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Yeats E, Hall TL. Aberration correction in abdominal histotripsy. Int J Hyperthermia 2023; 40:2266594. [PMID: 37813397 PMCID: PMC10637766 DOI: 10.1080/02656736.2023.2266594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
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.
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Affiliation(s)
- Ellen Yeats
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
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2
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Chen X, Dong F, Yin C, Tu J, Zhang D, Guo X. Ultrasonic Imaging Based on Pulsed Airy Beams. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1146-1156. [PMID: 37490370 DOI: 10.1109/tuffc.2023.3298596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In ultrasonic imaging, high impedance obstacles in tissues may lead to artifacts behind them, making the examination of the target area difficult. Acoustical Airy beams possess the characteristics of self-bending and self-healing within a specific range. They are limited-diffracting when generated from finite aperture sources and are expected to have great potential in medical imaging and therapy. In this article, pulsed Airy (pAiry) beams are employed for ultrasonic imaging at megahertz frequency, and the protocol is demonstrated via both simulations and experiments. First, the generation of pAiry beams using a linear array is simulated, and the pulsed beams inherit some characteristics of continuous wave Airy beams, such as propagating along curved paths and self-healing. In experiments where obstacles are present at the beam paths, the image quality in pAiry-based imaging is superior to that in classical iso-depth imaging. The results demonstrate the feasibility and benefits of ultrasonic imaging based on pAiry beams and provide an important basis for developing imaging techniques employing nondiffracting acoustic beams.
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Lorton O, Guillemin PC, Peloso A, M’Rad Y, Crowe LA, Koessler T, Poletti PA, Boudabbous S, Ricoeur A, Salomir R. In Vivo Thermal Ablation of Deep Intrahepatic Targets Using a Super-Convergent MRgHIFU Applicator and a Pseudo-Tumor Model. Cancers (Basel) 2023; 15:3961. [PMID: 37568777 PMCID: PMC10417404 DOI: 10.3390/cancers15153961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND HIFU ablation of liver malignancies is particularly challenging due to respiratory motion, high tissue perfusion and the presence of the rib cage. Based on our previous development of a super-convergent phased-array transducer, we aimed to further investigate, in vivo, its applicability to deep intrahepatic targets. METHODS In a series of six pigs, a pseudo-tumor model was used as target, visible both on intra-operatory MRI and post-mortem gross pathology. The transcostal MRgHIFU ablation was prescribed coplanar with the pseudo-tumor, either axial or sagittal, but deliberately shifted 7 to 18 mm to the side. No specific means of protection of the ribs were implemented. Post-treatment MRI follow-up was performed at D7, followed by animal necropsy and gross pathology of the liver. RESULTS The pseudo-tumor was clearly identified on T1w MR imaging and subsequently allowed the MRgHIFU planning. The peak temperature at the focal point ranged from 58-87 °C. Gross pathology confirmed the presence of the pseudo-tumor and the well-delineated MRgHIFU ablation at the expected locations. CONCLUSIONS The specific design of the transducer enabled a reliable workflow. It demonstrated a good safety profile for in vivo transcostal MRgHIFU ablation of deep-liver targets, graded as challenging for standard surgery.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Pauline Coralie Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Andrea Peloso
- Visceral Surgery Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Yacine M’Rad
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | | | - Thibaud Koessler
- Oncology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | | | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Alexis Ricoeur
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, 1205 Geneva, Switzerland
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Yeats E, Lu N, Sukovich JR, Xu Z, Hall TL. Soft Tissue Aberration Correction for Histotripsy Using Acoustic Emissions From Cavitation Cloud Nucleation and Collapse. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1182-1193. [PMID: 36759271 PMCID: PMC10082475 DOI: 10.1016/j.ultrasmedbio.2023.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/01/2022] [Accepted: 01/03/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Phase aberration from soft tissue limits the efficacy of histotripsy, a therapeutic ultrasound technique based on acoustic cavitation. Previous work has shown that the acoustic emissions from cavitation can serve as "point sources" for aberration correction (AC). This study compared the efficacy of soft tissue AC for histotripsy using acoustic cavitation emissions (ACE) from bubble cloud nucleation and collapse. METHODS A 750-kHz, receive-capable histotripsy array was pulsed to generate cavitation in ex vivo porcine liver through an intervening abdominal wall. Received ACE signals were used to determine the arrival time differences to the focus and compute corrective delays. Corrections from single pulses and from the median of multiple pulses were tested. DISCUSSION On average, ACE AC obtained 96% ± 3% of the pressure amplitude obtained by hydrophone-based correction (compared with 71% ± 5% without AC). Both nucleation- and collapse-based corrections obtained >96% of the hydrophone-corrected pressure when using medians of ≥10 pulses. When using single-pulse corrections, nucleation obtained a range of 49%-99% of the hydrophone-corrected pressure, while collapse obtained 95%-99%. CONCLUSION The results suggest that (i) ACE AC can recover nearly all pressure amplitude lost owing to soft tissue aberration and that (ii) the collapse signal permits robust AC using a small number of pulses.
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Affiliation(s)
- Ellen Yeats
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Ning Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan R Sukovich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Knott EA, Longo KC, Vlaisavljevich E, Zhang X, Swietlik JF, Xu Z, Rodgers AC, Zlevor AM, Laeseke PF, Hall TL, Lee FT, Ziemlewicz TJ. Transcostal Histotripsy Ablation in an In Vivo Acute Hepatic Porcine Model. Cardiovasc Intervent Radiol 2021; 44:1643-1650. [PMID: 34244841 DOI: 10.1007/s00270-021-02914-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine whether histotripsy can create human-scale transcostal ablations in porcine liver without causing severe thermal wall injuries along the beam path. MATERIALS AND METHODS Histotripsy was applied to the liver using a preclinical prototype robotic system through a transcostal window in six female swine. A 3.0 cm spherical ablation zone was prescribed. Duration of treatment (75 min) was longer than a prior subcostal treatment study (24 min, 15 s) to minimize beam path heating. Animals then underwent contrast-enhanced MRI, necropsy, and histopathology. Images and tissue were analyzed for ablation zone size, shape, completeness of necrosis, and off-target effects. RESULTS Ablation zones demonstrated complete necrosis with no viable tissue remaining in 6/6 animals by histopathology. Ablation zone volume was close to prescribed (13.8 ± 1.8 cm3 vs. prescribed 14.1 cm3). Edema was noted in the body wall overlying the ablation on T2 MRI in 5/5 (one animal did not receive MRI), though there was no gross or histologic evidence of injury to the chest wall at necropsy. At gross inspection, lung discoloration in the right lower lobe was present in 5/6 animals (mean size: 1 × 2 × 4 cm) with alveolar hemorrhage, preservation of blood vessels and bronchioles, and minor injuries to pneumocytes noted at histology. CONCLUSION Transcostal hepatic histotripsy ablation appears feasible, effective, and no severe injuries were identified in an acute porcine model when prolonged cooling time is added to minimize body wall heating.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Katherine C Longo
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, 325 Stanger St, Blacksburg, VA, USA
| | - Xaiofei Zhang
- Department of Pathology and Laboratory Medicine, University of Wiscosin-Madison, 600 Highland Ave, Madison, WI, USA
| | - John F Swietlik
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, MI, USA
| | - Allison C Rodgers
- Department of Medicine, University of Wiscosin-Madison, 600 Highland Ave, Madison, WI, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, MI, USA
| | - Fred T Lee
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wiscosin-Madison, E3/311 CSC, 600 Highland Ave, Madison, WI, 53792, USA.
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Shan W, Mao X, Wang X, Hogan RE, Wang Q. Potential surgical therapies for drug-resistant focal epilepsy. CNS Neurosci Ther 2021; 27:994-1011. [PMID: 34101365 PMCID: PMC8339538 DOI: 10.1111/cns.13690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.
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Affiliation(s)
- Wei Shan
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
| | - Xuewei Mao
- Shandong Key Laboratory of Industrial Control TechnologySchool of AutomationQingdao UniversityQingdaoChina
| | - Xiu Wang
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
| | - Robert E. Hogan
- Departments of Neurology and NeurosurgerySchool of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Qun Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
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Zubair M, Dickinson R. Calculating the Effect of Ribs on the Focus Quality of a Therapeutic Spherical Random Phased Array. SENSORS 2021; 21:s21041211. [PMID: 33572208 PMCID: PMC7915479 DOI: 10.3390/s21041211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
The overlaying rib cage is a major hindrance in treating liver tumors with high intensity focused ultrasound (HIFU). The problems caused are overheating of the ribs due to its high ultrasonic absorption capability and degradation of the ultrasound intensity distribution in the target plane. In this work, a correction method based on binarized apodization and geometric ray tracing approach was employed to avoid heating the ribs. A detailed calculation of the intensity distribution in the focus plane was undertaken to quantify and avoid the effect on HIFU beam generated by a 1-MHz 256-element random phased array after the ultrasonic beam passes through the rib cage. Focusing through the ribs was simulated for 18 different idealized ribs-array configurations and 10 anatomically correct ribs-array configurations, to show the effect of width of the ribs, intercostal spacing and the relative position of ribs and array on the quality of focus, and to identify the positions that are more effective for HIFU applications in the presence of ribs. Acoustic simulations showed that for a single focus without beam steering and for the same total acoustic power, the peak intensity at the target varies from a minimum of 211 W/cm2 to a maximum of 293 W/cm2 for a nominal acoustic input power of 15 W, whereas the side lobe level varies from 0.07 Ipeak to 0.28 Ipeak and the separation between the main lobe and side lobes varies from 2.5 mm to 6.3 mm, depending on the relative positioning of the array and ribs and the beam alignment. An increase in the side lobe level was observed by increasing the distance between the array and the ribs. The parameters of focus splitting and the deterioration of focus quality caused by the ultrasonic propagation through the ribs were quantified in various possible different clinical scenarios. In addition to idealized rib topology, anatomical realistic ribs were used to determine the focus quality of the HIFU beam when the beam is steered both in axial and transverse directions and when the transducer is positioned at different depths from the rib cage.
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Affiliation(s)
- Muhammad Zubair
- Department of Radiation Oncology, University of California, San Francisco, CA 90007, USA
- Correspondence:
| | - Robert Dickinson
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK;
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Zubair M, Dickinson RJ. 3D synthetic aperture imaging with a therapeutic spherical random phased array for transcostal applications. Phys Med Biol 2021; 66:035024. [PMID: 33276351 DOI: 10.1088/1361-6560/abd0d0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Experimental validation of a synthetic aperture imaging technique using a therapeutic random phased array is described, demonstrating the dual nature of imaging and therapy of such an array. The transducer is capable of generating both continuous wave high intensity beams for ablating the tumor and low intensity ultrasound pulses to image the target area. Pulse-echo data is collected from the elements of the phased array to obtain B-mode images of the targets. Since therapeutic arrays are optimized for therapy only with concave apertures having low f-number and large directive elements often coarsely sampled, imaging can not be performed using conventional beamforming. We show that synthetic aperture imaging is capable of processing the acquired RF data to obtain images of the field of interest. Simulations were performed to compare different synthetic aperture imaging techniques to identify the best algorithm in terms of spatial resolution. Experimental validation was performed using a 1 MHz, 256-elements, spherical random phased array with 130 mm radius of curvature. The array was integrated with a research ultrasound scanner via custom connectors to acquire raw RF data for variety of targets. Imaging was implemented using synthetic aperture beamforming to produce images of a rib phantom and ex vivo ribs. The array was shown to resolve spherical targets within ±15 mm of either side of the axis in the focal plane and obtain 3D images of the rib phantom up to ±40 mm of either side of the central axis and at a depth of 3-9 cm from the array surface. The lateral and axial full width half maximum was 1.15 mm and 2.75 mm, respectively. This study was undertaken to emphasize that both therapy and image guidance with a therapeutic random phased array is possible and such a system has the potential to address some major limitations in the existing high intensity focused ultrasound (HIFU) systems. The 3D images obtained with a therapeutic array can be used to identify and locate strong scattering objects aiding to image guidance and treatment planning of the HIFU procedure.
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Affiliation(s)
- Muhammad Zubair
- Department of Bioengineering, Imperial College London, United Kingdom
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Lorton O, Guillemin P, Holman R, Desgranges S, Gui L, Crowe LA, Terraz S, Nastasi A, Lazeyras F, Contino-Pépin C, Salomir R. Enhancement of HIFU thermal therapy in perfused tissue models using micron-sized FTAC-stabilized PFOB-core endovascular sonosensitizers. Int J Hyperthermia 2020; 37:1116-1130. [PMID: 32990101 PMCID: PMC8352380 DOI: 10.1080/02656736.2020.1817575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) is clinically accepted for the treatment of solid tumors but remains challenging in highly perfused tissue due to the heat sink effect. Endovascular liquid-core sonosensitizers have been previously suggested to enhance the thermal energy deposition at the focal area and to lower the near-/far-field heating. We are investigating the therapeutic potential of PFOB-FTAC micro-droplets in a perfused tissue-mimicking model and postmortem excised organs. METHOD A custom-made in vitro perfused tissue-mimicking model, freshly excised pig kidneys (n = 3) and liver (n = 1) were perfused and subjected to focused ultrasound generated by an MR-compatible HIFU transducer. PFOB-FTAC sonosensitizers were injected in the perfusion fluid up to 0.235% v/v ratio. Targeting and on-line PRFS thermometry were performed on a 3 T MR scanner. Assessment of the fluid perfusion was performed with pulsed color Doppler in vitro and with dynamic contrast-enhanced (DCE)-MRI in excised organs. RESULTS Our in vitro model of perfused tissue demonstrated re-usability. Sonosensitizer concentration and perfusion rate were tunable in situ. Differential heating under equivalent HIFU sonications demonstrated a dramatic improvement in the thermal deposition due to the sonosensitizers activity. Typically, the energy deposition was multiplied by a factor between 2.5 and 3 in perfused organs after the administration of micro-droplets, while DCE-MRI indicated an effective perfusion. CONCLUSION The current PFOB-FTAC micro-droplet sonosensitizers provided a large and sustained enhancement of the HIFU thermal deposition at the focal area, suggesting solutions for less technological constraints, lower risk for the near-/far- field heating. We also report a suitable experimental model for other MRgHIFU studies.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ryan Holman
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lindsey A Crowe
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Antonio Nastasi
- Visceral and Transplantation Division, University Hospitals, Geneva, Switzerland
| | - François Lazeyras
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | | | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
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Cao R, Huang Z, Nabi G, Melzer A. Patient-Specific 3-Dimensional Model for High-Intensity Focused Ultrasound Treatment Through the Rib Cage: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:883-899. [PMID: 31721248 DOI: 10.1002/jum.15170] [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: 04/13/2019] [Revised: 09/12/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The purpose of this study was to develop a patient-specific 3-dimensional model for high-intensity focused ultrasound (HIFU) treatment through the rib cage using patient data. METHODS Experimental testing to derive parameters used in defining the amount of energy and alteration needed in treatment protocols for upper abdominal disorders under the rib cage was performed. Reconstructed rib cage models based on patient data, tissue-mimicking material phantoms, and magnetic resonance imaging-guided HIFU using a multielement phased array transducer were used in the experiments. Changes in the focal temperature, acoustic power, and acoustic pressure distribution were investigated with and without the presence of the rib cage model. An ExAblate system (InSightec Ltd, Tirat Carmel, Israel) was used to sonicate phantoms by varying the target phantom or rib cage model location. RESULTS The effect of the rib cage on the acoustic pressure distribution and acoustic power was closely related to the anatomic structures of the ribs. Thermometry revealed that heating at the focus could be controlled by changing either the power or duration of HIFU application to improve the focal temperature change. The focal temperature change was found to be related to the distance between the rib cage model and focus and the shadow area on the transducer elements covered by the rib cage model in the beam path. CONCLUSIONS Experimental results suggest that the rib cage model is a valuable and useful tool that can provide realistic human anatomic structures and properties for evaluating the effects of the rib cage on ultrasound propagation.
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Affiliation(s)
- Rui Cao
- Tianjin Key Laboratory of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin, China
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ghulam Nabi
- School of Medicine, Ninewells Hospital, Dundee, UK
| | - Andreas Melzer
- Institute for Medical Science and Technology, Dundee, UK
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11
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Khokhlova TD, Schade GR, Wang YN, Buravkov SV, Chernikov VP, Simon JC, Starr F, Maxwell AD, Bailey MR, Kreider W, Khokhlova VA. Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney. Sci Rep 2019; 9:20176. [PMID: 31882870 PMCID: PMC6934604 DOI: 10.1038/s41598-019-56658-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
Boiling histotripsy (BH) is a High Intensity Focused Ultrasound (HIFU) method for precise mechanical disintegration of target tissue using millisecond-long pulses containing shocks. BH treatments with real-time ultrasound (US) guidance allowed by BH-generated bubbles were previously demonstrated ex vivo and in vivo in exposed porcine liver and small animals. Here, the feasibility of US-guided transabdominal and partially transcostal BH ablation of kidney and liver in an acute in vivo swine model was evaluated for 6 animals. BH parameters were: 1.5 MHz frequency, 5–30 pulses of 1–10 ms duration per focus, 1% duty cycle, peak acoustic powers 0.9–3.8 kW, sonication foci spaced 1–1.5 mm apart in a rectangular grid with 5–15 mm linear dimensions. In kidneys, well-demarcated volumetric BH lesions were generated without respiratory gating and renal medulla and collecting system were more resistant to BH than cortex. The treatment was accelerated 10-fold by using shorter BH pulses of larger peak power without affecting the quality of tissue fractionation. In liver, respiratory motion and aberrations from subcutaneous fat affected the treatment but increasing the peak power provided successful lesion generation. These data indicate BH is a promising technology for transabdominal and transcostal mechanical ablation of tumors in kidney and liver.
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Affiliation(s)
- 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.
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Sergey V Buravkov
- Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow, Russia
| | | | - Julianna C Simon
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Frank Starr
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.,Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Wayne Kreider
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Vera A Khokhlova
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.,Physics Faculty, M.V. Lomonosov Moscow State University, Moscow, Russia
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Eranki A, Mikhail AS, Negussie AH, Katti PS, Wood BJ, Partanen A. Tissue-mimicking thermochromic phantom for characterization of HIFU devices and applications. Int J Hyperthermia 2019; 36:518-529. [PMID: 31046513 DOI: 10.1080/02656736.2019.1605458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Tissue-mimicking phantoms (TMPs) are synthetic materials designed to replicate properties of biological tissues. There is a need to quantify temperature changes following ultrasound or magnetic resonance imaging-guided high intensity focused ultrasound (MR-HIFU). This work describes development, characterization and evaluation of tissue-mimicking thermochromic phantom (TMTCP) for direct visualization and quantification of HIFU heating. The objectives were to (1) develop an MR-imageable, HIFU-compatible TMTCP that reports absolute temperatures, (2) characterize TMTCP physical properties and (3) examine TMTCP color change after HIFU. METHODS AND MATERIALS A TMTCP was prepared to contain thermochromic ink, silicon dioxide and bovine serum albumin (BSA) and its properties were quantified. A clinical MRI-guided and a preclinical US-guided HIFU system were used to perform sonications in TMTCP. MRI thermometry was performed during HIFU, followed by T2-weighted MRI post-HIFU. Locations of color and signal intensity change were compared to the sonication plan and to MRI temperature maps. RESULTS TMTCP properties were comparable to those in human soft tissues. Upon heating, the TMTCP exhibited an incremental but permanent color change for temperatures between 45 and 70 °C. For HIFU sonications the TMTCP revealed spatially sharp regions of color change at the target locations, correlating with MRI thermometry and hypointense regions on T2-weighted MRI. TMTCP-based assessment of various HIFU applications was also demonstrated. CONCLUSIONS We developed a novel MR-imageable and HIFU-compatible TMTCP to characterize HIFU heating without MRI or thermocouples. The HIFU-optimized TMTCP reports absolute temperatures and ablation zone geometry with high spatial resolution. Consequently, the TMTCP can be used to evaluate HIFU heating and may provide an in vitro tool for peak temperature assessment, and reduce preclinical in vivo requirements for clinical translation.
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Affiliation(s)
- Avinash Eranki
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA.,b Sheikh Zayed Institute for Pediatric Surgical Innovation , Children's National Medical Center , Washington , DC , USA
| | - Andrew S Mikhail
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Ayele H Negussie
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Prateek S Katti
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA.,c Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Bradford J Wood
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Ari Partanen
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center and National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
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Robin J, Simon A, Arnal B, Tanter M, Pernot M. Self-adaptive ultrasonic beam amplifiers: application to transcostal shock wave therapy. Phys Med Biol 2018; 63:175014. [PMID: 30101750 DOI: 10.1088/1361-6560/aad9b5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ultrasound shock wave therapy is increasingly used for non-invasive surgery. It requires the focusing of very high pressure amplitude in precisely controlled focal spots. In transcostal therapy of the heart or the liver, the high impedance mismatch between the bones and surrounding tissues gives rise to strong aberrations and attenuation of the therapeutic wavefront, with potential risks of injury at the tissue-bone interface. An adaptive propagation of the ultrasonic beam through the intercostal spaces would be required. Several solutions have been developed so far, but they require a prior knowledge of the patient's anatomy or an invasive calibration process, not applicable in clinic. Here, we develop a non-invasive adaptive focusing method for ultrasound therapy through the ribcage using a time reversal cavity (TRC) acting as an ultrasonic beam amplifier. This method is based on ribcage imaging through the TRC and a projection orthogonally to the strongest identified reflectors. The focal pressure of our device was improved by up to 30% using such self-adaptive processing, without degrading the focal spots size and shape. This improvement allowed lesion formation in an Ultracal® phantom through a ribcage without invasive calibration of the device. This adaptive method could be particularly interesting to improve the efficiency and the safety of pulsed cavitational therapy of the heart or the liver.
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Affiliation(s)
- J Robin
- Institut Langevin, ESPCI Paris, Inserm U979, CNRS UMR 7587, Université Paris Diderot, PSL Research University, Paris, France
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Ilovitsh T, Ilovitsh A, Foiret J, Ferrara KW. Imaging beyond ultrasonically-impenetrable objects. Sci Rep 2018; 8:5759. [PMID: 29636513 PMCID: PMC5893560 DOI: 10.1038/s41598-018-23776-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
Ultrasound images are severely degraded by the presence of obstacles such as bones and air gaps along the beam path. This paper describes a method for imaging structures that are distal to obstacles that are otherwise impenetrable to ultrasound. The method uses an optically-inspired holographic algorithm to beam-shape the emitted ultrasound field in order to bypass the obstacle and place the beam focus beyond the obstruction. The resulting performance depends on the transducer aperture, the size and position of the obstacle, and the position of the target. Improvement compared to standard ultrasound imaging is significant for obstacles for which the width is larger than one fourth of the transducer aperture and the depth is within a few centimeters of the transducer. For such cases, the improvement in focal intensity at the location of the target reaches 30-fold, and the improvement in peak-to-side-lobe ratio reaches 3-fold. The method can be implemented in conventional ultrasound systems, and the entire process can be performed in real time. This method has applications in the fields of cancer detection, abdominal imaging, imaging of vertebral structure and ultrasound tomography. Here, its effectiveness is demonstrated using wire targets, tissue mimicking phantoms and an ex vivo biological sample.
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Affiliation(s)
- Tali Ilovitsh
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Asaf Ilovitsh
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Josquin Foiret
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Katherine W Ferrara
- Department of Biomedical Engineering, University of California, Davis, California, USA.
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Matthew Hawkins C, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor AS, Towbin RB, Cahill AM, Lungren MP. Role of interventional radiology in managing pediatric liver tumors : Part 2: percutaneous interventions. Pediatr Radiol 2018; 48:565-580. [PMID: 29396792 DOI: 10.1007/s00247-018-4072-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/22/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
Hepatoblastoma and hepatocellular carcinoma (HCC) are the most common pediatric liver malignancies, with hepatoblastoma occurring more commonly in younger children and HCC occurring more commonly in older children and adolescents. Although surgical resection (including transplant when necessary) and systemic chemotherapy have improved overall survival rate for hepatoblastoma to approximately 80% from 30%, a number of children with this tumor type are not eligible for operative treatment. In contradistinction, pediatric HCC continues to carry a dismal prognosis with an overall 5-year survival rate of 30%. The Paediatric Hepatic International Tumour Trial (PHITT) is an international trial aimed at evaluating both existing and emerging oncologic therapies for primary pediatric liver tumors. Interventional radiology offers a number of minimally invasive procedures that aid in diagnosis and therapy of pediatric liver tumors. For diagnosis, the PHITT biopsy guidelines emphasize and recommend percutaneous image-guided tumor biopsy. Additionally, both percutaneous and endovascular procedures provide therapeutic alternatives that have been, to this point, only minimally utilized in the pediatric population. Specifically, percutaneous ablation offers a number of cytotoxic technologies that can potentially eradicate disease or downstage children with unresectable disease. Percutaneous portal vein embolization is an additional minimally invasive procedure that might be useful to induce remnant liver hypertrophy prior to extended liver resection in the setting of a primary liver tumor. PHITT offers an opportunity to collect data from children treated with these emerging therapeutic options across the world. The purpose of this manuscript is to describe the potential role of minimally invasive percutaneous transhepatic procedures, as well as review the existing data largely stemming from the adult HCC experience.
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Affiliation(s)
- C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA.
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Eric J Monroe
- Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA
| | - Avnesh S Thakor
- Department of Radiology, Lucille Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew P Lungren
- Department of Radiology, Lucille Packard Children's Hospital, Stanford University, Stanford, CA, USA
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Eranki A, Farr N, Partanen A, Sharma KV, Rossi CT, Rosenberg AZ, Kim A, Oetgen M, Celik H, Woods D, Yarmolenko PS, Kim PCW, Wood BJ. Mechanical fractionation of tissues using microsecond-long HIFU pulses on a clinical MR-HIFU system. Int J Hyperthermia 2018; 34:1213-1224. [PMID: 29429375 DOI: 10.1080/02656736.2018.1438672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE High intensity focussed ultrasound (HIFU) can non-invasively treat tumours with minimal or no damage to intervening tissues. While continuous-wave HIFU thermally ablates target tissue, the effect of hundreds of microsecond-long pulsed sonications is examined in this work. The objective of this study was to characterise sonication parameter-dependent thermomechanical bioeffects to provide the foundation for future preclinical studies and facilitate clinical translation. METHODS AND MATERIALS Acoustic power, number of cycles/pulse, sonication time and pulse repetition frequency (PRF) were varied on a clinical magnetic resonance imaging (MRI)-guided HIFU (MR-HIFU) system. Ex vivo porcine liver, kidney and cardiac muscle tissue samples were sonicated (3 × 3 grid pattern, 1 mm spacing). Temperature, thermal dose and T2 relaxation times were quantified using MRI. Lesions were histologically analysed using H&E and vimentin stains for lesion structure and viability. RESULTS Thermomechanical HIFU bioeffects produced distinct types of fractionated tissue lesions: solid/thermal, paste-like and vacuolated. Sonications at 20 or 60 Hz PRF generated substantial tissue damage beyond the focal region, with reduced viability on vimentin staining, whereas H&E staining indicated intact tissue. Same sonication parameters produced dissimilar lesions in different tissue types, while significant differences in temperature, thermal dose and T2 were observed between the parameter sets. CONCLUSION Clinical MR-HIFU system was utilised to generate distinct types of lesions and to produce targeted thermomechanical bioeffects in ex vivo tissues. The results guide HIFU research on thermomechanical tissue bioeffects, inform future studies and advice sonication parameter selection for direct tumour ablation or immunomodulation using a clinical MR-HIFU system.
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Affiliation(s)
- Avinash Eranki
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA.,b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA
| | - Navid Farr
- b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA
| | - Ari Partanen
- b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA.,c Clinical Science MR Therapy, Philips , Andover , MA , USA
| | - Karun V Sharma
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA
| | - Christopher T Rossi
- d Department of Pathology , Children's National Health System , Washington , DC , USA
| | - Avi Z Rosenberg
- e Department of Pathology , Johns Hopkins University , Baltimore , MD , USA
| | - AeRang Kim
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA
| | - Matthew Oetgen
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA
| | - Haydar Celik
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA.,b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA
| | - David Woods
- b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA
| | - Pavel S Yarmolenko
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA
| | - Peter C W Kim
- a Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System , Washington , DC , USA
| | - Bradford J Wood
- b Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center , National Institutes of Health , Bethesda , MD , USA
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Bour P, Ozenne V, Marquet F, Denis de Senneville B, Dumont E, Quesson B. Real-time 3D ultrasound based motion tracking for the treatment of mobile organs with MR-guided high-intensity focused ultrasound. Int J Hyperthermia 2018; 34:1225-1235. [PMID: 29378441 DOI: 10.1080/02656736.2018.1433879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatments of mobile organs require locking the HIFU beam on the targeted tissue to maximise heating efficiency. We propose to use a standalone 3 D ultrasound (US)-based motion correction technique using the HIFU transducer in pulse-echo mode. Validation of the method was performed in vitro and in vivo in the liver of pig under MR-thermometry. METHODS 3 D-motion estimation was implemented using ultrasonic speckle-tracking between consecutive acquisitions. Displacement was estimated along four sub-apertures of the HIFU transducer by computing the normalised cross-correlation of backscattered signals followed by a triangulation algorithm. The HIFU beam was steered accordingly and energy was delivered under real-time MR-thermometry (using the proton resonance frequency shift method with online motion compensation and correction of associated susceptibility artefacts). An MR-navigator echo was used to assess the quality of the US-based motion correction. RESULTS Displacement estimations from US measurements were in good agreement with 1 D MR-navigator echo readings. In vitro, the maximum temperature increase was improved by 37% as compared to experiments performed without motion correction and temperature distribution remained much more focussed. Similar results were reported in vivo, with an increase of 35% on the maximum temperature using this US-based HIFU target locking. CONCLUSION This standalone 3D US-based motion correction technique is robust and allows maintaining the HIFU focal spot in the presence of motion without adding any burden or complexity to MR thermal imaging. In vitro and in vivo results showed about 35% improvement in heating efficiency when focus position was locked on the target using the proposed technique.
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Affiliation(s)
- Pierre Bour
- a IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Universite´ , Pessac-Bordeaux , France.,b Centre de Recherche Cardio-Thoracique de Bordeaux , Univ. Bordeaux , Bordeaux , France.,c INSERM , Centre de Recherche Cardio-Thoracique de Bordeaux , Bordeaux , France.,d Image Guided Therapy SA , Pessac , France
| | - Valéry Ozenne
- a IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Universite´ , Pessac-Bordeaux , France.,b Centre de Recherche Cardio-Thoracique de Bordeaux , Univ. Bordeaux , Bordeaux , France.,c INSERM , Centre de Recherche Cardio-Thoracique de Bordeaux , Bordeaux , France
| | - Fabrice Marquet
- a IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Universite´ , Pessac-Bordeaux , France.,b Centre de Recherche Cardio-Thoracique de Bordeaux , Univ. Bordeaux , Bordeaux , France.,c INSERM , Centre de Recherche Cardio-Thoracique de Bordeaux , Bordeaux , France
| | | | | | - Bruno Quesson
- a IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Universite´ , Pessac-Bordeaux , France.,b Centre de Recherche Cardio-Thoracique de Bordeaux , Univ. Bordeaux , Bordeaux , France.,c INSERM , Centre de Recherche Cardio-Thoracique de Bordeaux , Bordeaux , France
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18
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Menikou G, Yiannakou M, Yiallouras C, Ioannides C, Damianou C. MRI-compatible breast/rib phantom for evaluating ultrasonic thermal exposures. Int J Med Robot 2017; 14. [DOI: 10.1002/rcs.1849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/12/2023]
Affiliation(s)
| | | | - Christos Yiallouras
- Cyprus University of Technology; Limassol Cyprus
- MEDSONIC LTD; Limassol Cyprus
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19
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van Breugel JMM, de Greef M, Wijlemans JW, Schubert G, van den Bosch MAAJ, Moonen CTW, Ries MG. Thermal ablation of a confluent lesion in the porcine kidney with a clinically available MR-HIFU system. Phys Med Biol 2017; 62:5312-5326. [PMID: 28557798 DOI: 10.1088/1361-6560/aa75b3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of small renal masses (SRMs) sized <4 cm has increased over the decades (as co-findings/or due to introduction of cross sectional imaging). Currently, partial nephrectomy (PN) or watchful waiting is advised in these patients. Ultimately, 80-90% of these SRMs require surgical treatment and PN is associated with a 15% complication rate. In this aging population, with possible comorbidities and poor health condition, both PN and watchful waiting are non-ideal treatment options. This resulted in an increased need for early, non-invasive treatment strategies such as MR-guided high intensity focused ultrasound (MR-HIFU). (i) To investigate the feasibility of creating a confluent lesion in the kidney using respiratory-gated MR-HIFU under clinical conditions in a pre-clinical study and (ii) to evaluate the reproducibility of the MR-HIFU ablation strategy. Healthy pigs (n = 10) under general anesthesia were positioned on a clinical MR-HIFU system with integrated cooling. A honeycomb pattern of seven overlapping ablation cells (4 × 4 × 10 mm3, 450 W, <30 s) was ablated successively in the cortex of the porcine kidney. Both MR thermometry and acoustic energy delivery were respiratory gated using a pencil beam navigator on the contralateral kidney. The non-perfused volume (NPV) was visualized after the last sonication by contrast-enhanced (CE) T 1-weighted MR (T 1 w) imaging. Cell viability staining was performed to visualize the extent of necrosis. RESULTS a median NPV of 0.62 ml was observed on CE-T 1 w images (IQR 0.58-1.57 ml, range 0.33-2.75 ml). Cell viability staining showed a median damaged volume of 0.59 ml (IQR 0.24-1.35 ml, range 0-4.1 ml). Overlooking of the false rib, shivering of the pig, and too large depth combined with a large heat-sink effect resulted in insufficient heating in 4 cases. The NPV and necrosed volume were confluent in all cases in which an ablated volume could be observed. Our results demonstrated the feasibility of creating a confluent volume of ablated kidney cortical tissue in vivo with MR-HIFU on a clinically available system using respiratory gating and near-field cooling and showed its reproducibility.
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Affiliation(s)
- J M M van Breugel
- Center for Imaging Sciences, University Medical Center Utrecht, Utrecht, Netherlands
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Schwenke M, Georgii J, Preusser T. Fast Numerical Simulation of Focused Ultrasound Treatments During Respiratory Motion With Discontinuous Motion Boundaries. IEEE Trans Biomed Eng 2017; 64:1455-1468. [DOI: 10.1109/tbme.2016.2619741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michael Schwenke
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
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Kuroda K. MR techniques for guiding high-intensity focused ultrasound (HIFU) treatments. J Magn Reson Imaging 2017; 47:316-331. [PMID: 28580706 DOI: 10.1002/jmri.25770] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/02/2017] [Indexed: 12/17/2022] Open
Abstract
To make full use of the ability of magnetic resonance (MR) to guide high-intensity focused ultrasound (HIFU) treatment, effort has been made to improve techniques for thermometry, motion tracking, and sound beam visualization. For monitoring rapid temperature elevation with proton resonance frequency (PRF) shift, data acquisition and processing can be accelerated with parallel imaging and/or sparse sampling in conjunction with appropriate signal processing methods. Thermometry should be robust against tissue motion, motion-induced magnetic field variation, and susceptibility change. Thus, multibaseline, referenceless, or hybrid techniques have become important. In cases with adipose or bony tissues, for which PRF shift cannot be used, thermometry with relaxation times or signal intensity may be utilized. Motion tracking is crucial not only for thermometry but also for targeting the focus of an ultrasound in moving organs such as the liver, kidney, or heart. Various techniques for motion tracking, such as those based on an anatomical image atlas with optical-flow displacement detection, a navigator echo to seize the diaphragm position, and/or rapid imaging to track vessel positions, have been proposed. Techniques for avoiding the ribcage and near-field heating have also been examined. MR acoustic radiation force imaging (MR-ARFI) is an alternative to thermometry that can identify the location and shape of the focal spot and sound beam path. This technique could be useful for treating heterogeneous tissue regions or performing transcranial therapy. All of these developments, which will be discussed further in this review, expand the applicability of HIFU treatments to a variety of clinical targets while maintaining safety and precision. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:316-331.
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Affiliation(s)
- Kagayaki Kuroda
- Department of Human and Information Science, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan.,Center for Frontier Medical Engineering, Chiba University, Inage, Chiba, Japan
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Eranki A, Farr N, Partanen A, V. Sharma K, Chen H, Rossi CT, Kothapalli SVVN, Oetgen M, Kim A, H. Negussie A, Woods D, J. Wood B, C. W. Kim P, S. Yarmolenko P. Boiling histotripsy lesion characterization on a clinical magnetic resonance imaging-guided high intensity focused ultrasound system. PLoS One 2017; 12:e0173867. [PMID: 28301597 PMCID: PMC5354405 DOI: 10.1371/journal.pone.0173867] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 02/21/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose High intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that can thermally ablate tumors. Boiling histotripsy (BH) is a HIFU approach that can emulsify tissue in a few milliseconds. Lesion volume and temperature effects for different BH sonication parameters are currently not well characterized. In this work, lesion volume, temperature distribution, and area of lethal thermal dose were characterized for varying BH sonication parameters in tissue-mimicking phantoms (TMP) and demonstrated in ex vivo tissues. Methods The following BH sonication parameters were varied using a clinical MR-HIFU system (Sonalleve V2, Philips, Vantaa, Finland): acoustic power, number of cycles/pulse, total sonication time, and pulse repetition frequency (PRF). A 3×3×3 pattern was sonicated inside TMP’s and ex vivo tissues. Post sonication, lesion volumes were quantified using 3D ultrasonography and temperature and thermal dose distributions were analyzed offline. Ex vivo tissues were sectioned and stained with H&E post sonication to assess tissue damage. Results Significant increase in lesion volume was observed while increasing the number of cycles/pulse and PRF. Other sonication parameters had no significant effect on lesion volume. Temperature full width at half maximum at the end of sonication increased significantly with all parameters except total sonication time. Positive correlation was also found between lethal thermal dose and lesion volume for all parameters except number of cycles/pulse. Gross pathology of ex vivo tissues post sonication displayed either completely or partially damaged tissue at the focal region. Surrounding tissues presented sharp boundaries, with little or no structural damage to adjacent critical structures such as bile duct and nerves. Conclusion Our characterization of effects of HIFU sonication parameters on the resulting lesion demonstrates the ability to control lesion morphologic and thermal characteristics with a clinical MR-HIFU system in TMP’s and ex vivo tissues. We demonstrate that this system can produce spatially precise lesions in both phantoms and ex vivo tissues. The results provide guidance on a preliminary set of BH sonication parameters for this system, with a potential to facilitate BH translation to the clinic.
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Affiliation(s)
- Avinash Eranki
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail: ,
| | - Navid Farr
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ari Partanen
- Clinical Science MR Therapy, Philips, Andover, Massachusetts, United States of America
| | - Karun V. Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Hong Chen
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, Missouri, United States of America
| | - Christopher T. Rossi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Satya V. V. N. Kothapalli
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, Missouri, United States of America
| | - Matthew Oetgen
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - AeRang Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Ayele H. Negussie
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Woods
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peter C. W. Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
| | - Pavel S. Yarmolenko
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, United States of America
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Ramaekers P, Ries M, Moonen CT, de Greef M. Improved intercostal HIFU ablation using a phased array transducer based on Fermat's spiral and Voronoi tessellation: A numerical evaluation. Med Phys 2017; 44:1071-1088. [DOI: 10.1002/mp.12082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 11/22/2016] [Accepted: 12/25/2016] [Indexed: 01/25/2023] Open
Affiliation(s)
- Pascal Ramaekers
- Imaging Division; University Medical Center Utrecht; 3508 GA Utrecht The Netherlands
| | - Mario Ries
- Imaging Division; University Medical Center Utrecht; 3508 GA Utrecht The Netherlands
| | - Chrit T.W. Moonen
- Imaging Division; University Medical Center Utrecht; 3508 GA Utrecht The Netherlands
| | - Martijn de Greef
- Imaging Division; University Medical Center Utrecht; 3508 GA Utrecht The Netherlands
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Zhang S, Cui Z, Xu T, Liu P, Li D, Shang S, Xu R, Zong Y, Niu G, Wang S, He X, Wan M. Inverse effects of flowing phase-shift nanodroplets and lipid-shelled microbubbles on subsequent cavitation during focused ultrasound exposures. ULTRASONICS SONOCHEMISTRY 2017; 34:400-409. [PMID: 27773262 DOI: 10.1016/j.ultsonch.2016.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Siyuan Zhang
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Zhiwei Cui
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Tianqi Xu
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Pan Liu
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Dapeng Li
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Shaoqiang Shang
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Ranxiang Xu
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Yujin Zong
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Supin Wang
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Xijing He
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, People's Republic of China
| | - Mingxi Wan
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China.
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Karakitsios I, Joy J, Mihcin S, Melzer A. Acoustic characterization of Thiel liver for magnetic resonance-guided focused ultrasound treatment. MINIM INVASIV THER 2016; 26:92-96. [PMID: 27784190 DOI: 10.1080/13645706.2016.1253589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this work was to measure the essential acoustic parameters, i.e., acoustic impedance, reflection coefficient, attenuation coefficient, of Thiel embalmed human and animal liver. The Thiel embalmed tissue can be a promising, pre-clinical model to study liver treatment with Magnetic Resonance-guided Focused Ultrasound (MRgFUS). MATERIAL AND METHODS Using a single-element transducer and the contact pulse-echo method, the acoustic parameters, i.e., acoustic impedance, reflection coefficient and attenuation coefficient of Thiel embalmed human and animal liver were measured. RESULTS The Thiel embalmed livers had higher impedance, similar reflection and lower attenuation compared to the fresh tissue. CONCLUSIONS Embalming liver with Thiel fluid affects its acoustic properties. During MRgFUS sonication of a Thiel organ, more focused ultrasound (FUS) will be backscattered by the organ, and higher acoustic powers are required to reach coagulation levels (temperatures >56 °C).
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Affiliation(s)
- Ioannis Karakitsios
- a Institute of Medical Science and Technology , University of Dundee , Dundee , UK
| | - Joyce Joy
- a Institute of Medical Science and Technology , University of Dundee , Dundee , UK
| | - Senay Mihcin
- a Institute of Medical Science and Technology , University of Dundee , Dundee , UK
| | - Andreas Melzer
- a Institute of Medical Science and Technology , University of Dundee , Dundee , UK
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Peng S, Zhou P, He W, Liao M, Chen L, Ma CM. Treatment of hepatic tumors by thermal versus mechanical effects of pulsed high intensity focused ultrasound in vivo. Phys Med Biol 2016; 61:6754-6769. [PMID: 27580168 DOI: 10.1088/0031-9155/61/18/6754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study is to comparatively assess the thermal versus mechanical effects of pulsed high intensity focused ultrasound (HIFU) treatment on hepatic tumors in vivo. Forty-five rabbits with hepatic VX2 tumors were randomly separated into three groups (15 animals per group) before HIFU ablation. The total HIFU energy (in situ) of 1250 J was used for each tumor for three groups. In groups I and II, animals were treated with 1 MHz pulsed ultrasound at 1 Hz pulsed repetition frequency (PRF), 0.5 duty cycle (0.5 s on and 0.5 s off) and10 s duration for one spot sonication. For group II, in addition to HIFU treatment, microbubbles (SonoVue, Bracco, Milan, Italy) were injected via vein before sonication acting as a synergist. In group III, animals were treated with 1 MHz pulsed ultrasound at 10 Hz PRF, 0.1 duty cycle (0.1 s on and 0.9 s off) and 10 s duration for one sonication. The total treatment spots were calculated according to the tumor volume. Tumors were examined with contrast-enhanced computed tomography (CECT) immediately prior to and post HIFU treatment. Histopathologic assessment was performed 3 h after treatment. Our study showed that all animals tolerated the HIFU treatment well. Our data showed that mechanical HIFU could lead to controlled injury in rabbit hepatic tumors with different histological changes in comparison to thermal HIFU with or without microbubbles.
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Affiliation(s)
- Song Peng
- Department of Diagnostic Imaging, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, People's Republic of China
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Hynynen K, Jones RM. Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy. Phys Med Biol 2016; 61:R206-48. [PMID: 27494561 PMCID: PMC5022373 DOI: 10.1088/0031-9155/61/17/r206] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada. Department of Medical Biophysics, University of Toronto, Toronto, Canada. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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Fortin PY, Lepetit-Coiffé M, Genevois C, Debeissat C, Quesson B, Moonen CTW, Konsman JP, Couillaud F. Spatiotemporal control of gene expression in bone-marrow derived cells of the tumor microenvironment induced by MRI guided focused ultrasound. Oncotarget 2016; 6:23417-26. [PMID: 26299614 PMCID: PMC4695127 DOI: 10.18632/oncotarget.4288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022] Open
Abstract
The tumor microenvironment is an interesting target for anticancer therapies but modifying this compartment is challenging. Here, we demonstrate the feasibility of a gene therapy strategy that combined targeting to bone marrow-derived tumor microenvironment using genetically modified bone-marrow derived cells and control of transgene expression by local hyperthermia through a thermo-inducible promoter. Chimera were obtained by engraftment of bone marrow from transgenic mice expressing reporter genes under transcriptional control of heat shock promoter and inoculated sub-cutaneously with tumors cells. Heat shocks were applied at the tumor site using a water bath or magnetic resonance guided high intensity focused ultrasound device. Reporter gene expression was followed by bioluminescence and fluorescence imaging and immunohistochemistry. Bone marrow-derived cells expressing reporter genes were identified to be mainly tumor-associated macrophages. We thus provide the proof of concept for a gene therapy strategy that allows for spatiotemporal control of transgenes expression by macrophages targeted to the tumor microenvironment.
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Affiliation(s)
- Pierre-Yves Fortin
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France.,Institut de Bio-Imagerie (IBIO), CNRS/UMS 3428, Université de Bordeaux, Bordeaux, France
| | - Matthieu Lepetit-Coiffé
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France
| | - Coralie Genevois
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France.,Institut de Bio-Imagerie (IBIO), CNRS/UMS 3428, Université de Bordeaux, Bordeaux, France
| | - Christelle Debeissat
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France
| | - Bruno Quesson
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France
| | - Chrit T W Moonen
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France
| | - Jan Pieter Konsman
- Centre de Résonance Magnétique des Systèmes Biologiques (RMSB), CNRS/UMR 5536, Université de Bordeaux, Bordeaux, France
| | - Franck Couillaud
- Laboratoire d'Imagerie Moléculaire et Fonctionnelle (IMF), CNRS/UMR 5231, Université de Bordeaux, Bordeaux, France.,Centre de Résonance Magnétique des Systèmes Biologiques (RMSB), CNRS/UMR 5536, Université de Bordeaux, Bordeaux, France
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van Breugel JMM, Wijlemans JW, Vaessen HHB, de Greef M, Moonen CTW, van den Bosch MAAJ, Ries MG. Procedural sedation and analgesia for respiratory-gated MR-HIFU in the liver: a feasibility study. J Ther Ultrasound 2016; 4:19. [PMID: 27478615 PMCID: PMC4966712 DOI: 10.1186/s40349-016-0063-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies demonstrated both pre-clinically and clinically the feasibility of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablations in the liver. To overcome the associated problem of respiratory motion of the ablation area, general anesthesia (GA) and mechanical ventilation was used in conjunction with either respiratory-gated energy delivery or energy delivery during induced apnea. However, clinical procedures requiring GA are generally associated with increased mortality, morbidity, and complication rate compared to procedural sedation and analgesia (PSA). Furthermore, PSA is associated with faster recovery and an increased eligibility for non- and mini-invasive interventions. METHODS In this study, we investigate both in an animal model and on a small patient group the kinetics of the diaphragm during free-breathing, when a tailored remifentanil/propofol-based PSA protocol inducing partial respiratory depression is used. Subsequently, we demonstrate in an animal study the compatibility of the resulting respiratory pattern of the PSA protocol with a gated HIFU ablation in the liver by direct comparison with gated ablations conducted under GA. Wilcoxon signed-rank tests were performed for statistical analysis of non-perfused and necrosed tissue volumes. Duty cycles (ratio or percentage of the breathing cycle with the diaphragm in its resting position, such that acoustic energy delivery with MR-HIFU was allowed) were statistically compared for both GA and PSA using student's t tests. RESULTS In both animal and human experiments, the breathing frequency was decreased below 9/min, while maintaining stable vital functions. Furthermore an end-exhalation resting phase was induced by this PSA protocol during which the diaphragm is virtually immobile. Median non-perfused volumes, non-viable volumes based on NADH staining, and duty cycles were larger under PSA than under GA or equal. CONCLUSIONS We conclude that MR-HIFU ablations of the liver under PSA are feasible and potentially increase the non-invasive nature of this type of intervention.
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Affiliation(s)
- Johanna M. M. van Breugel
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Postbox: 85500, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Joost W. Wijlemans
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn de Greef
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chrit T. W. Moonen
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mario G. Ries
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
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Loeve AJ, Al-Issawi J, Fernandez-Gutiérrez F, Langø T, Strehlow J, Haase S, Matzko M, Napoli A, Melzer A, Dankelman J. Workflow and intervention times of MR-guided focused ultrasound – Predicting the impact of new techniques. J Biomed Inform 2016; 60:38-48. [DOI: 10.1016/j.jbi.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 12/28/2015] [Accepted: 01/01/2016] [Indexed: 12/30/2022]
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Ramaekers P, de Greef M, van Breugel JMM, Moonen CTW, Ries M. Increasing the HIFU ablation rate through an MRI-guided sonication strategy using shock waves: feasibility in thein vivoporcine liver. Phys Med Biol 2016; 61:1057-77. [DOI: 10.1088/0031-9155/61/3/1057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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MRI-Guided HIFU Methods for the Ablation of Liver and Renal Cancers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:43-63. [DOI: 10.1007/978-3-319-22536-4_3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Copelan A, Hartman J, Chehab M, Venkatesan AM. High-Intensity Focused Ultrasound: Current Status for Image-Guided Therapy. Semin Intervent Radiol 2015; 32:398-415. [PMID: 26622104 DOI: 10.1055/s-0035-1564793] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Image-guided high-intensity focused ultrasound (HIFU) is an innovative therapeutic technology, permitting extracorporeal or endocavitary delivery of targeted thermal ablation while minimizing injury to the surrounding structures. While ultrasound-guided HIFU was the original image-guided system, MR-guided HIFU has many inherent advantages, including superior depiction of anatomic detail and superb real-time thermometry during thermoablation sessions, and it has recently demonstrated promising results in the treatment of both benign and malignant tumors. HIFU has been employed in the management of prostate cancer, hepatocellular carcinoma, uterine leiomyomas, and breast tumors, and has been associated with success in limited studies for palliative pain management in pancreatic cancer and bone tumors. Nonthermal HIFU bioeffects, including immune system modulation and targeted drug/gene therapy, are currently being explored in the preclinical realm, with an emphasis on leveraging these therapeutic effects in the care of the oncology patient. Although still in its early stages, the wide spectrum of therapeutic capabilities of HIFU offers great potential in the field of image-guided oncologic therapy.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jason Hartman
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Monzer Chehab
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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Lam MK, de Greef M, Bouwman JG, Moonen CTW, Viergever MA, Bartels LW. Multi-gradient echo MR thermometry for monitoring of the near-field area during MR-guided high intensity focused ultrasound heating. Phys Med Biol 2015; 60:7729-45. [DOI: 10.1088/0031-9155/60/19/7729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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A clinically feasible treatment protocol for magnetic resonance-guided high-intensity focused ultrasound ablation in the liver. Invest Radiol 2015; 50:24-31. [PMID: 25198833 DOI: 10.1097/rli.0000000000000091] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) allows for noninvasive thermal ablation under real-time temperature imaging guidance. The purpose of this study was to assess the feasibility and safety of MR-HIFU ablation of liver tissue in a clinically acceptable setting. The experimental protocol was designed with a clinical ablation procedure of a small malignant tumor in mind; the procedures were performed within a clinically feasible time frame and care was taken to avoid adverse events. The main outcome was the size and quality of the ablated liver tissue volume on imaging and histology. Secondary outcomes were safety and treatment time. MATERIALS AND METHODS Healthy pigs (n = 10) under general anesthesia were positioned on a clinical MR-HIFU system, which consisted of an HIFU tabletop with a skin cooling system integrated into a 1.5-T MR scanner. A liver tissue volume was ablated with multiple sonication cells (4 × 4 × 10 mm, 450 W). Both MR thermometry and sonication were respiratory-gated using a pencil beam navigator on the diaphragm. Contrast-enhanced T1-weighted (CE-T1w) imaging was performed for treatment evaluation. Targeted total treatment time was 3 hours. The abdominal wall, liver, and adjacent organs were inspected postmortem for thermal damage. Ablated tissue volumes were processed for cell viability staining. The ablated volumes were analyzed using MR imaging, MR thermometry, and cell viability histology. RESULTS Eleven volume ablations were performed in 10 animals, resulting in a median nonperfused volume (NPV) on CE-T1w imaging of 1.6 mL (interquartile range [IQR], 0.8-2.3; range, 0.7-3.0). Cell viability histology showed a damaged volume of 1.5 mL (IQR, 1.1-1.8; range, 0.7-2.3). The NPV was confluent in 10 of the 11 cases. The ablated tissue volume on cell viability histology was confluent in all 9 available cases. In all cases, there was a good correspondence between the aspects of the NPV on CE-T1w and the ablated volume on cell viability histology. Two treatment-related adverse events occurred: 1 animal had a 7-mm skin burn and 1 animal showed evidence of thermal damage on the surface of the spleen. Median ablation time was 108 minutes (IQR, 101-120; range, 96-181 minutes) and median total treatment time was 180 minutes (IQR, 165-224; 130-250 minutes). CONCLUSIONS Our results demonstrate the feasibility and safety of MR-HIFU ablation of liver tissue volumes. The imaging data and cell viability histology show, for the first time, that confluent ablation volumes can be achieved with motion-gated ablation and MR guidance. These results were obtained using a readily available MR-HIFU system with only minor modifications, within a clinically acceptable time frame, and with only minor adverse events. This shows that this technique is sufficiently reliable and safe to initiate a clinical trial.
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de Greef M, Schubert G, Wijlemans JW, Koskela J, Bartels LW, Moonen CTW, Ries M. Intercostal high intensity focused ultrasound for liver ablation: The influence of beam shaping on sonication efficacy and near-field risks. Med Phys 2015; 42:4685-97. [DOI: 10.1118/1.4925056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Odéen H, Todd N, Diakite M, Minalga E, Payne A, Parker DL. Sampling strategies for subsampled segmented EPI PRF thermometry in MR guided high intensity focused ultrasound. Med Phys 2015; 41:092301. [PMID: 25186406 DOI: 10.1118/1.4892171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate k-space subsampling strategies to achieve fast, large field-of-view (FOV) temperature monitoring using segmented echo planar imaging (EPI) proton resonance frequency shift thermometry for MR guided high intensity focused ultrasound (MRgHIFU) applications. METHODS Five different k-space sampling approaches were investigated, varying sample spacing (equally vs nonequally spaced within the echo train), sampling density (variable sampling density in zero, one, and two dimensions), and utilizing sequential or centric sampling. Three of the schemes utilized sequential sampling with the sampling density varied in zero, one, and two dimensions, to investigate sampling the k-space center more frequently. Two of the schemes utilized centric sampling to acquire the k-space center with a longer echo time for improved phase measurements, and vary the sampling density in zero and two dimensions, respectively. Phantom experiments and a theoretical point spread function analysis were performed to investigate their performance. Variable density sampling in zero and two dimensions was also implemented in a non-EPI GRE pulse sequence for comparison. All subsampled data were reconstructed with a previously described temporally constrained reconstruction (TCR) algorithm. RESULTS The accuracy of each sampling strategy in measuring the temperature rise in the HIFU focal spot was measured in terms of the root-mean-square-error (RMSE) compared to fully sampled "truth." For the schemes utilizing sequential sampling, the accuracy was found to improve with the dimensionality of the variable density sampling, giving values of 0.65 °C, 0.49 °C, and 0.35 °C for density variation in zero, one, and two dimensions, respectively. The schemes utilizing centric sampling were found to underestimate the temperature rise, with RMSE values of 1.05 °C and 1.31 °C, for variable density sampling in zero and two dimensions, respectively. Similar subsampling schemes with variable density sampling implemented in zero and two dimensions in a non-EPI GRE pulse sequence both resulted in accurate temperature measurements (RMSE of 0.70 °C and 0.63 °C, respectively). With sequential sampling in the described EPI implementation, temperature monitoring over a 192×144×135 mm3 FOV with a temporal resolution of 3.6 s was achieved, while keeping the RMSE compared to fully sampled "truth" below 0.35 °C. CONCLUSIONS When segmented EPI readouts are used in conjunction with k-space subsampling for MR thermometry applications, sampling schemes with sequential sampling, with or without variable density sampling, obtain accurate phase and temperature measurements when using a TCR reconstruction algorithm. Improved temperature measurement accuracy can be achieved with variable density sampling. Centric sampling leads to phase bias, resulting in temperature underestimations.
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Affiliation(s)
- Henrik Odéen
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84108 and Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Nick Todd
- Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Mahamadou Diakite
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84108 and Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Emilee Minalga
- Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Allison Payne
- Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Dennis L Parker
- Department of Radiology, University of Utah, Salt Lake City, Utah 84108
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Ramaekers P, de Greef M, Moonen CTW, Ries MG. Cavitation-enhanced back projection for acoustic rib detection and attenuation mapping. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1726-1736. [PMID: 25843516 DOI: 10.1016/j.ultrasmedbio.2015.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 06/04/2023]
Abstract
High-intensity focused ultrasound allows for minimally invasive, highly localized cancer therapies that can complement surgical procedures or chemotherapy. For high-intensity focused ultrasound interventions in the upper abdomen, the thoracic cage obstructs and aberrates the ultrasonic beam, causing undesired heating of healthy tissue. When a phased array therapeutic transducer is used, such complications can be minimized by applying an apodization law based on analysis of beam path obstructions. In this work, a rib detection method based on cavitation-enhanced ultrasonic reflections is introduced and validated on a porcine tissue sample containing ribs. Apodization laws obtained for different transducer positions were approximately 90% similar to those obtained using image analysis. Additionally, the proposed method provides information on attenuation between transducer elements and the focus. This principle was confirmed experimentally on a polymer phantom. The proposed methods could, in principle, be implemented in real time for determination of the optimal shot position in intercostal high-intensity focused ultrasound therapy.
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Affiliation(s)
- Pascal Ramaekers
- Imaging Division, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Martijn de Greef
- Imaging Division, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Chrit T W Moonen
- Imaging Division, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mario G Ries
- Imaging Division, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Gélat P, Ter Haar G, Saffari N. An assessment of the DORT method on simple scatterers using boundary element modelling. Phys Med Biol 2015; 60:3715-30. [DOI: 10.1088/0031-9155/60/9/3715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Petrusca L, Salomir R, Manasseh G, Becker CD, Terraz S. Spatio-temporal quantitative thermography of pre-focal interactions between high intensity focused ultrasound and the rib cage. Int J Hyperthermia 2015; 31:421-32. [PMID: 25753370 DOI: 10.3109/02656736.2015.1009501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this paper is to quantitatively investigate the thermal effects generated by the pre-focal interactions of a HIFU beam with a rib cage, in the context of minimally invasive transcostal therapy of liver malignancies. MATERIALS AND METHODS HIFU sonications were produced by a phased-array MR-compatible transducer on Turkey muscle placed on a sheep thoracic cage specimen. The thoracic wall was positioned in the pre-focal zone 3.5 to 6.5 cm below the focus. Thermal monitoring was simultaneously performed using fluoroptic sensors inserted into the medullar cavity of the ribs and high resolution MR-thermometry (voxel: 1 × 1 × 5 mm3, four multi-planar slices). RESULTS MR-thermometry data indicated nearly isotropic distribution of the thermal energy at the ribs' surface. The temperature elevation at the focus was comparable with the pericostal temperature elevation around unprotected ribs, while being systematically inferior, by more than a factor of four on average, to the intra-medullar values. The spatial profiles of the pericostal and intra-medullar thermal build-up measurements could be smoothly connected using a Gaussian function. The dynamics of the post-sonication thermal relaxation as determined by fluoroptic measurements was demonstrated to be theoretically coherent with the experimental observations. CONCLUSION The experimental findings motivate further efforts for the transfer towards clinical routine of effective rib-sparing strategies for hepatic HIFU.
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Affiliation(s)
- Lorena Petrusca
- Hepatobiliary Interventional Radiology, Faculty of Medicine, University of Geneva , Geneva, Switzerland
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Zhang D, Xu M, Quan L, Yang Y, Qin Q, Zhu W. Segmentation of tumor ultrasound image in HIFU therapy based on texture and boundary encoding. Phys Med Biol 2015; 60:1807-30. [PMID: 25658334 DOI: 10.1088/0031-9155/60/5/1807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is crucial in high intensity focused ultrasound (HIFU) therapy to detect the tumor precisely with less manual intervention for enhancing the therapy efficiency. Ultrasound image segmentation becomes a difficult task due to signal attenuation, speckle effect and shadows. This paper presents an unsupervised approach based on texture and boundary encoding customized for ultrasound image segmentation in HIFU therapy. The approach oversegments the ultrasound image into some small regions, which are merged by using the principle of minimum description length (MDL) afterwards. Small regions belonging to the same tumor are clustered as they preserve similar texture features. The mergence is completed by obtaining the shortest coding length from encoding textures and boundaries of these regions in the clustering process. The tumor region is finally selected from merged regions by a proposed algorithm without manual interaction. The performance of the method is tested on 50 uterine fibroid ultrasound images from HIFU guiding transducers. The segmentations are compared with manual delineations to verify its feasibility. The quantitative evaluation with HIFU images shows that the mean true positive of the approach is 93.53%, the mean false positive is 4.06%, the mean similarity is 89.92%, the mean norm Hausdorff distance is 3.62% and the mean norm maximum average distance is 0.57%. The experiments validate that the proposed method can achieve favorable segmentation without manual initialization and effectively handle the poor quality of the ultrasound guidance image in HIFU therapy, which indicates that the approach is applicable in HIFU therapy.
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Affiliation(s)
- Dong Zhang
- School of Physics and Technology, Wuhan University, Wuhan, 430072, People's Republic of China
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Wijlemans JW, de Greef M, Schubert G, Moonen CT, van den Bosch MA, Ries M. Intrapleural fluid infusion for MR-guided high-intensity focused ultrasound ablation in the liver dome. Acad Radiol 2014; 21:1597-602. [PMID: 25126972 DOI: 10.1016/j.acra.2014.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of tumors in the liver dome is challenging because of the presence of air in the costophrenic angle. In this study, we used a porcine liver model and a clinical MR-HIFU system to assess the feasibility and safety of using intrapleural fluid infusion (IPI) to create an acoustic window for MR-HIFU ablation in the liver dome. MATERIALS AND METHODS Healthy adult Dalland land pigs (n = 6) under general anesthesia were used with animal committee approval. Degassed saline (200-800 mL) was infused into the intrapleural space under ultrasound guidance. A clinical 1.5-T MR-HIFU system was used to perform sonications (4-mm treatment cells, 300-450 W, 20-30 seconds) in the liver dome under real-time MR thermometry. An intercostal firing technique was used to prevent rib heating in one experiment. Technical success was defined as a temperature increase (>10°C) in the target area. After termination, the animal was examined for thermal damage to liver, diaphragm, pleura, lung, or intercostal muscle. RESULTS An acoustic window was established in all animals. A temperature increase in the target area was achieved in all animals (max. 47°C-67°C). MR thermometry showed no heating outside the target area. Intercostal firing effectively reduced rib heating (55°C vs. 42°C). Postmortem examination revealed no unwanted thermal damage. One complication occurred, in the first experiment, because of an ill-suited needle (displacement of the needle). CONCLUSIONS The results indicate that IPI may be used safely to assist MR-HIFU ablation of tumors in the liver dome. For reliable tissue coagulation, IPI must be combined with an intercostal sonication technique. Considering the proportion of patients with tumors in the liver dome, IPI widens the applicability of MR-HIFU ablation for liver tumors considerably.
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Kim YS. Advances in MR image-guided high-intensity focused ultrasound therapy. Int J Hyperthermia 2014; 31:225-32. [DOI: 10.3109/02656736.2014.976773] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Abstract
Radiofrequency ablation (RFA) has gained a wide acceptance as a first-line therapeutic option for small hepatocellular carcinoma (HCC). For very early-stage HCC, despite a higher rate of local tumour progression, RFA is considered as a viable alternative to surgical resection owing to its comparable long-term survival, reduced morbidity, and greater preservation of hepatic parenchyma. For HCCs larger than 2 cm, RFA can contribute to near-curative therapy when combined with chemoembolization. RFA can be used as part of a multimodal treatment strategy for more advanced or recurrent cases, and could be a useful bridging therapy for patients who are waiting for liver transplantation. However, the use of RFA is still limited in treating large tumours and some tumours in high-risk locations. To overcome its current limitations, other ablation techniques are being developed and it is important to validate the role of other techniques for enhancing performance of ablation therapy for HCC.
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Sonographic analysis of the intercostal spaces for the application of high-intensity focused ultrasound therapy to the liver. AJR Am J Roentgenol 2014; 203:201-8. [PMID: 24951216 DOI: 10.2214/ajr.13.11744] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to assess the widths of the intercostal spaces of the right inferior human rib cage through which high-intensity focused ultrasound therapy would be applied for treating liver cancer and to elucidate the demographic factors associated with intercostal space width. SUBJECTS AND METHODS From March 2013 to June 2013, the widths of the intercostal spaces and the ribs at six areas of the right inferior rib cage (area 1, lowest intercostal space on anterior axillary line and the adjacent upper rib; area 2, second-lowest intercostal space on anterior axillary line and the adjacent upper rib; areas 3 and 4, lowest and second-lowest spaces on midaxillary line; areas 5 and 6, lowest and second-lowest spaces on posterior axillary line) were sonographically measured in 466 patients (214 men, 252 women; mean age, 53.0 years) after an abdominal sonographic examination. Demographic factors and the presence or absence of chronic liver disease were evaluated by multivariate analysis to investigate which factors influence intercostal width. RESULTS The width of the intercostal space was 19.7 ± 3.7 mm (range, 9-33 mm) at area 1, 18.3 ± 3.4 mm (range, 9-33 mm) at area 2, 17.4 ± 4.0 mm (range, 7-33 mm) at area 3, 15.4 ± 3.5 mm (range, 5-26 mm) at area 4, 17.2 ± 3.7 mm (range, 7-28 mm) at area 5, and 14.5 ± 3.6 mm (range, 4-26 mm) at area 6. The corresponding widths of the ribs were 15.2 ± 2.3 mm (range, 8-22 mm), 14.5 ± 2.3 mm (range, 9-22 mm), 13.2 ± 2.0 mm (range, 9-20), 14.3 ± 2.2 mm (range, 9-20 mm), 15.0 ± 2.2 mm (range, 10-22 mm), and 15.1 ± 2.3 mm (range, 8-21 mm). Only female sex was significantly associated with the narrower intercostal width at areas 1, 2, 3, and 5 (regression coefficient, 1.124-1.885; p = 0.01-0.04). CONCLUSION There was substantial variation in the widths of the intercostal spaces of the right inferior rib cage such that the anterior and inferior aspects of the intercostal space were relatively wider. Women had significantly narrower intercostal spaces than men.
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Courivaud F, Kazaryan AM, Lund A, Orszagh VC, Svindland A, Marangos IP, Halvorsen PS, Jebsen P, Fosse E, Hol PK, Edwin B. Thermal fixation of swine liver tissue after magnetic resonance-guided high-intensity focused ultrasound ablation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1564-1577. [PMID: 24768489 DOI: 10.1016/j.ultrasmedbio.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/23/2014] [Accepted: 02/01/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to investigate experimental conditions for efficient and controlled in vivo liver tissue ablation by magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) in a swine model, with the ultimate goal of improving clinical treatment outcome. Histological changes were examined both acutely (four animals) and 1 wk after treatment (five animals). Effects of acoustic power and multiple sonication cycles were investigated. There was good correlation between target size and observed ablation size by thermal dose calculation, post-procedural MR imaging and histopathology, when temperature at the focal point was kept below 90°C. Structural histopathology investigations revealed tissue thermal fixation in ablated regions. In the presence of cavitation, mechanical tissue destruction occurred, resulting in an ablation larger than the target. Complete extra-corporeal MR-guided HIFU ablation in the liver is feasible using high acoustic power. Nearby large vessels were preserved, which makes MR-guided HIFU promising for the ablation of liver tumors adjacent to large veins.
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Affiliation(s)
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Alice Lund
- Department of Pathology, Oslo University Hospital, University of Oslo, Oslo, Norway; Department of Pathology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vivian C Orszagh
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | - Aud Svindland
- Department of Pathology, Oslo University Hospital, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Irina Pavlik Marangos
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | | | - Peter Jebsen
- Department of Pathology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | | | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital, Oslo, Norway
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Gélat P, Ter Haar G, Saffari N. A comparison of methods for focusing the field of a HIFU array transducer through human ribs. Phys Med Biol 2014; 59:3139-71. [PMID: 24861888 DOI: 10.1088/0031-9155/59/12/3139] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A forward model, which predicts the scattering by human ribs of a multi-element high-intensity focused ultrasound transducer, was used to investigate the efficacy of a range of focusing approaches described in the literature. This forward model is based on the boundary element method and was described by Gélat et al (2011 Phys. Med. Biol. 56 5553-81; 2012 Phys. Med. Biol. 57 8471-97). The model has since been improved and features a complex surface impedance condition at the surface of the ribs. The inverse problem of focusing through the ribs was implemented on six transducer array-rib topologies and five methods of focusing were investigated, including spherical focusing, binarized apodization based on geometric ray tracing, phase conjugation and the decomposition of the time-reversal operator method. The excitation frequency was 1 MHz and the array was of spherical-section type. Both human and idealized rib topologies were considered. The merit of each method of focusing was examined. It was concluded that the constrained optimization approach offers greater potential than the other focusing methods in terms of maximizing the ratio of acoustic pressure magnitudes at the focus to those on the surface of the ribs whilst taking full advantage of the dynamic range of the phased array.
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Affiliation(s)
- P Gélat
- National Physical Laboratory, Hampton Road, Teddington TW11 0LW, UK. Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
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Zhang S, Li C, Zhou F, Wan M, Wang S. Enhanced lesion-to-bubble ratio on ultrasonic Nakagami imaging for monitoring of high-intensity focused ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:959-970. [PMID: 24866603 DOI: 10.7863/ultra.33.6.959] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This work explored the feasibility of using ultrasonic Nakagami imaging to enhance the contrast between thermal lesions and bubbles induced by high-intensity focused ultrasound (US) in a transparent tissue-mimicking phantom at different acoustic power levels. METHODS The term "lesion-to-bubble ratio" was proposed and defined as the ratio of the scattered power from the thermal lesion to the scattered power from the bubbles calculated in the various monitoring of images for high-intensity focused US. Two-dimensional radiofrequency data backscattered from the exposed region were captured by a modified diagnostic US scanner to estimate the Nakagami statistical parameter, m, and reconstruct the ultrasonic B-mode images and Nakagami parameter images. The dynamic changes in the lesion-to-bubble ratio over the US exposure procedure were calculated simultaneously and compared among video photos, B-mode images, and Nakagami images for monitoring of high-intensity focused US. RESULTS After a small thermal lesion was induced by high-intensity focused US in the phantom, the lesion-to-bubble ratio values corresponding to the video photo, B-mode image, and Nakagami image were 5.3, 1, and 9.8 dB, respectively. When a large thermal lesion appeared in the phantom, the ratio values increased to 7.2, 3, and 14 dB. During US exposure, the ratio values calculated for the video photo, B-mode image, and Nakagami image began to increase gradually and rose to peak values of 8.3, 2.9, and 14.8 dB at the end of the US exposure. CONCLUSIONS This preliminary study on a tissue-mimicking phantom suggests that Nakagami imaging may have a potential use in enhancing the lesion-to-bubble ratio for monitoring high-intensity focused US. Further studies in vivo and in vitro will be needed to evaluate the potential applications for high-intensity focused US.
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Affiliation(s)
- Siyuan Zhang
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chong Li
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Fanyu Zhou
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Mingxi Wan
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.
| | - Supin Wang
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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Kim Y, Vlaisavljevich E, Owens GE, Allen SP, Cain CA, Xu Z. In vivotranscostal histotripsy therapy without aberration correction. Phys Med Biol 2014; 59:2553-68. [DOI: 10.1088/0031-9155/59/11/2553] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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50
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Elbes D, Denost Q, Robert B, Köhler MO, Tanter M, Bruno Q. Magnetic resonance imaging for the exploitation of bubble-enhanced heating by high-intensity focused ultrasound: a feasibility study in ex vivo liver. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:956-964. [PMID: 24462160 DOI: 10.1016/j.ultrasmedbio.2013.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/09/2013] [Accepted: 11/16/2013] [Indexed: 06/03/2023]
Abstract
Bubble-enhanced heating (BEH) may be exploited to improve the heating efficiency of high-intensity focused ultrasound in liver and to protect tissues located beyond the focal point. The objectives of this study, performed in ex vivo pig liver, were (i) to develop a method to determine the acoustic power threshold for induction of BEH from displacement images measured by magnetic resonance acoustic radiation force imaging (MR-ARFI), and (ii) to compare temperature distribution with MR thermometry for HIFU protocols with and without BEH. The acoustic threshold for generation of BEH was determined in ex vivo pig liver from MR-ARFI calibration curves of local tissue displacement resulting from sonication at different powers. Temperature distributions (MR thermometry) resulting from "conventional" sonications (20 W, 30 s) were compared with those from "composite" sonications performed at identical parameters, but after a HIFU burst pulse (0.5 s, acoustic power over the threshold for induction of BEH). Displacement images (MR-ARFI) were acquired between sonications to measure potential modifications of local tissue displacement associated with modifications of tissue acoustic characteristics induced by the burst HIFU pulse. The acoustic threshold for induction of BEH corresponded to a displacement amplitude of approximately 50 μm in ex vivo liver. The displacement and temperature images of the composite group exhibited a nearly spherical pattern, shifted approximately 4 mm toward the transducer, in contrast to elliptical shapes centered on the natural focal position for the conventional group. The gains in maximum temperature and displacement values were 1.5 and 2, and the full widths at half-maximum of the displacement data were 1.7 and 2.2 times larger than in the conventional group in directions perpendicular to ultrasound propagation axes. Combination of MR-ARFI and MR thermometry for calibration and exploitation of BEH appears to increase the efficiency and safety of HIFU treatment.
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Affiliation(s)
- Delphine Elbes
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France; Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France; CHU de Bordeaux, Service de Cardiologie, Bordeaux, France; Laboratoire d'Imagerie Fonctionnelle et Moléculaire, UMR 5231 CNRS/Université de Bordeaux, Bordeaux, France.
| | - Quentin Denost
- Laboratoire d'Imagerie Fonctionnelle et Moléculaire, UMR 5231 CNRS/Université de Bordeaux, Bordeaux, France; Département de Chirurgie Digestive, Hôpital Saint André, Université de Bordeaux, Bordeaux, France
| | - Benjamin Robert
- Institut Langevin, ESPCI ParisTech, CNRS, INSERM, Paris, France
| | | | - Mickaël Tanter
- Institut Langevin, ESPCI ParisTech, CNRS, INSERM, Paris, France
| | - Quesson Bruno
- Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France; Laboratoire d'Imagerie Fonctionnelle et Moléculaire, UMR 5231 CNRS/Université de Bordeaux, Bordeaux, France
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