In the study described here, we prepared copolymer MBs, compared their characteristics and contrast-enhanced effects with those of SonoVue and investigated the influence of external pressure, temperature, plasma components, renal microcirculation and cardiac motion on their circulatory persistence. The mean size of the copolymer MBs was 3.57 μm, larger than that of SonoVue. The copolymer MBs had longer circulatory persistence than SonoVue. At external pressures of 110 and 150 mm Hg, neither the quantity nor the morphology of the copolymer MBs changed. Further, their quantity and size were similar after incubation at 4°C and 39.4°C and when rabbit plasma and saline were compared. In vivo contrast-enhanced ultrasonography revealed a slightly larger area under the curve for the renal artery than for the renal vein. Thus, copolymer MBs exhibited good stability. However, the quantity of copolymer MBs decreased significantly after 180 s of circulation in an isolated toad heart perfusion model, indicating that cardiac motion was the main factor affecting their circulatory persistence.
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Affiliation(s)
- Wanping Chen
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Hongjiao Cai
- Fisheries College of Jimei University, Xiamen, China
| | - Xiujuan Zhang
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Danfeng Huang
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Cong Chen
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Qingfu Qian
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Yimi He
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Zhikui Chen
- Department of Ultrasound, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China.
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Abbass MA, Garbo AJ, Mahalingam N, Killin JK, Mast TD. Optimized Echo Decorrelation Imaging Feedback for Bulk Ultrasound Ablation Control. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:1743-1755. [PMID: 29994657 PMCID: PMC6294441 DOI: 10.1109/tuffc.2018.2847599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Feasibility of controlling bulk ultrasound (US) thermal ablation using echo decorrelation imaging was investigated in ex vivo bovine liver. The first of two ablation and control procedures used a sequence of constant-intensity sonication cycles, ceased when the minimum echo decorrelation within a control region of interest (ROI) exceeded a predetermined threshold. The second procedure used a variable-intensity sonication sequence, with spatially averaged decorrelation as the stopping criterion. US exposures and echo decorrelation imaging were performed by a linear image-ablate array. Based on preliminary experiments, control ROIs and thresholds for the minimum-decorrelation and average-decorrelation criteria were specified. Controlled trials for the minimum-decorrelation and average-decorrelation criteria were compared with uncontrolled trials employing 9 or 18 cycles of matching sonication sequences. Lesion dimensions, treatment times, ablation rates, and areas under receiver operating characteristic curves were statistically compared. Successfully controlled trials using both criteria required significantly shorter treatment times than corresponding 18-cycle treatments, with better ablation prediction performance than uncontrolled 9-cycle and 18-cycle treatments. Either control approach resulted in greater ablation rate than corresponding 9-cycle or 18-cycle uncontrolled approaches. A post hoc analysis studied the effect of exchanging control criteria between the two series of controlled experiments. For either group, the average time needed to exceed the alternative decorrelation threshold approximately matched the average duration of successfully controlled experimental trials. These results indicate that either approach, using minimum-decorrelation or average-decorrelation criteria, is feasible for control of bulk US ablation. In addition, use of a variable-intensity sonication sequence for bulk US thermal ablation can result in larger ablated regions compared to constant-intensity sonication sequences.
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Kang TW, Lim HK, Cha DI. Aggressive tumor recurrence after radiofrequency ablation for hepatocellular carcinoma. Clin Mol Hepatol 2017; 23:95-101. [PMID: 28349677 PMCID: PMC5381839 DOI: 10.3350/cmh.2017.0006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Image-guided radiofrequency ablation (RFA) is an evolving and growing treatment option for patients with hepatocellular carcinoma (HCC) and hepatic metastasis. RFA offers significant advantages as it is less invasive than surgery and carries a low risk of major complications. However, serious complications, including aggressive tumor recurrence, may be observed during follow-up, and recently, mechanical or thermal damage during RFA has been proposed to be one of the causes of this kind of recurrence. Although the exact mechanism of this still remains unclear, physicians should be familiar with the imaging features of aggressive tumor recurrence after RFA for HCC and its risk factors. In addition, in order to prevent or minimize this newly recognized tumor recurrence, a modified RFA technique, combined RFA treatments with transarterial chemoembolization, and cryoablation can be used as alternative treatments. Ultimately, combining an understanding of this potential complication of RFA with an understanding of the possible risk factors for aggressive tumor recurrence and choosing alternative treatments are crucial to optimize clinical outcomes in each patient with HCC.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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