Cavitation Dynamics and Inertial Cavitation Threshold of Lipid Coated Microbubbles in Viscoelastic Media with Bubble-Bubble Interactions

Numerical simulation study on opening blood-brain barrier by ultrasonic cavitation

Experimental studies have shown that ultrasonic cavitation can reversibly open the blood-brain barrier (BBB) to assist drug delivery. Nevertheless, the majority of the present study focused on experimental aspects of BBB opening. In this study, we developed a three-bubble-liquid-solid model to investigate the dynamic behavior of multiple bubbles within the blood vessels, and elucidate the physical mechanism of drug molecules through endothelial cells under ultrasonic cavitation excitation. The results showed that the large bubbles have a significant inhibitory effect on the movement of small bubbles, and the vibration morphology of intravascular microbubbles was affected by the acoustic parameters, microbubble size, and the distance between the microbubbles. The ultrasonic cavitation can significantly enhance the unidirectional flux of drug molecules, and the unidirectional flux growth rate of the wall can reach more than 5 %. Microjets and shock waves emitted from microbubbles generate different stress distribution patterns on the vascular wall, which in turn affects the pore size of the vessel wall and the permeability of drug molecules. The vibration morphology of microbubbles is related to the concentration, arrangement and scale of microbubbles, and the drug permeation impact can be enhanced by optimizing bubble size and acoustic parameters. The results offer an extensive depiction of the factors influencing the blood-brain barrier opening through ultrasonic cavitation, and the model may provide a potential technique to actively regulate the penetration capacity of drugs through endothelial layer of the neurovascular system by regulating BBB opening.

Enhancing sonothrombolysis outcomes with dual-frequency ultrasound: Insights from an in silico microbubble dynamics study

Sonothrombolysis is a technique that employs the ultrasound waves to break down the clot. Recent studies have demonstrated significant improvement in the treatment efficacy when combining two ultrasound waves of different frequencies. Nevertheless, the findings remain conflicted on the ideal frequency pairing that leads to an optimal treatment outcome. Existing experimental studies are constrained by the limited range of frequencies that can be investigated, while numerical studies are typically confined to spherical microbubble dynamics, thereby restricting the scope of the analysis. To overcome this, the present study investigated the microbubble dynamics caused by the different combinations of ultrasound frequencies. This was carried out using computational modelling as it enables the visualisation of the microbubble behaviour, which is difficult in experimental studies due to the opacity of blood. The results showed that the pairings of two ultrasound waves with low frequencies generally produced stronger cavitation and higher flow-induced shear stress on the clot surface. However, one should avoid the frequency pairings that are integer multipliers of each other, i.e., frequency ratio of 1/3, 1/2 and 2, as they led to resultant wave with low pressure amplitude that weakened the cavitation. At 0.5 + 0.85 MHz, the microbubble caused the highest shear stress of 60.5 kPa, due to its large translational distance towards the clot. Although the pressure threshold for inertial cavitation was reduced using dual-frequency ultrasound, the impact of the high-speed jet can only be realised when the microbubble travelled close to the clot. The results obtained from the present study provide groundwork for deeper understanding on the microbubble dynamics during dual-frequency sonothrombolysis, which is of paramount importance for its optimisations and the subsequent clinical translation.

Influence of interactions between bubbles on physico-chemical effects of acoustic cavitation

Ultrasound technology has been extensively used as one of the efficient and economic methodology to achieve the desired outcomes in many applications by harnessing the physico-chemical effects of acoustic cavitation. However, the cavitation-associated effects, primarily determined by the oscillatory dynamics of cavitation bubbles, are considerably complex and still remain poorly understood. The main objective of this study was to perform a numerical analysis of the acoustic cavitation (i.e., the cavitation dynamics, the resultant temperature, pressure and chemical yields within collapsing bubbles), particularly focusing on the influence of the interactions between bubbles. A comprehensive model was developed to simulate the acoustic cavitation dynamics via combining the influences of mass transfer, heat conduction and chemical reactions as well as the interaction effects between bubbles. The results demonstrated that only the large bubble exerts a greater impact on the small one in a two-bubble system. Specifically, within parameter ranges covered this study, there are noticeable decreases in the expansion ratio of the small bubble, the resultant temperature, pressure and molar yields of free radicals, hence weakening the cavitation intensity and cavitation- associated physico-chemical effects. Moreover, the influences of the interactions between bubbles were further assessed quantitatively under various parameters, such as the ultrasound amplitude PA and frequency f, the distance between bubbles d0, the initial radius of the large bubble R20, as well as the liquid properties (e.g., surface tension σ and viscosity μ). It was found that the suppression effect can be amplified when subjected to ultrasound with an increased PA and/or a decreased f, probably due to a stronger cavitation intensity under this condition. Additionally, the suppression effect is also enhanced with a decrease in d0, σ and μ, but with R20 increasing. This study can contribute to deepening knowledge about acoustic cavitation and the resultant physical and/or chemical effects, potentially further facilitating the ultrasound-assisted various applications involving acoustic cavitation.

Safety of Sonazoid in Assisting High-Intensity Focused Ultrasound Ablation Therapy for Advanced Liver Malignant Lesions: A Single-Arm Clinical Study

OBJECTIVE

The aim of the study described here was to evaluate the safety of Sonazoid-assisted high-intensity focused ultrasound (HIFU) in the treatment of advanced malignant liver lesions.

METHODS

A single-arm study was designed to enroll participants who were diagnosed with advanced primary liver cancer or liver metastases and proposed to receive Sonazoid assistance during HIFU treatment. Serological examination was conducted within 1 wk, and side effects in each patient were monitored for 1 mo. To evaluate therapeutic efficacy, the contrast-enhanced magnetic resonance imaging was performed 1 mo after treatment, and short-term follow-up was conducted a year later.

RESULTS

A total of 17 participants (12 male, 5 female) with an average age of 58 y (range: 46-73 y) were enrolled, including 11 patients with hepatocellular carcinoma, 2 patients with hepatic metastasis and 4 patients with cholangiocarcinoma. The total volume of tumor mass was 111.82 (11.01-272.30) cm3. The average total ablation time for a patient was 2021 ± 1030 s, and the energy efficiency factor was 5979.7 (3108.0, 45634.5) J/cm3. Immediately after HIFU treatment, 1 patient (5.9%) achieved complete response (CR), 4 patients (23.5%) had a moderate response, 8 patients (47.1%) had partial reperfusion and 4 patients (23.5%) had stable disease (SD). The average ablation rate for all the tumors was 51.5 ± 26.7%. The level of glutamic-pyruvic transaminase (ALT) was mildly increased in 71.6% (12/17) of patients after HIFU therapy. Mean ALT values before and after treatment were 22 (14, 35) U/L and 36 (25, 41) U/L, respectively (Z = 1.947, p = 0.051). Mild or obvious edema in skin and subcutaneous soft tissues were observed in 76.5% of patients, but no serious side effects were found. Twelve months after treatment, the follow-up results revealed that 1 patient (5.8%) achieved a CR, 8 patients (47.1%) had SD and 8 patients (47.1%) had progressive disease. The estimated median time to progression was 11 mo after treatment, with a 95% confidence interval of 6, 11 for all involved patients.

CONCLUSION

Use of Sonazoid is safe and feasible for improving HIFU ablation efficiency during the treatment of advanced malignant liver lesions. The therapeutic efficacy of Sonazoid-assisted HIFU needs to be explored in additional controlled clinical investigations.

Sonothrombolysis: State-of-the-Art and Potential Applications in Children

In recent years, advances in ultrasound therapeutics have been implemented into treatment algorithms for the adult population; however, the use of therapeutic ultrasound in the pediatric population still needs to be further elucidated. In order to better characterize the utilization and practicality of sonothrombolysis in the juvenile population, the authors conducted a literature review of current pediatric research in therapeutic ultrasound. The PubMed database was used to search for all clinical and preclinical studies detailing the use and applications of sonothrombolysis, with a focus on the pediatric population. As illustrated by various review articles, case studies, and original research, sonothrombolysis demonstrates efficacy and safety in clot dissolution in vitro and in animal studies, particularly when combined with microbubbles, with potential applications in conditions such as deep venous thrombosis, peripheral vascular disease, ischemic stroke, myocardial infarction, and pulmonary embolism. Although there is limited literature on the use of therapeutic ultrasound in children, mainly due to the lower prevalence of thrombotic events, sonothrombolysis shows potential as a noninvasive thrombolytic treatment. However, more pediatric sonothrombolysis research needs to be conducted to quantify the safety and ethical considerations specific to this vulnerable population.

Investigation of interaction effects on dual-frequency driven cavitation dynamics in a two-bubble system

The cavitation dynamics of a two-bubble system in viscoelastic media excited by dual-frequency ultrasound is studied numerically with a focus on the effects of inter-bubble interactions. Compared to the isolated bubble cases, the enhancement or suppression effects can be exerted on the amplitude and nonlinearity of the bubble oscillations to different degrees. Moreover, the interaction effects are found to be highly sensitive to multiple paramount parameters related to the two-bubble system, the dual-frequency ultrasound and the medium viscoelasticity. Specifically, the larger bubble of a two-bubble system shows a stronger effect on the smaller one, and this effect becomes more pronounced when the larger bubble undergoes harmonic and/or subharmonic resonances as well as the two bubbles get closer (e.g., d0 < 100 μm). For the influences of the dual-frequency excitation, the results show that the bubbles can achieve enhanced harmonic and/or subharmonic oscillations as the frequency combinations with small frequency differences (e.g., Δf < 0.2 MHz) close to the corresponding resonance frequencies of bubbles, and the interaction effects are consequently intensified. Similarly, the bubble oscillations and the interaction effects can also be enhanced as the acoustic pressure amplitude of each frequency component is equal and the pressure amplitude pA increases. Above a pressure threshold (pA = 215 kPa), a larger bubble undergoes period 2 (P2) oscillations, which can force a smaller bubble to change its oscillation pattern from period 1 (P1) into P2 oscillations. In addition, it is found that the medium viscosity dampens the bubble oscillations while the medium elasticity affects the bubble resonances, accordingly exhibiting stronger interaction effects at smaller viscosities (e.g., μ < 4 mPa·s) or certain elasticities (approximately G = 70-120 kPa, G = 160-200 kPa and G = 640-780 kPa) at which the bubble resonances occur. The study can contribute to a better understanding of the complex dynamic behaviors of interacting cavitation bubbles in viscoelastic tissues for high efficient cavitation-mediated biomedical applications using dual-frequency ultrasound.

Weakly nonlinear focused ultrasound in viscoelastic media containing multiple bubbles

To facilitate practical medical applications such as cancer treatment utilizing focused ultrasound and bubbles, a mathematical model that can describe the soft viscoelasticity of human body, the nonlinear propagation of focused ultrasound, and the nonlinear oscillations of multiple bubbles is theoretically derived and numerically solved. The Zener viscoelastic model and Keller-Miksis bubble equation, which have been used for analyses of single or few bubbles in viscoelastic liquid, are used to model the liquid containing multiple bubbles. From the theoretical analysis based on the perturbation expansion with the multiple-scales method, the Khokhlov-Zabolotskaya-Kuznetsov (KZK) equation, which has been used as a mathematical model of weakly nonlinear propagation in single phase liquid, is extended to viscoelastic liquid containing multiple bubbles. The results show that liquid elasticity decreases the magnitudes of the nonlinearity, dissipation, and dispersion of ultrasound and increases the phase velocity of the ultrasound and linear natural frequency of the bubble oscillation. From the numerical calculation of resultant KZK equation, the spatial distribution of the liquid pressure fluctuation for the focused ultrasound is obtained for cases in which the liquid is water or liver tissue. In addition, frequency analysis is carried out using the fast Fourier transform, and the generation of higher harmonic components is compared for water and liver tissue. The elasticity suppresses the generation of higher harmonic components and promotes the remnant of the fundamental frequency components. This indicates that the elasticity of liquid suppresses shock wave formation in practical applications.

Bubble pulsation characteristics in multi-bubble systems affected by bubble size polydispersity and spatial structure

This study seeks to explore the bubble pulsation characteristics in multi-bubble environment with a special focus on the influences of the size polydispersity and the two-dimensional structure of bubbles. Three representative configurations of three interacting bubbles are formed by setting the initial radii of cavitation bubbles and inter-bubble distances appropriately, then the pulsation characteristics of a small bubble are investigated and compared by the bifurcation analysis. The results illustrate that the bubble size polydispersity and two-dimensional structure would greatly affect the bubble pulsations (i.e., the amplitude and nonlinearity of pulsations). Furthermore, the effects of two-dimensional structure are strong at a small inter-bubble distance of the large and small bubbles while the bubble size polydispersity always significantly affects the bubble pulsations for all cases. Moreover, the influences of both bubble size polydispersity and two-dimensional structure can be enhanced as the acoustic pressure increases, which can also become stronger when the large bubble is located at the same side as the small bubble and the initial radius of large bubble increases. Additionally, the effects would also be increased when the tissue viscoelasticity varies within a certain range. The present findings shed new light on the dynamics of multiple polydisperse microbubbles in viscoelastic tissues, potentially contributing to an optimization of their applications with ultrasound excitation.

A computational framework for the multiphysics simulation of microbubble-mediated sonothrombolysis using a forward-viewing intravascular transducer

Sonothrombolysis is a technique that utilises ultrasound waves to excite microbubbles surrounding a clot. Clot lysis is achieved through mechanical damage induced by acoustic cavitation and through local clot displacement induced by acoustic radiation force (ARF). Despite the potential of microbubble-mediated sonothrombolysis, the selection of the optimal ultrasound and microbubble parameters remains a challenge. Existing experimental studies are not able to provide a complete picture of how ultrasound and microbubble characteristics influence the outcome of sonothrombolysis. Likewise, computational studies have not been applied in detail in the context of sonothrombolysis. Hence, the effect of interaction between the bubble dynamics and acoustic propagation on the acoustic streaming and clot deformation remains unclear. In the present study, we report for the first time the computational framework that couples the bubble dynamic phenomena with the acoustic propagation in a bubbly medium to simulate microbubble-mediated sonothrombolysis using a forward-viewing transducer. The computational framework was used to investigate the effects of ultrasound properties (pressure and frequency) and microbubble characteristics (radius and concentration) on the outcome of sonothrombolysis. Four major findings were obtained from the simulation results: (i) ultrasound pressure plays the most dominant role over all the other parameters in affecting the bubble dynamics, acoustic attenuation, ARF, acoustic streaming, and clot displacement, (ii) smaller microbubbles could contribute to a more violent oscillation and improve the ARF simultaneously when they are stimulated at higher ultrasound pressure, (iii) higher microbubbles concentration increases the ARF, and (iv) the effect of ultrasound frequency on acoustic attenuation is dependent on the ultrasound pressure. These results may provide fundamental insight that is crucial in bringing sonothrombolysis closer to clinical implementation.

Probing the pressure dependence of sound speed and attenuation in bubbly media: Experimental observations, a theoretical model and numerical calculations

The problem of attenuation and sound speed of bubbly media has remained partially unsolved. Comprehensive data regarding pressure-dependent changes of the attenuation and sound speed of a bubbly medium are not available. Our theoretical understanding of the problem is limited to linear or semi-linear theoretical models, which are not accurate in the regime of large amplitude bubble oscillations. Here, by controlling the size of the lipid coated bubbles (mean diameter of ≈5.4μm), we report the first time observation and characterization of the simultaneous pressure dependence of sound speed and attenuation in bubbly water below, at and above microbubbles resonance (frequency range between 1-3 MHz). With increasing acoustic pressure (between 12.5-100 kPa), the frequency of the peak attenuation and sound speed decreases while maximum and minimum amplitudes of the sound speed increase. We propose a nonlinear model for the estimation of the pressure dependent sound speed and attenuation with good agreement with the experiments. The model calculations are validated by comparing with the linear and semi-linear models predictions. One of the major challenges of the previously developed models is the significant overestimation of the attenuation at the bubble resonance at higher void fractions (e.g. 0.005). We addressed this problem by incorporating bubble-bubble interactions and comparing the results to experiments. Influence of the bubble-bubble interactions increases with increasing pressure. Within the examined exposure parameters, we numerically show that, even for low void fractions (e.g. 5.1×10-6) with increasing pressure the sound speed may become 4 times higher than the sound speed in the non-bubbly medium.

Resonance behaviors of encapsulated microbubbles oscillating nonlinearly with ultrasonic excitation

The resonance behaviors of a few lipid-coated microbubbles acoustically activated in viscoelastic media were comprehensively examined via radius response analysis. The size polydispersity and random spatial distribution of the interacting microbubbles, the rheological properties of the lipid shell and the viscoelasticity of the surrounding medium were considered simultaneously. The obtained radius response curves present a successive occurrence of linear resonances, nonlinear harmonic and sub-harmonic resonances with the acoustic pressure increasing. The microbubble resonance is radius-, pressure- and frequency-dependent. Specifically, the maximum bubble expansion ratio at the main resonance peak increases but the resonant radius decreases as the ultrasound pressure increases, while both of them decrease with the ultrasound frequency increasing. Moreover, compared to an isolated microbubble case, it is found that large microbubbles in close proximity prominently suppress the resonant oscillations while slightly increase the resonant radii for both harmonic and subharmonic resonances, even leading to the disappearance of the subharmonic resonance with the influences increasing to a certain degree. In addition, the results also suggest that both the encapsulating shell and surrounding medium can substantially dampen the harmonic and subharmonic resonances while increase the resonant radii, which seem to be affected by the medium viscoelasticity to a greater degree rather than the shell properties. This work offers valuable insights into the resonance behaviors of microbubbles oscillating in viscoelastic biological media, greatly contributing to further optimizing their biomedical applications.

Study on the Motion Characteristics of Solid Particles in Fine Flow Channels by Ultrasonic Cavitation

Microjets caused by the cavitation effect in microchannels can affect the motion trajectory of solid particles in microchannels under ultrasonic conditions. The optimal parameters for an observation experiment were obtained through simulations, and an experiment was designed to verify these parameters. When the cavitation bubbles collapse in the near-wall area, the solid particles in the microchannel can be displaced along the expected motion trajectory. Using fluent software to simulate the bubble collapse process, it can be seen that, when an ultrasonic sound pressure acts on a bubble near the wall, the pressure causes the top of the bubble wall to sink inward and eventually penetrate the bottom of the bubble wall, forming a high-speed microjet. The maximum speed of the jet can reach nearly 28 m/s, and the liquid near the top of the bubble also moves at a high speed, driving the particles in the liquid towards the wall. A high-speed camera was used to observe the ultrasonic cavitation process of bubbles in the water to verify the simulation results. A comparison of particle motion with and without ultrasonic waves proved the feasibility of using the ultrasonic cavitation effect to guide small particles towards the wall. This method provides a novel experimental basis for changing the fluid layer state in the microchannel and improving precision machining.

Enhancing cavitation dynamics and its mechanical effects with dual-frequency ultrasound

Objective. Acoustic cavitation and its mechanical effects (e.g. stress and strain) play a primary role in ultrasound applications. Introducing encapsulated microbubbles as cavitation nuclei and utilizing dual-frequency ultrasound excitation are highly effective approaches to reduce cavitation thresholds and enhance cavitation effects. However, the cavitation dynamics of encapsulated microbubbles and the resultant stress/strain in viscoelastic tissues under dual-frequency excitation are poorly understood, especially for the enhancement effects caused by a dual-frequency approach. The goal of this study was to numerically investigate the dynamics of a lipid-coated microbubble and the spatiotemporal distributions of the stress and strain under dual-frequency excitation. Approach. The Gilmore–Zener bubble model was coupled with a shell model for the nonlinear changes of both shell elasticity and viscosity to accurately simulate the cavitation dynamics of lipid-coated microbubbles in viscoelastic tissues. Then, the spatiotemporal evolutions of the cavitation-induced stress and strain in the surrounding tissues were characterized quantitatively. Finally, the influences of some paramount parameters were examined to optimize the outcomes. Main results. We demonstrated that the cavitation dynamics and associated stress/strain were prominently enhanced by a dual-frequency excitation, highlighting positive correlations between the maximum bubble expansion and the maximum stress/strain. Moreover, the results showed that the dual-frequency ultrasound with smaller differences in its frequencies and pressure amplitudes could enhance the bubble oscillations and stress/strain more efficiently, whereas the phase difference manifested small influences under these conditions. Additionally, the dual-frequency approach seemed to show a stronger enhancement effect with the shell/tissue viscoelasticity increasing to a certain extent. Significance. This study might contribute to optimizing the dual-frequency operation in terms of cavitation dynamics and its mechanical effects for high-efficient ultrasound applications.