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Riemer K, Tan Q, Morse S, Bau L, Toulemonde M, Yan J, Zhu J, Wang B, Taylor L, Lerendegui M, Wu Q, Stride E, Dunsby C, Weinberg PD, Tang MX. 3D Acoustic Wave Sparsely Activated Localization Microscopy With Phase Change Contrast Agents. Invest Radiol 2024; 59:379-390. [PMID: 37843819 DOI: 10.1097/rli.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study is to demonstrate 3-dimensional (3D) acoustic wave sparsely activated localization microscopy (AWSALM) of microvascular flow in vivo using phase change contrast agents (PCCAs). MATERIALS AND METHODS Three-dimensional AWSALM using acoustically activable PCCAs was evaluated on a crossed tube microflow phantom, the kidney of New Zealand White rabbits, and the brain of C57BL/6J mice through intact skull. A mixture of C 3 F 8 and C 4 F 10 low-boiling-point fluorocarbon gas was used to generate PCCAs with an appropriate activation pressure. A multiplexed 8-MHz matrix array connected to a 256-channel ultrasound research platform was used for transmitting activation and imaging ultrasound pulses and recording echoes. The in vitro and in vivo echo data were subsequently beamformed and processed using a set of customized algorithms for generating 3D super-resolution ultrasound images through localizing and tracking activated contrast agents. RESULTS With 3D AWSALM, the acoustic activation of PCCAs can be controlled both spatially and temporally, enabling contrast on demand and capable of revealing 3D microvascular connectivity. The spatial resolution of the 3D AWSALM images measured using Fourier shell correlation is 64 μm, presenting a 9-time improvement compared with the point spread function and 1.5 times compared with half the wavelength. Compared with the microbubble-based approach, more signals were localized in the microvasculature at similar concentrations while retaining sparsity and longer tracks in larger vessels. Transcranial imaging was demonstrated as a proof of principle of PCCA activation in the mouse brain with 3D AWSALM. CONCLUSIONS Three-dimensional AWSALM generates volumetric ultrasound super-resolution microvascular images in vivo with spatiotemporal selectivity and enhanced microvascular penetration.
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Affiliation(s)
- Kai Riemer
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (K.R., Q.T., S.M., M.T., J.Y., J.Z., B.W., L.T., M.L., P.D.W., M.-X.T.); NDORMS, University of Oxford, Oxford, United Kingdom (L.B., Q.W., E.S.); and Department of Physics, Imperial College London, London, United Kingdom (C.D.)
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Yu J, Liu Y, Zhang Y, Ran R, Kong Z, Zhao D, Liu M, Zhao W, Cui Y, Hua Y, Gao L, Zhang Z, Yang Y. Smart nanogels for cancer treatment from the perspective of functional groups. Front Bioeng Biotechnol 2024; 11:1329311. [PMID: 38268937 PMCID: PMC10806105 DOI: 10.3389/fbioe.2023.1329311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction: Cancer remains a significant health challenge, with chemotherapy being a critical treatment modality. However, traditional chemotherapy faces limitations due to non-specificity and toxicity. Nanogels, as advanced drug carriers, offer potential for targeted and controlled drug release, improving therapeutic efficacy and reducing side effects. Methods: This review summarizes the latest developments in nanogel-based chemotherapy drug delivery systems, focusing on the role of functional groups in drug loading and the design of smart hydrogels with controlled release mechanisms. We discuss the preparation methods of various nanogels based on different functional groups and their application in cancer treatment. Results: Nanogels composed of natural and synthetic polymers, such as chitosan, alginate, and polyacrylic acid, have been developed for chemotherapy drug delivery. Functional groups like carboxyl, disulfide, and hydroxyl groups play crucial roles in drug encapsulation and release. Smart hydrogels have been engineered to respond to tumor microenvironmental cues, such as pH, redox potential, temperature, and external stimuli like light and ultrasound, enabling targeted drug release. Discussion: The use of functional groups in nanogel preparation allows for the creation of multifunctional nanogels with high drug loading capacity, controllable release, and good targeting. These nanogels have shown promising results in preclinical studies, with enhanced antitumor effects and reduced systemic toxicity compared to traditional chemotherapy. Conclusion: The development of smart nanogels with functional group-mediated drug delivery and controlled release strategies represents a promising direction in cancer therapy. These systems offer the potential for improved patient outcomes by enhancing drug targeting and minimizing adverse effects. Further research is needed to optimize nanogel design, evaluate their safety and efficacy in clinical trials, and explore their potential for personalized medicine.
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Affiliation(s)
- Jiachen Yu
- General Hospital of Northern Theater Command, China Medical University, Shenyang, China
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yuting Liu
- General Hospital of Northern Theater Command, China Medical University, Shenyang, China
- Shenyang Traditional Chinese Medicine Hospital, China Medical University, Shenyang, China
| | - Yingchun Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Rong Ran
- Department of Anesthesia, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Zixiao Kong
- China Medical University, Shenyang, Liaoning, China
| | - Duoyi Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Minda Liu
- Department of Oral-maxillofacial Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Wei Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yan Cui
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yingqi Hua
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Bone Tumor Institution, Shanghai, China
| | - Lianbo Gao
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Zhiyu Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yingxin Yang
- General Hospital of Northern Theater Command, China Medical University, Shenyang, China
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Micaletti F, Escoffre JM, Kerneis S, Bouakaz A, Galvin JJ, Boullaud L, Bakhos D. Microbubble-assisted ultrasound for inner ear drug delivery. Adv Drug Deliv Rev 2024; 204:115145. [PMID: 38042259 DOI: 10.1016/j.addr.2023.115145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
Treating pathologies of the inner ear is a major challenge. To date, a wide range of procedures exists for administering therapeutic agents to the inner ear, with varying degrees of success. The key is to deliver therapeutics in a way that is minimally invasive, effective, long-lasting, and without adverse effects on vestibular and cochlear function. Microbubble-assisted ultrasound ("sonoporation") is a promising new modality that can be adapted to the inner ear. Combining ultrasound technology with microbubbles in the middle ear can increase the permeability of the round window, enabling therapeutic agents to be delivered safely and effectively to the inner ear in a targeted manner. As such, sonoporation is a promising new approach to treat hearing loss and vertigo. This review summarizes all studies on the delivery of therapeutic molecules to the inner ear using sonoporation.
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Affiliation(s)
- Fabrice Micaletti
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044 Tours, France.
| | | | - Sandrine Kerneis
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - John J Galvin
- Faculty of medicine, Université de Tours, 10 boulevard Tonnellé, 37044 Tours, France; House Institute Foundation, 2100 W 3rd Street, Suite 111, Los Angeles, CA 90057, USA
| | - Luc Boullaud
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - David Bakhos
- ENT and Cervico-Facial Surgery Department, University Hospital Center of Tours, 2 Boulevard Tonnellé, 37044 Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Faculty of medicine, Université de Tours, 10 boulevard Tonnellé, 37044 Tours, France; House Institute Foundation, 2100 W 3rd Street, Suite 111, Los Angeles, CA 90057, USA
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AIUM Official Statement for the Statement on Biological Effects of Therapeutic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E68-E73. [PMID: 37584480 DOI: 10.1002/jum.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
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Liu Y, Luo J. Experimental study on damage mechanism of blood vessel by cavitation bubbles. ULTRASONICS SONOCHEMISTRY 2023; 99:106562. [PMID: 37619475 PMCID: PMC10470397 DOI: 10.1016/j.ultsonch.2023.106562] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Ultrasound-induced cavitation in blood vessels is a common scenario in medical procedures. This paper focuses on understanding the mechanism of microscopic damage to vessel walls caused by the evolution of cavitation bubbles within the vessels. In this study, cavitation bubbles were generated using the low-voltage discharge method in 0.9% sodium chloride saline, and vessel models with wall thicknesses ranging from 0.7 mm to 2 mm were made using a 3D laminating process. The interaction between cavitation bubbles and vessel models with different wall thicknesses was observed using a combination of high-speed photography. Results show that cavitation bubble morphology and collapse time increased and then stabilized as the vessel wall thickness increased. When the cavitation bubble was located in vessel axial line, pair of opposing micro-jets were formed along the axis of the vessel, and the peak of micro-jet velocity decreased with increasing wall thickness. However, when the cavitation bubble deviated from the vessel model center, no micro-jet towards the vessel model wall was observed. Further analysis of the vessel wall deformation under varying distances from the cavitation bubble to the vessel wall revealed that the magnitude of vessel wall stretch due to the cavitation bubble expansion was greater than that of the contraction. A comparative analysis of the interaction of between the cavitation bubble and different forms of elastic membranes showed that the oscillation period of the cavitation bubble under the influence of elastic vessel model was lower than the elastic membrane. Furthermore, the degree of deformation of elastic vessel models under the expansion of the cavitation bubble was smaller than that of elastic membranes, whereas the degree of deformation of elastic vessel models in the contraction phase of the cavitation bubble was larger than that of elastic membranes. These new findings provide important theoretical insights into the microscopic mechanisms of blood vessel potential damage caused by ultrasound-induced cavitation bubble, as well as cavitation in pipelines in hydrodynamic systems.
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Affiliation(s)
- Yanyang Liu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jing Luo
- State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu, China.
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Chen W, Yang W, Li D, Wang Z, Zhao Q, Li Y, Cui R, Shen L. Comparative analysis of ultrasonic elastosonography and contrast-enhanced ultrasonography in the diagnosis of benign and malignant intraocular tumors. Graefes Arch Clin Exp Ophthalmol 2023; 261:2987-2996. [PMID: 37148291 DOI: 10.1007/s00417-023-06068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023] Open
Abstract
PURPOSE To compare the diagnostic value of ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) for benign and malignant intraocular tumors. METHODS This retrospective study enrolled patients with intraocular tumors at Beijing Tongren Hospital, Capital Medical University (August 2016 to January 2020). The strain rate ratio (strain rate of tumor tissue divided by strain rate of surrounding normal tissue) was measured by UE. CEUS was performed using SonoVue® contrast agent. The performance of each method at differentiating benign from malignant intraocular tumors was evaluated by receiver operating characteristic curve analysis. RESULTS The analysis included 147 eyes in 145 patients (45.6 ± 13.4 years-old; 66 males): 117 patients (119 eyes) with malignant tumors and 28 patients (28 eyes) with benign tumors. At an optimal cutoff of 22.67 for the strain rate ratio, UE distinguished benign from malignant tumors with a sensitivity of 86.6% and a specificity of 96.4%. CEUS showed that 117 eyes with malignant tumors had a fast-in, fast-out time-intensity curve, and only two eyes with malignant tumors had a fast-in, slow-out curve, while all 28 eyes with benign tumors had a fast-in, slow-out curve. CEUS differentiated benign from malignant tumors with a sensitivity of 98.3% and a specificity of 100%. The diagnostic results differed significantly between the two methods (P = 0.004, McNemar test). The diagnostic performances of the two tests were moderately consistent (κ = 0.657, P < 0.001). CONCLUSION Both CEUS and UE have good diagnostic value in the differentiation of benign intraocular tumors from malignant intraocular tumors.
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Affiliation(s)
- Wei Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wenli Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Dongjun Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ziyang Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Qi Zhao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yifeng Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Rui Cui
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Lin Shen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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Plut D, Prutki M, Slak P. The Use of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of the Neonatal Brain. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1303. [PMID: 37628302 PMCID: PMC10453292 DOI: 10.3390/children10081303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
In recent years, advancements in technology have allowed the use of contrast-enhanced ultrasounds (CEUS) with high-frequency transducers, which in turn, led to new possibilities in diagnosing a variety of diseases and conditions in the field of radiology, including neonatal brain imaging. CEUSs overcome some of the limitations of conventional ultrasounds (US) and Doppler USs. It allows the visualization of dynamic perfusion even in the smallest vessels in the whole brain and allows the quantitative analysis of perfusion parameters. An increasing number of articles are published on the topic of the use of CEUSs on children each year. In the area of brain imaging, the CEUS has already proven to be useful in cases with clinical indications, such as hypoxic-ischemic injuries, stroke, intracranial hemorrhages, vascular anomalies, brain tumors, and infections. We present and discuss the basic principles of the CEUS and its safety considerations, the examination protocol for imaging the neonatal brain, and current and emerging clinical applications.
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Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Prutki
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Peter Slak
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Ehemann J, Kim JJY. Rare vascular complication of ESWL pseudoaneurysm of arc of Buhler. BMJ Case Rep 2023; 16:e256089. [PMID: 37491127 PMCID: PMC10373728 DOI: 10.1136/bcr-2023-256089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Extracorporeal shock wave lithotripsy (ESWL) is a standard treatment for nephrolithiasis. It is widely employed due to its relative safety profile when compared with other treatment options. Recognised complications include localised pain at site, steinstrasse, perinephric haematoma and ureteric obstruction. This report presents a rare non-documented complication of ESWL, pseudoaneurysm of the arc of Buhler, a branch artery of the superior mesenteric artery.
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Affiliation(s)
- Joanne Ehemann
- Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jason Jae Yeun Kim
- Urology, Gold Coast University Hospital, Southport, Queensland, Australia
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Margolis R, Basavarajappa L, Li J, Obaid G, Hoyt K. Image-guided focused ultrasound-mediated molecular delivery to breast cancer in an animal model. Phys Med Biol 2023; 68:10.1088/1361-6560/ace23d. [PMID: 37369225 PMCID: PMC10439523 DOI: 10.1088/1361-6560/ace23d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Abstract
Tumors become inoperable due to their size or location, making neoadjuvant chemotherapy the primary treatment. However, target tissue accumulation of anticancer agents is limited by the physical barriers of the tumor microenvironment. Low-intensity focused ultrasound (FUS) in combination with microbubble (MB) contrast agents can increase microvascular permeability and improve drug delivery to the target tissue after systemic administration. The goal of this research was to investigate image-guided FUS-mediated molecular delivery in volume space. Three-dimensional (3-D) FUS therapy functionality was implemented on a programmable ultrasound scanner (Vantage 256, Verasonics Inc.) equipped with a linear array for image guidance and a 128-element therapy transducer (HIFUPlex-06, Sonic Concepts). FUS treatment was performed on breast cancer-bearing female mice (N= 25). Animals were randomly divided into three groups, namely, 3-D FUS therapy, two-dimensional (2-D) FUS therapy, or sham (control) therapy. Immediately prior to the application of FUS therapy, animals received a slow bolus injection of MBs (Definity, Lantheus Medical Imaging Inc.) and near-infrared dye (IR-780, surrogate drug) for optical reporting and quantification of molecular delivery. Dye accumulation was monitored viain vivooptical imaging at 0, 1, 24, and 48 h (Pearl Trilogy, LI-COR). Following the 48 h time point, animals were humanely euthanized and tumors excised forex vivoanalyzes. Optical imaging results revealed that 3-D FUS therapy improved delivery of the IR-780 dye by 66.4% and 168.1% at 48 h compared to 2-D FUS (p= 0.18) and sham (p= 0.047) therapeutic strategies, respectively.Ex vivoanalysis revealed similar trends. Overall, 3-D FUS therapy can improve accumulation of a surrogate drug throughout the entire target tumor burden after systemic administration.
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Affiliation(s)
- Ryan Margolis
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Lokesh Basavarajappa
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Junjie Li
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Girgis Obaid
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States of America
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Riemer K, Toulemonde M, Yan J, Lerendegui M, Stride E, Weinberg PD, Dunsby C, Tang MX. Fast and Selective Super-Resolution Ultrasound In Vivo With Acoustically Activated Nanodroplets. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:1056-1067. [PMID: 36399587 DOI: 10.1109/tmi.2022.3223554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Perfusion by the microcirculation is key to the development, maintenance and pathology of tissue. Its measurement with high spatiotemporal resolution is consequently valuable but remains a challenge in deep tissue. Ultrasound Localization Microscopy (ULM) provides very high spatiotemporal resolution but the use of microbubbles requires low contrast agent concentrations, a long acquisition time, and gives little control over the spatial and temporal distribution of the microbubbles. The present study is the first to demonstrate Acoustic Wave Sparsely-Activated Localization Microscopy (AWSALM) and fast-AWSALM for in vivo super-resolution ultrasound imaging, offering contrast on demand and vascular selectivity. Three different formulations of acoustically activatable contrast agents were used. We demonstrate their use with ultrasound mechanical indices well within recommended safety limits to enable fast on-demand sparse activation and destruction at very high agent concentrations. We produce super-localization maps of the rabbit renal vasculature with acquisition times between 5.5 s and 0.25 s, and a 4-fold improvement in spatial resolution. We present the unique selectivity of AWSALM in visualizing specific vascular branches and downstream microvasculature, and we show super-localized kidney structures in systole (0.25 s) and diastole (0.25 s) with fast-AWSALM outperforming microbubble based ULM. In conclusion, we demonstrate the feasibility of fast and selective imaging of microvascular dynamics in vivo with subwavelength resolution using ultrasound and acoustically activatable nanodroplet contrast agents.
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Hwang M, Tierradentro-Garcia LO. A concise guide to transtemporal contrast-enhanced ultrasound in children. J Ultrasound 2023; 26:229-237. [PMID: 35567704 PMCID: PMC10063699 DOI: 10.1007/s40477-022-00690-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/22/2022] [Indexed: 12/27/2022] Open
Abstract
Brain contrast-enhanced ultrasound offers insights into the brain beyond the anatomic information offered by conventional grayscale ultrasound. In infants, the open fontanelles serve as acoustic windows. In children, whose fontanelles are closed, the temporal bone serves as the ideal acoustic window due to its relatively smaller thickness than the other skull bones. Diagnosis of common neurologic diseases such as stroke, hemorrhage, and hydrocephalus has been performed using the technique. Transtemporal ultrasound and contrast-enhanced ultrasound, however, are rarely used in children due to the prevalent notion that the limited acoustic penetrance degrades diagnostic quality. This review seeks to provide guidelines for the use of transtemporal brain contrast-enhanced ultrasound in children.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Hersey E, Rodriguez M, Johnsen E. Dynamics of an oscillating microbubble in a blood-like Carreau fluid. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:1836. [PMID: 37002083 DOI: 10.1121/10.0017342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
A numerical model for cavitation in blood is developed based on the Keller-Miksis equation for spherical bubble dynamics with the Carreau model to represent the non-Newtonian behavior of blood. Three different pressure waveforms driving the bubble oscillations are considered: a single-cycle Gaussian waveform causing free growth and collapse, a sinusoidal waveform continuously driving the bubble, and a multi-cycle pulse relevant to contrast-enhanced ultrasound. Parameters in the Carreau model are fit to experimental measurements of blood viscosity. In the Carreau model, the relaxation time constant is 5-6 orders of magnitude larger than the Rayleigh collapse time. As a result, non-Newtonian effects do not significantly modify the bubble dynamics but do give rise to variations in the near-field stresses as non-Newtonian behavior is observed at distances 10-100 initial bubble radii away from the bubble wall. For sinusoidal forcing, a scaling relation is found for the maximum non-Newtonian length, as well as for the shear stress, which is 3 orders of magnitude larger than the maximum bubble radius.
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Affiliation(s)
- Eric Hersey
- Department of Aerospace Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Mauro Rodriguez
- School of Engineering, Brown University, Providence, Rhode Island 02912, USA
| | - Eric Johnsen
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
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Quarato CMI, Lacedonia D, Salvemini M, Tuccari G, Mastrodonato G, Villani R, Fiore LA, Scioscia G, Mirijello A, Saponara A, Sperandeo M. A Review on Biological Effects of Ultrasounds: Key Messages for Clinicians. Diagnostics (Basel) 2023; 13:855. [PMID: 36899998 PMCID: PMC10001275 DOI: 10.3390/diagnostics13050855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Ultrasound (US) is acoustic energy that interacts with human tissues, thus, producing bioeffects that may be hazardous, especially in sensitive organs (i.e., brain, eye, heart, lung, and digestive tract) and embryos/fetuses. Two basic mechanisms of US interaction with biological systems have been identified: thermal and non-thermal. As a result, thermal and mechanical indexes have been developed to provide a means of assessing the potential for biological effects from exposure to diagnostic US. The main aims of this paper were to describe the models and assumptions used to estimate the "safety" of acoustic outputs and indices and to summarize the current state of knowledge about US-induced effects on living systems deriving from in vitro models and in vivo experiments on animals. This review work has made it possible to highlight the limits associated with the use of the estimated safety values of thermal and mechanical indices relating above all to the use of new US technologies, such as contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) shear wave elastography (SWE). US for diagnostic and research purposes has been officially declared safe, and no harmful biological effects in humans have yet been demonstrated with new imaging modalities; however, physicians should be adequately informed on the potential risks of biological effects. US exposure, according to the ALARA (As Low As Reasonably Achievable) principle, should be as low as reasonably possible.
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Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Michela Salvemini
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Giulia Tuccari
- Department of Medical and Surgical Sciences, Institute of Geriatric, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Grazia Mastrodonato
- Department of Basic Medical Science, Neuroscience and Sensory Organs, Institute of Sports Medicine, University “Aldo Moro” of Bari, 70122 Bari, Italy
| | - Rosanna Villani
- Department of Medical and Surgical Sciences, Institute of Internal Medicine, Liver Unit, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Lucia Angela Fiore
- Department of Medical and Surgical Sciences, Institute of Geriatric, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Antonio Mirijello
- Department of Internal of Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | | | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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14
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Characterization of spatially mapped volumetric molecular ultrasound signals for predicting response to anti-vascular therapy. Sci Rep 2023; 13:1686. [PMID: 36717575 PMCID: PMC9886917 DOI: 10.1038/s41598-022-26273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 12/13/2022] [Indexed: 01/31/2023] Open
Abstract
Quantitative three-dimensional molecular ultrasound is a promising technology for longitudinal imaging applications such as therapy monitoring; the risk profile is favorable compared to positron emission tomography and computed tomography. However, clinical translation of quantitative methods for this technology are limited in that they assume that tumor tissues are homogeneous, and often depend on contrast-destruction events that can produce unintended bioeffects. Here, we develop quantitative features (henceforth image features) that capture tumor spatial information, and that are extracted without contrast destruction. We compare these techniques with the contrast-destruction derived differential targeted enhancement parameter (dTE) in predicting response to therapy. We found thirty-three reproducible image features that predict response to antiangiogenic therapy, without the need for a contrast agent disruption pulse. Multiparametric analysis shows that several of these image features can differentiate treated versus control animals with comparable performance to post-destruction measurements, suggesting that these can potentially replace parameters such as the dTE. The highest performing pre-destruction image features showed strong linear correlations with conventional dTE parameters with less overall variance. Thus, our study suggests that image features obtained during the wash in of the molecular agent, pre-destruction, may replace conventional post-destruction image features or the dTE parameter.
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15
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Han Y, Sun J, Wei H, Hao J, Liu W, Wang X. Ultrasound-Targeted Microbubble Destruction: Modulation in the Tumor Microenvironment and Application in Tumor Immunotherapy. Front Immunol 2022; 13:937344. [PMID: 35844515 PMCID: PMC9283646 DOI: 10.3389/fimmu.2022.937344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Tumor immunotherapy has shown strong therapeutic potential for stimulating or reconstructing the immune system to control and kill tumor cells. It is a promising and effective anti-cancer treatment besides surgery, radiotherapy and chemotherapy. Presently, some immunotherapy methods have been approved for clinical application, and numerous others have demonstrated promising in vitro results and have entered clinical trial stages. Although immunotherapy has exhibited encouraging results in various cancer types, however, a large proportion of patients are limited from these benefits due to specific characteristics of the tumor microenvironment such as hypoxia, tumor vascular malformation and immune escape, and current limitations of immunotherapy such as off-target toxicity, insufficient drug penetration and accumulation and immune cell dysfunction. Ultrasound-target microbubble destruction (UTMD) treatment can help reduce immunotherapy-related adverse events. Using the ultrasonic cavitation effect of microstreaming, microjets and free radicals, UTMD can cause a series of changes in vascular endothelial cells, such as enhancing endothelial cells’ permeability, increasing intracellular calcium levels, regulating gene expression, and stimulating nitric oxide synthase activities. These effects have been shown to promote drug penetration, enhance blood perfusion, increase drug delivery and induce tumor cell death. UTMD, in combination with immunotherapy, has been used to treat melanoma, non-small cell lung cancer, bladder cancer, and ovarian cancer. In this review, we summarized the effects of UTMD on tumor angiogenesis and immune microenvironment, and discussed the application and progress of UTMD in tumor immunotherapy.
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16
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Gumus M, Oommen KC, Squires JH. Contrast-enhanced ultrasound of the neonatal brain. Pediatr Radiol 2022; 52:837-846. [PMID: 34333692 DOI: 10.1007/s00247-021-05157-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Cranial US is an integral component of evaluating the neonatal brain, especially in the setting of critically ill infants and in the emergency setting, because cranial US can be performed portably at the bedside, is safe, and can be repeated whenever needed. Contrast-enhanced ultrasound (CEUS) involves intravenously injecting microbubbles to allow for improved visibility of large and small vessels to assess vascularity and is becoming a widespread technique to improve diagnostic performance of US across a broad spectrum of applications. CEUS has the potential to add value to routine brain US and become a useful adjunct to MRI in infants in need of bedside imaging. In this review we describe the basics of US contrast agents and CEUS technique, including safety considerations, and detail the potential clinical uses of brain CEUS.
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Affiliation(s)
- Memduha Gumus
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin C Oommen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, 2nd Floor Radiology, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
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17
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Evaluation of Liposome-Loaded Microbubbles as a Theranostic Tool in a Murine Collagen-Induced Arthritis Model. Sci Pharm 2022. [DOI: 10.3390/scipharm90010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by severe inflammation of the synovial tissue. Here, we assess the feasibility of liposome-loaded microbubbles as theranostic agents in a murine arthritis model. First, contrast-enhanced ultrasound (CEUS) was used to quantify neovascularization in this model since CEUS is well-established for RA diagnosis in humans. Next, the potential of liposome-loaded microbubbles and ultrasound (US) to selectively enhance liposome delivery to the synovium was evaluated with in vivo fluorescence imaging. This procedure is made very challenging by the presence of hard joints and by the limited lifetime of the microbubbles. The inflamed knee joints were exposed to therapeutic US after intravenous injection of liposome-loaded microbubbles. Loaded microbubbles were found to be quickly captured by the liver. This resulted in fast clearance of attached liposomes while free and long-circulating liposomes were able to accumulate over time in the inflamed joints. Our observations show that murine arthritis models are not well-suited for evaluating the potential of microbubble-mediated drug delivery in joints given: (i) restricted microbubble passage in murine synovial vasculature and (ii) limited control over the exact ultrasound conditions in situ given the much shorter length scale of the murine joints as compared to the therapeutic wavelength.
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18
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AlSadiq H, Tupally KR, Vogel R, Parekh HS, Veidt M. Multi-physics study of acoustofluidic delivery agents' clustering behavior. Phys Med Biol 2021; 67. [PMID: 34952530 DOI: 10.1088/1361-6560/ac4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/24/2021] [Indexed: 11/12/2022]
Abstract
Acoustofluidicly manipulated microbubbles (MBs) and echogenic liposomes (ELIPs) have been suggested as drug delivery systems for the 'on demand' release of drug in target tissue. This requires a clear understanding of their behaviour during ultrasonication and after ultrasonication stops. The main focus of this study is to investigate the behaviour of MBs and ELIPs clusters after ultrasonication stops and the underlaying cause of cluster diffusion considering electrostatic repulsion, steric repulsion and Brownian motion. It also examines the capability of existing models used to predict MBs' attraction velocity due to secondary radiation force, on predicting ELIPs' attraction velocity. Tunable resistive pulse sensing (TRPS) and phase analysis light scattering (PALS) techniques were used to measure zeta potentials of the agents and the size distributions were measured using TRPS. The zeta potentials were found to be -2.43 mV and -0.62 mV for Definity™ MBs, and -3.62 mV and -2.35 mV for ELIPs using TRPS and PALS, respectively. Both agents were shown to have significant cluster formation at pressures as low as 6 kPa. Clusters of both agents were shown to diffuse as sonication stops at a rate that approximately equals the sum of the diffusion coefficients of the agents forming them. The de-clustering behaviours are due to Brownian motion as no sign of electrostatic repulsion was observed and particles movements were observed to be faster for smaller diameters. These findings are important to design and optimise effective drug delivery systems using acoustofluidically manipulated MBs and ELIPs.
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Affiliation(s)
- Hussain AlSadiq
- School of Mechanical and Mining Engineering, The University of Queensland, Saint Lucia, AUSTRALIA
| | - Karnaker Reddy Tupally
- school of Pharmacy , The University of Queensland, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Robert Vogel
- The University of Queensland, School of Mathematics and Physics, Saint Lucia, Queensland, 4067, AUSTRALIA
| | - Harendra S Parekh
- The University of Queensland, School of Pharmacy, Saint Lucia, Queensland, 4102, AUSTRALIA
| | - Martin Veidt
- School of Mechanical and Mining Engineering, University of Queensland, Brisbane, Queensland, AUSTRALIA
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19
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Lawrence KM, Coons BE, Sridharan A, Davey MG, Flake AW, Didier RA. Contrast-Enhanced Brain Ultrasound Perfusion Metrics in the EXTra-Uterine Environment for Neonatal Development (EXTEND): Correlation With Hemodynamic Parameters. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2571-2579. [PMID: 33512029 DOI: 10.1002/jum.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Contrast-enhanced ultrasound (CEUS) can provide quantitative perfusion metrics and may be useful to detect cerebral pathology in neonates and premature infants, particularly in extrauterine environments. The effect of hemodynamics on cerebral perfusion metrics is unknown, which limits the clinical application of this technology. We aimed to determine associations between systemic hemodynamics and concurrently measured brain perfusion parameters in an animal model of extrauterine support. METHODS Nine fetal lambs were transferred to an extrauterine support device. Lumason® ultrasound contrast (0.1-0.3 ml) was administered via the umbilical vein and 90-second cine clips were obtained. Time-intensity-curves (TICs) were generated and time-dependent and area-under-curve (AUC) parameters were derived. Associations between brain perfusion metrics and hemodynamics including heart rate (HR) and mean arterial pressure (MAP) were evaluated by multilevel linear mixed-effects models. RESULTS Eighty-six ultrasound examinations were performed and 72 examinations were quantifiable. Time-dependent measurements were independent of all hemodynamic parameters (all p ≥.05). Oxygen delivery and mean blood flow were correlated with AUC measurements (all p ≤.01). Physiologic HR and MAP were not correlated with any measurements (all p ≥.05). CONCLUSION Detected aberrations in time-dependent CEUS measurements are not correlated with hemodynamic parameters and are thought to reflect the changes in cerebral blood flow, thus providing a promising tool for evaluation of brain perfusion. CEUS brain perfusion parameters are not correlated with physiologic HR and MAP, but AUC-dependent measurements are correlated with oxygen delivery and blood flow, suggesting that CEUS offers additional value over standard monitoring. Overall, these findings enhance the applicability of this technology.
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Affiliation(s)
- Kendall M Lawrence
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Barbara E Coons
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Anush Sridharan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marcus G Davey
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryne A Didier
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Sabuncu S, Yildirim A. Gas-stabilizing nanoparticles for ultrasound imaging and therapy of cancer. NANO CONVERGENCE 2021; 8:39. [PMID: 34851458 PMCID: PMC8636532 DOI: 10.1186/s40580-021-00287-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 05/06/2023]
Abstract
The use of ultrasound in the clinic has been long established for cancer detection and image-guided tissue biopsies. In addition, ultrasound-based methods have been widely explored to develop more effective cancer therapies such as localized drug delivery, sonodynamic therapy, and focused ultrasound surgery. Stabilized fluorocarbon microbubbles have been in use as contrast agents for ultrasound imaging in the clinic for several decades. It is also known that microbubble cavitation could generate thermal, mechanical, and chemical effects in the tissue to improve ultrasound-based therapies. However, the large size, poor stability, and short-term cavitation activity of microbubbles limit their applications in cancer imaging and therapy. This review will focus on an alternative type of ultrasound responsive material; gas-stabilizing nanoparticles, which can address the limitations of microbubbles with their nanoscale size, robustness, and high cavitation activity. This review will be of interest to researchers who wish to explore new agents to develop improved methods for molecular ultrasound imaging and therapy of cancer.
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Affiliation(s)
- Sinan Sabuncu
- CEDAR, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Adem Yildirim
- CEDAR, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland, OR, 97201, USA.
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21
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Ntoulia A, Anupindi SA, Back SJ, Didier RA, Hwang M, Johnson AM, McCarville MB, Papadopoulou F, Piskunowicz M, Sellars ME, Darge K. Contrast-enhanced ultrasound: a comprehensive review of safety in children. Pediatr Radiol 2021; 51:2161-2180. [PMID: 34716453 DOI: 10.1007/s00247-021-05223-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) has been increasingly used in pediatric radiology practice worldwide. For nearly two decades, CEUS applications have been performed with the off-label use of gas-containing second-generation ultrasound contrast agents (UCAs). Since 2016, the United States Food and Drug Administration (FDA) has approved the UCA Lumason for three pediatric indications: the evaluation of focal liver lesions and echocardiography via intravenous administration and the assessment of vesicoureteral reflux via intravesical application (contrast-enhanced voiding urosonography, ceVUS). Prior to the FDA approval of Lumason, numerous studies with the use of second-generation UCAs had been conducted in adults and children. Comprehensive protocols for clinical safety evaluations have demonstrated the highly favorable safety profile of UCA for intravenous, intravesical and other intracavitary uses. The safety data on CEUS continue to accumulate as this imaging modality is increasingly utilized in clinical settings worldwide. As of August 2021, 57 pediatric-only original research studies encompassing a total of 4,518 children with 4,906 intravenous CEUS examinations had been published. As in adults, there were a few adverse events; the majority of these were non-serious, although very rarely serious anaphylactic reactions were reported. In the published pediatric-only intravenous CEUS studies included in our analysis, the overall incidence rate of serious adverse events was 0.22% (10/4,518) of children and 0.20% (10/4,906) of all CEUS examinations. Non-serious adverse events from the intravenous CEUS were observed in 1.20% (54/4,518) of children and 1.10% (54/4,906) of CEUS examinations. During the same time period, 31 studies with the intravesical use of UCA were conducted in 12,362 children. A few non-serious adverse events were encountered (0.31%; 38/12,362), but these were most likely attributable to the bladder catheterization rather than the UCA. Other developing clinical applications of UCA in children, including intracavitary and intralymphatic, are ongoing. To date, no serious adverse events have been reported with these applications. This article reviews the existing pediatric CEUS literature and provides an overview of safety-related information reported from UCA uses in children.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann M Johnson
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, UK
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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22
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Hwang M, Barnewolt CE, Jüngert J, Prada F, Sridharan A, Didier RA. Contrast-enhanced ultrasound of the pediatric brain. Pediatr Radiol 2021; 51:2270-2283. [PMID: 33599780 DOI: 10.1007/s00247-021-04974-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
Brain contrast-enhanced ultrasound (CEUS) is an emerging application that can complement gray-scale US and yield additional insights into cerebral flow dynamics. CEUS uses intravenous injection of ultrasound contrast agents (UCAs) to highlight tissue perfusion and thus more clearly delineate cerebral pathologies including stroke, hypoxic-ischemic injury and focal lesions such as tumors and vascular malformations. It can be applied not only in infants with open fontanelles but also in older children and adults via a transtemporal window or surgically created acoustic window. Advancements in CEUS technology and post-processing methods for quantitative analysis of UCA kinetics further elucidate cerebral microcirculation. In this review article we discuss the CEUS examination protocol for brain imaging in children, current clinical applications and future directions for research and clinical uses of brain CEUS.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Jörg Jüngert
- Department of Pediatrics, Friedrich-Alexander University Erlangen - Nürnberg, Erlangen, Germany
| | - Francesco Prada
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.,Focused Ultrasound Foundation, Charlottesville, VA, USA
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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23
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Nielsen MB, Søgaard SB, Bech Andersen S, Skjoldbye B, Hansen KL, Rafaelsen S, Nørgaard N, Carlsen JF. Highlights of the development in ultrasound during the last 70 years: A historical review. Acta Radiol 2021; 62:1499-1514. [PMID: 34791887 DOI: 10.1177/02841851211050859] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review looks at highlights of the development in ultrasound, ranging from interventional ultrasound and Doppler to the newest techniques like contrast-enhanced ultrasound and elastography, and gives reference to some of the valuable articles in Acta Radiologica. Ultrasound equipment is now available in any size and for any purpose, ranging from handheld devices to high-end devices, and the scientific societies include ultrasound professionals of all disciplines publishing guidelines and recommendations. Interventional ultrasound is expanding the field of use of ultrasound-guided interventions into nearly all specialties of medicine, from ultrasound guidance in minimally invasive robotic procedures to simple ultrasound-guided punctures performed by general practitioners. Each medical specialty is urged to define minimum requirements for equipment, education, training, and maintenance of skills, also for medical students. The clinical application of contrast-enhanced ultrasound and elastography is a topic often seen in current research settings.
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Affiliation(s)
- Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stinne Byrholdt Søgaard
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Bech Andersen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Skjoldbye
- Department of Radiology, Aleris-Hamlet Hospitals, Copenhagen Denmark
| | - Kristoffer Lindskov Hansen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nis Nørgaard
- Department of Urology, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Jonathan F. Carlsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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Abstract
Low-intensity ultrasound-triggered sonodynamic therapy (SDT) is a promising noninvasive therapeutic modality due to its strong tissue penetration ability. In recent years, with the development of nanotechnology, nanoparticle-based sonosensitizer-mediated SDT has been widely investigated. With the increasing demand for precise and personalized treatment, abundant novel sonosensitizers with imaging capabilities have been developed for determining the optimal therapeutic window, thus significantly enhancing treatment efficacy. In this review, we focus on the molecular imaging-guided SDT. The prevalent mechanisms of SDT are discussed, including ultrasonic cavitation, sonoluminescence, reactive oxygen species, and mechanical damage. In addition, we introduce the major molecular imaging techniques and the design principles based on nanoparticles to achieve efficient imaging. Furthermore, the imaging-guided SDT for the treatment of cancer, bacterial infections, and vascular diseases is summarized. The ultimate goal is to design more effective imaging-guided SDT modalities and provide novel ideas for clinical translation of SDT.
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Affiliation(s)
- Juan Guo
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Bionanomaterials & Translational Engineering Laboratory, Beijing Key Laboratory of Bioprocess, Beijing University of Chemical Technology, Beijing 100029, P.R. China
| | - Xueting Pan
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Bionanomaterials & Translational Engineering Laboratory, Beijing Key Laboratory of Bioprocess, Beijing University of Chemical Technology, Beijing 100029, P.R. China
| | - Chaohui Wang
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Bionanomaterials & Translational Engineering Laboratory, Beijing Key Laboratory of Bioprocess, Beijing University of Chemical Technology, Beijing 100029, P.R. China
| | - Huiyu Liu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Bionanomaterials & Translational Engineering Laboratory, Beijing Key Laboratory of Bioprocess, Beijing University of Chemical Technology, Beijing 100029, P.R. China
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25
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Bismuth M, Katz S, Rosenblatt H, Twito M, Aronovich R, Ilovitsh T. Acoustically Detonated Microbubbles Coupled with Low Frequency Insonation: Multiparameter Evaluation of Low Energy Mechanical Ablation. Bioconjug Chem 2021; 33:1069-1079. [PMID: 34280311 PMCID: PMC9204695 DOI: 10.1021/acs.bioconjchem.1c00203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
![]()
Noninvasive
ultrasound surgery can be achieved using focused ultrasound
to locally affect the targeted site without damaging intervening tissues.
Mechanical ablation and histotripsy use short and intense acoustic
pulses to destroy the tissue via a purely mechanical effect. Here,
we show that coupled with low-frequency excitation, targeted microbubbles
can serve as mechanical therapeutic warheads that trigger potent mechanical
effects in tumors using focused ultrasound. Upon low frequency excitation
(250 kHz and below), high amplitude microbubble oscillations occur
at substantially lower pressures as compared to higher MHz ultrasonic
frequencies. For example, inertial cavitation was initiated at a pressure
of 75 kPa for a center frequency of 80 kHz. Low frequency insonation
of targeted microbubbles was then used to achieve low energy tumor
cell fractionation at pressures below a mechanical index of 1.9, and
in accordance with the Food and Drug Administration guidelines. We
demonstrate these capabilities in vitro and in vivo. In cell cultures,
cell viability was reduced to 16% at a peak negative pressure of 800
kPa at the 250 kHz frequency (mechanical index of 1.6) and to 10%
at a peak negative pressure of 250 kPa at a frequency of 80 kHz (mechanical
index of 0.9). Following an intratumoral injection of targeted microbubbles
into tumor-bearing mice, and coupled with low frequency ultrasound
application, significant tumor debulking and cancer cell death was
observed. Our findings suggest that reducing the center frequency
enhances microbubble-mediated mechanical ablation; thus, this technology
provides a unique theranostic platform for safe low energy tumor fractionation,
while reducing off-target effects.
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Affiliation(s)
- Mike Bismuth
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sharon Katz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel.,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagar Rosenblatt
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maayan Twito
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ramona Aronovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tali Ilovitsh
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel.,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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Wang G, Zhang S, Lu H, Mu Y. Therapeutic Angiogenesis for Ovarian Transplantation through Ultrasound-Targeted Microbubble Destruction. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1868-1880. [PMID: 33832825 DOI: 10.1016/j.ultrasmedbio.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Timely angiogenesis and effective microcirculation perfusion are essential for the survival and functional recovery of transplanted ovaries. Ultrasound-targeted microbubble destruction (UTMD) can lead to angiogenesis and increase flow perfusion by causing transient inflammation. The purpose of this study was to evaluate the effects of UTMD on transplanted ovarian revascularization and survival. In vitro, for the criteria of cell viability and tube formation capability, the optimal exposure parameters were determined to be a microbubble concentration of 1 × 108/mL, mechanical index of 1 and exposure time of 30 s. After ovarian transplantation, 40 female Sprague Dawley rats were divided into four groups: transplantation alone, ultrasound alone, microbubbles alone and ultrasound and microbubbles (UTMD). At 7 d after transplantation, ovarian perfusion was assessed using qualitative and quantitative methods. The effect of angiogenesis was assessed by contrast-enhanced ultrasound, laser Doppler perfusion imaging and histologic analysis. The results, in which ovarian perfusion was highest in the UTMD group, suggest that UTMD can effectively improve ovarian perfusion. Compared with the other three groups, the number of follicles, microvascular density and rate of Ki-67-positive cells increased significantly in the UTMD group, while apoptosis decreased significantly (p < 0.05). The study indicates that UTMD promoted ovarian re-vascularization after ovarian transplantation and maintained follicular reserve.
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Affiliation(s)
- Guodong Wang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shan Zhang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hanbing Lu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications. AJR Am J Roentgenol 2021; 217:1217-1231. [PMID: 33908269 DOI: 10.2214/ajr.21.25713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents in children. Although only FDA-approved for IV use in children for characterizing focal liver lesions and for use during echocardiography, growing off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This review explores the implementation of CEUS in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.
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Rifu K, Sasanuma H, Takayama N, Nitta N, Ogata Y, Akiyama I, Taniguchi N. Acoustic radiation force impulse under clinical conditions with single infusion of ultrasound contrast agent evoking arrhythmias in rabbit heart. J Med Ultrason (2001) 2021; 48:137-144. [PMID: 33837866 DOI: 10.1007/s10396-021-01085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We previously reported that acoustic radiation force impulse (ARFI) with concomitant administration of perfluorobutane as an ultrasound contrast agent (UCA)-induced arrhythmias at a mechanical index (MI) of 1.8 or 4.0 in a rabbit model. The present study identified the location of arrhythmias with a MI < 1.8 using a new system that can transmit ARFI with B-mode imaging. METHODS Under general anesthesia, six male Japanese white rabbits were placed in a supine position. Using this system, we targeted ARFI to the exact site of the heart. ARFI exposure with MI 0.9-1.2 was performed to the right or left ventricle of the heart 2 min after UCA injection. RESULTS ARFI with a MI lower than previously reported to rabbit heart evoked extrasystolic waves with single UCA infusion. Arrhythmias were not observed using ARFI without UCA. Extrasystolic waves were observed significantly more frequently in the right ventricle group than in the left ventricle group, with arrhythmias showing reversed shapes. No fatal arrhythmias were observed. CONCLUSION ARFI applied to simulate clinical conditions in rabbit heart evoked extrasystolic waves with single UCA infusion. The right ventricle group was significantly more sensitive to ARFI exposure, resulting in arrhythmias, than the left ventricle group. The shapes of PVCs that occurred in the right ventricle group and the left ventricle group were reversed. Ultrasound practitioners who use ARFI should be aware of this adverse reaction, even if the MI is below the previously determined value of 1.9.
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Affiliation(s)
- Kazuma Rifu
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hideki Sasanuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Noriya Takayama
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naotaka Nitta
- National Institute of Advanced Industrial Science and Technology, Health and Medical Research Institute, 1-2-1 Namiki, Tsukuba, Ibaraki, 305-8564, Japan
| | - Yukiyo Ogata
- Department of Cardiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Iwaki Akiyama
- Medical Ultrasound Research Center, Doshisha University, 1-3 Tatara-miyakodani, Kyotanabe, Kyoto, 610-0321, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Basavarajappa L, Rijal G, Hoyt K. Multifocused Ultrasound Therapy for Controlled Microvascular Permeabilization and Improved Drug Delivery. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:961-968. [PMID: 32976098 PMCID: PMC8034541 DOI: 10.1109/tuffc.2020.3026697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Focused ultrasound (FUS) exposure of micro-bubble (MB) contrast agents can transiently increase microvascular permeability allowing anticancer drugs to extravasate into a targeted tumor tissue. Either fixed or mechanically steered in space, most studies to date have used a single element focused transducer to deliver the ultrasound (US) energy. The goal of this study was to investigate various multi-FUS strategies implemented on a programmable US scanner (Vantage 256, Verasonics Inc.) equipped with a linear array for image guidance and a 128-element therapy transducer (HIFUPlex-06, Sonic Concepts). The multi-FUS strategies include multi-FUS with sequential excitation (multi-FUS-SE) and multi-FUS with temporal sequential excitation (multi-FUS-TSE) and were compared to single-FUS and sham treatment. This study was performed using athymic mice implanted with breast cancer cells ( N = 20 ). FUS therapy experiments were performed for 10 min after a solution containing MBs (Definity, Lantheus Medical Imaging Inc.) and near-infrared (NIR, surrogate drug) dye were injected via the tail vein. The fluorescent signal was monitored using an in vivo optical imaging system (Pearl Trilogy, LI-COR) to quantify intratumoral dye accumulation at baseline and again at 0.1, 24, and 48 h after receiving US therapy. Animals were then euthanized for ex vivo dye extraction analysis. At 48 h, fluorescent tracer accumulation within the tumor space for the multi-FUS-TSE therapy group animals was found to be 67.3%, 50.3%, and 36.2% higher when compared to sham, single-FUS, and multi-FUS-SE therapy group measures, respectively. Also, dye extraction and fluorescence measurements from excised tumor tissue found increases of 243.2%, 163.1%, and 68.1% for the multi-FUS-TSE group compared to sham, single-FUS, and multi-FUS-SE therapy group measures, respectively. In summary, experimental results revealed that for a multi-FUS sequence, increased microvascular permeability was considerably influenced by both the spatial and temporal aspects of the applied US therapy.
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Morshedi Rad D, Alsadat Rad M, Razavi Bazaz S, Kashaninejad N, Jin D, Ebrahimi Warkiani M. A Comprehensive Review on Intracellular Delivery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2005363. [PMID: 33594744 DOI: 10.1002/adma.202005363] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/22/2020] [Indexed: 05/22/2023]
Abstract
Intracellular delivery is considered an indispensable process for various studies, ranging from medical applications (cell-based therapy) to fundamental (genome-editing) and industrial (biomanufacture) approaches. Conventional macroscale delivery systems critically suffer from such issues as low cell viability, cytotoxicity, and inconsistent material delivery, which have opened up an interest in the development of more efficient intracellular delivery systems. In line with the advances in microfluidics and nanotechnology, intracellular delivery based on micro- and nanoengineered platforms has progressed rapidly and held great promises owing to their unique features. These approaches have been advanced to introduce a smorgasbord of diverse cargoes into various cell types with the maximum efficiency and the highest precision. This review differentiates macro-, micro-, and nanoengineered approaches for intracellular delivery. The macroengineered delivery platforms are first summarized and then each method is categorized based on whether it employs a carrier- or membrane-disruption-mediated mechanism to load cargoes inside the cells. Second, particular emphasis is placed on the micro- and nanoengineered advances in the delivery of biomolecules inside the cells. Furthermore, the applications and challenges of the established and emerging delivery approaches are summarized. The topic is concluded by evaluating the future perspective of intracellular delivery toward the micro- and nanoengineered approaches.
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Affiliation(s)
- Dorsa Morshedi Rad
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Maryam Alsadat Rad
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Navid Kashaninejad
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Dayong Jin
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Majid Ebrahimi Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute for Biomedical Materials & Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia
- Institute of Molecular Medicine, Sechenov University, Moscow, 119991, Russia
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31
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Nazer B, Giraud D, Zhao Y, Qi Y, Mason O, Jones PD, Diederich CJ, Gerstenfeld EP, Lindner JR. Microbubble-Facilitated Ultrasound Catheter Ablation Causes Microvascular Damage and Fibrosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:131-138. [PMID: 33092899 PMCID: PMC8211318 DOI: 10.1016/j.ultrasmedbio.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
High-intensity ultrasound (US) ablation produces deeper myocardial lesions than radiofrequency ablation. The presence of intravascular microbubble (MB) contrast agents enhances pulsed-wave US ablation via cavitation-related histotripsy, potentially facilitating ablation in persistently perfused/conducting myocardium. US ablation catheters were developed and tested in the presence of MBs using ex vivo and in vivo models. High-frame-rate videomicroscopy and US imaging of gel phantom models confirmed MB destruction by inertial cavitation. MB-facilitated US ablation in an ex vivo perfused myocardium model generated shallow (2 mm) lesions and, in an in vivo murine hindlimb model, reduced perfusion by 42% with perivascular hemorrhage and inflammation, but no myonecrosis.
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Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
| | - David Giraud
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Yan Zhao
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Yue Qi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - O'Neil Mason
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter D Jones
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Chris J Diederich
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Tumor perfusion enhancement by ultrasound stimulated microbubbles potentiates PD-L1 blockade of MC38 colon cancer in mice. Cancer Lett 2020; 498:121-129. [PMID: 33129956 DOI: 10.1016/j.canlet.2020.10.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023]
Abstract
Cancer immunotherapy holds tremendous promise as a strategy for eradicating solid tumors, and its therapeutic effect highly relies on sufficient CD8+ T cells infiltration. Here, we demonstrate that ultrasound stimulated microbubble cavitation (USMC) promotes tumor perfusion, thereby increasing CD8+ T cells infiltration and anti-PD-L1 antibody delivery, then further enhancing the PD-L1 blockade of MC38 colon cancer in mice. Firstly, we optimized the mechanic index (MI) of ultrasound, and found that USMC with MI of 0.4 (equal to peak negative pressure of 0.8 MPa) significantly improved the peak intensity and area under curve of tumor contrast-enhanced ultrasound. Also, flow cytometry exhibited higher percentage of infiltrating CD8+ T cells in the USMC (MI = 0.4)-treated tumors than that of the control. We further explored the combination therapy of optimized USMC with anti-PD-L1 antibody. The combination therapy enhanced tumor perfusion and even led to the tumor vascular normalization. More importantly, flow cytometry showed that the combination not only increased the percentage and absolute number of tumor infiltrating CD8+ T cells, but also promoted the expression of Ki67 as well as the secretions of IFN γ and granzyme B, therefore, the combination therapy achieved greater tumor growth inhibition and longer survival than that of the monotherapies. These suggest that USMC is a promising therapeutic modality for combining immune checkpoint blockade against solid tumors.
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33
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Andersen SB, Taghavi I, Hoyos CAV, Søgaard SB, Gran F, Lönn L, Hansen KL, Jensen JA, Nielsen MB, Sørensen CM. Super-Resolution Imaging with Ultrasound for Visualization of the Renal Microvasculature in Rats Before and After Renal Ischemia: A Pilot Study. Diagnostics (Basel) 2020; 10:diagnostics10110862. [PMID: 33105888 PMCID: PMC7690607 DOI: 10.3390/diagnostics10110862] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
In vivo monitoring of the microvasculature is relevant since diseases such as diabetes, ischemia, or cancer cause microvascular impairment. Super-resolution ultrasound imaging allows in vivo examination of the microvasculature by detecting and tracking sparsely distributed intravascular microbubbles over a minute-long period. The ability to create detailed images of the renal vasculature of Sprague-Dawley rats using a modified clinical ultrasound platform was investigated in this study. Additionally, we hypothesized that early ischemic damage to the renal microcirculation could be visualized. After a baseline scan of the exposed kidney, 10 rats underwent clamping of the renal vein (n = 5) or artery (n = 5) for 45 min. The kidneys were rescanned at the onset of clamp release and after 60 min of reperfusion. Using a processing pipeline for tissue motion compensation and microbubble tracking, super-resolution images with a very high level of detail were constructed. Image filtration allowed further characterization of the vasculature by isolating specific vessels such as the ascending vasa recta with a 15–20 μm diameter. Using the super-resolution images alone, it was only possible for six assessors to consistently distinguish the healthy renal microvasculature from the microvasculature at the onset of vein clamp release. Future studies will aim at attaining quantitative estimations of alterations in the renal microvascular blood flow using super-resolution ultrasound imaging.
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Affiliation(s)
- Sofie Bech Andersen
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (S.B.S.); (L.L.); (K.L.H.); (M.B.N.)
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Iman Taghavi
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark; (I.T.); (J.A.J.)
| | | | - Stinne Byrholdt Søgaard
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (S.B.S.); (L.L.); (K.L.H.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Fredrik Gran
- BK Medical ApS, 2730 Herlev, Denmark; (C.A.V.H.); (F.G.)
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (S.B.S.); (L.L.); (K.L.H.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (S.B.S.); (L.L.); (K.L.H.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark; (I.T.); (J.A.J.)
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (S.B.S.); (L.L.); (K.L.H.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Hyun D, Abou-Elkacem L, Bam R, Brickson LL, Herickhoff CD, Dahl JJ. Nondestructive Detection of Targeted Microbubbles Using Dual-Mode Data and Deep Learning for Real-Time Ultrasound Molecular Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3079-3088. [PMID: 32286963 PMCID: PMC7793556 DOI: 10.1109/tmi.2020.2986762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Ultrasound molecular imaging (UMI) is enabled by targeted microbubbles (MBs), which are highly reflective ultrasound contrast agents that bind to specific biomarkers. Distinguishing between adherent MBs and background signals can be challenging in vivo. The preferred preclinical technique is differential targeted enhancement (DTE), wherein a strong acoustic pulse is used to destroy MBs to verify their locations. However, DTE intrinsically cannot be used for real-time imaging and may cause undesirable bioeffects. In this work, we propose a simple 4-layer convolutional neural network to nondestructively detect adherent MB signatures. We investigated several types of input data to the network: "anatomy-mode" (fundamental frequency), "contrast-mode" (pulse-inversion harmonic frequency), or both, i.e., "dual-mode", using IQ channel signals, the channel sum, or the channel sum magnitude. Training and evaluation were performed on in vivo mouse tumor data and microvessel phantoms. The dual-mode channel signals yielded optimal performance, achieving a soft Dice coefficient of 0.45 and AUC of 0.91 in two test images. In a volumetric acquisition, the network best detected a breast cancer tumor, resulting in a generalized contrast-to-noise ratio (GCNR) of 0.93 and Kolmogorov-Smirnov statistic (KSS) of 0.86, outperforming both regular contrast mode imaging (GCNR = 0.76, KSS = 0.53) and DTE imaging (GCNR = 0.81, KSS = 0.62). Further development of the methodology is necessary to distinguish free from adherent MBs. These results demonstrate that neural networks can be trained to detect targeted MBs with DTE-like quality using nondestructive dual-mode data, and can be used to facilitate the safe and real-time translation of UMI to clinical applications.
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Kollmann C, Jenderka KV, Moran CM, Draghi F, Jimenez Diaz JF, Sande R. EFSUMB Clinical Safety Statement for Diagnostic Ultrasound - (2019 revision). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:387-389. [PMID: 31594007 DOI: 10.1055/a-1010-6018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This document is the updated 2019 revision of the EFSUMB Clinically Safety Statement. A Safety Statement has been published by EFSUMB annually since 1994 by the Safety Committee (ECMUS) of the federation. The text is deliberately brief and gives a concise overview of safety in the use of diagnostic ultrasound.
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Affiliation(s)
- Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
| | - Klaus-Vitold Jenderka
- Department of Engineering and Natural Sciences, University of Applied Sciences, Merseburg, Germany
| | - Carmel M Moran
- University-BHF Centre for Cardiovascular Science, Edinburgh-University, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Ferdinando Draghi
- Institute of Radiology, University of Pavia, IRCCS-Foundation, San Matteo Medical Center, Pavia, Italy
| | - J F Jimenez Diaz
- Castilla La Mancha University Education Faculty of Toledo - Sport Sciences Faculty Toledo, Castilla La Mancha, Spain
- UCAM - Sport Medicine Department Murcia, Murcia, Spain
| | - Ragnar Sande
- Stavanger University Hospital - Department of obstetrics and gynecology, Stavanger, Norway
- University of Bergen - Department of clinical science, Bergen, Hordaland, Norway
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Balica A, Kohut A, Tsai TJ, Groszmann YS, Brandt JS. A Bibliometric Analysis of Citation Classics in the Journal of Ultrasound in Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1289-1297. [PMID: 31944354 DOI: 10.1002/jum.15220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A bibliometric analysis of articles in the Journal of Ultrasound in Medicine (JUM) identified the journals' most impactful articles. METHODS A bibliometric analysis of citation classics that were published in the JUM from its inception in 1982 to 2019 was performed. All citation classics, defined as articles cited 100 or more times, were evaluated for the number of citations, citations per year, publication year, subspecialty, design, and country of origin. Characteristics were compared before and after 1998 by the Mann-Whitney test for unpaired data and 2-sample z tests of sample proportions. The Kruskal-Wallis test for nonparametric continuous data was used to compare the median number of citations per year by decade of publication. RESULTS A total of 7868 articles were published in the JUM between 1982 and 2019; 54 (0.7%) were citation classics. The median citation classics year of publication was 1998 (interquartile range [IQR], 1991-2003). Most citation classics originated from the United States (36 of 54 [66.7%]), were observational (47 of 54 [87%]), and were related to obstetric and gynecologic topics (16 of 54 [29.6%]). Citation classics after 1998 received significantly more citations per year (9.3 versus 4.7; P < .001), with no other differences noted. The median number of citations per year increased for each decade, with medians of 4 citations (IQR, 3.6-4.7) in 1982 to 1991 and 11.2 citations (IQR, 9-13.9) in 2002 to 2012 (P < .001). CONCLUSIONS This list provides insight into the most influential articles that were published in the JUM. Most citation classics were observational, were from the United States, and covered obstetric and gynecologic topics. Citation classics received more citations per year after 1998.
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Affiliation(s)
- Adrian Balica
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Adrian Kohut
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Te-Jung Tsai
- Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yvette S Groszmann
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Diagnostic Ultrasound Associates, Brookline, Massachusetts, USA
| | - Justin S Brandt
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Miller DL, Abo A, Abramowicz JS, Bigelow TA, Dalecki D, Dickman E, Donlon J, Harris G, Nomura J. Diagnostic Ultrasound Safety Review for Point-of-Care Ultrasound Practitioners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1069-1084. [PMID: 31868252 DOI: 10.1002/jum.15202] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Potential ultrasound exposure safety issues are reviewed, with guidance for prudent use of point-of-care ultrasound (POCUS). Safety assurance begins with the training of POCUS practitioners in the generation and interpretation of diagnostically valid and clinically relevant images. Sonographers themselves should minimize patient exposure in accordance with the as-low-as-reasonably-achievable principle, particularly for the safety of the eye, lung, and fetus. This practice entails the reduction of output indices or the exposure duration, consistent with the acquisition of diagnostically definitive images. Informed adoption of POCUS worldwide promises a reduction of ionizing radiation risks, enhanced cost-effectiveness, and prompt diagnoses for optimal patient care.
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Affiliation(s)
| | - Alyssa Abo
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Timothy A Bigelow
- Center for Nondestructive Evaluation, Iowa State University, Ames, Iowa, USA
| | - Diane Dalecki
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Eitan Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - John Donlon
- Acoustic Measurements, Philips Healthcare, Bothell, Washington, USA
| | - Gerald Harris
- Center for Devices and Radiological Health, United States Food and Drug Administration (retired), Silver Spring, Maryland, USA
| | - Jason Nomura
- Department of Emergency Medicine, Christiana Hospital, Newark, Delaware, USA
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Askari E, Seyfoori A, Amereh M, Gharaie SS, Ghazali HS, Ghazali ZS, Khunjush B, Akbari M. Stimuli-Responsive Hydrogels for Local Post-Surgical Drug Delivery. Gels 2020; 6:E14. [PMID: 32397180 PMCID: PMC7345431 DOI: 10.3390/gels6020014] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
Currently, surgical operations, followed by systemic drug delivery, are the prevailing treatment modality for most diseases, including cancers and trauma-based injuries. Although effective to some extent, the side effects of surgery include inflammation, pain, a lower rate of tissue regeneration, disease recurrence, and the non-specific toxicity of chemotherapies, which remain significant clinical challenges. The localized delivery of therapeutics has recently emerged as an alternative to systemic therapy, which not only allows the delivery of higher doses of therapeutic agents to the surgical site, but also enables overcoming post-surgical complications, such as infections, inflammations, and pain. Due to the limitations of the current drug delivery systems, and an increasing clinical need for disease-specific drug release systems, hydrogels have attracted considerable interest, due to their unique properties, including a high capacity for drug loading, as well as a sustained release profile. Hydrogels can be used as local drug performance carriers as a means for diminishing the side effects of current systemic drug delivery methods and are suitable for the majority of surgery-based injuries. This work summarizes recent advances in hydrogel-based drug delivery systems (DDSs), including formulations such as implantable, injectable, and sprayable hydrogels, with a particular emphasis on stimuli-responsive materials. Moreover, clinical applications and future opportunities for this type of post-surgery treatment are also highlighted.
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Affiliation(s)
- Esfandyar Askari
- Biomaterials and Tissue Engineering Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran P.O. Box 1517964311, Iran;
| | - Amir Seyfoori
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, BC V8P 5C2, Canada; (A.S.); (M.A.); (S.S.G.); (B.K.)
| | - Meitham Amereh
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, BC V8P 5C2, Canada; (A.S.); (M.A.); (S.S.G.); (B.K.)
| | - Sadaf Samimi Gharaie
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, BC V8P 5C2, Canada; (A.S.); (M.A.); (S.S.G.); (B.K.)
| | - Hanieh Sadat Ghazali
- Nanotechnology Department, School of Advanced Technologies, Iran University of Science and Technology, Tehran P.O. Box 16846-13114, Iran;
| | - Zahra Sadat Ghazali
- Biomedical Engineering Department, Amirkabir University of Technology (AUT), Tehran P.O. Box 158754413, Iran;
| | - Bardia Khunjush
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, BC V8P 5C2, Canada; (A.S.); (M.A.); (S.S.G.); (B.K.)
| | - Mohsen Akbari
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, BC V8P 5C2, Canada; (A.S.); (M.A.); (S.S.G.); (B.K.)
- Center for Biomedical Research, University of Victoria, Victoria, BC V8P 5C2, Canada
- Center for Advanced Materials and Related Technologies, University of Victoria, Victoria, BC V8P 5C2, Canada
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Bush N, Healey A, Shah A, Box G, Kirkin V, Eccles S, Sontum PC, Kotopoulis S, Kvåle S, van Wamel A, Davies CDL, Bamber J. Theranostic Attributes of Acoustic Cluster Therapy and Its Use for Enhancing the Effectiveness of Liposomal Doxorubicin Treatment of Human Triple Negative Breast Cancer in Mice. Front Pharmacol 2020; 11:75. [PMID: 32153400 PMCID: PMC7044119 DOI: 10.3389/fphar.2020.00075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/24/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Acoustic cluster therapy (ACT) comprises co-administration of a formulation containing microbubble/microdroplet clusters (PS101), together with a regular medicinal drug (e.g., a chemotherapeutic) and local ultrasound (US) insonation of the targeted pathological tissue (e.g., the tumor). PS101 is confined to the vascular compartment and, when the clusters are exposed to regular diagnostic imaging US fields, the microdroplets undergo a phase-shift to produce bubbles with a median diameter of 22 µm when unconstrained by the capillary wall. In vivo these bubbles transiently lodge in the tumor's microvasculature. Low frequency ultrasound (300 kHz) at a low mechanical index (MI = 0.15) is then applied to drive oscillations of the deposited ACT bubbles to induce a range of biomechanical effects that locally enhance extravasation, distribution, and uptake of the co-administered drug, significantly increasing its therapeutic efficacy. METHODS In this study we investigated the therapeutic efficacy of ACT with liposomal doxorubicin for the treatment of triple negative breast cancer using orthotopic human tumor xenografts (MDA-MB-231-H.luc) in athymic mice (ICR-NCr-Foxn1nu). Doxil® (6 mg/kg, i.v.) was administered at days 0 and 21, each time immediately followed by three sequential ACT (20 ml/kg PS101) treatment procedures (n = 7-10). B-mode and nonlinear ultrasound images acquired during the activation phase were correlated to the therapeutic efficacy. RESULTS Results show that combination with ACT induces a strong increase in the therapeutic efficacy of Doxil®, with 63% of animals in complete, stable remission at end of study, vs. 10% for Doxil® alone (p < 0.02). A significant positive correlation (p < 0.004) was found between B-mode contrast enhancement during ACT activation and therapy response. These observations indicate that ACT may also be used as a theranostic agent and that ultrasound contrast enhancement during or before ACT treatment may be employed as a biomarker of therapeutic response during clinical use.
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Affiliation(s)
- Nigel Bush
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | | | - Anant Shah
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- Department of Physics, CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Vladimir Kirkin
- Department of Physics, CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Sue Eccles
- Department of Physics, CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
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Bush N, Healey A, Shah A, Box G, Kirkin V, Kotopoulis S, Kvåle S, Sontum PC, Bamber J. Therapeutic Dose Response of Acoustic Cluster Therapy in Combination With Irinotecan for the Treatment of Human Colon Cancer in Mice. Front Pharmacol 2019; 10:1299. [PMID: 31803049 PMCID: PMC6877694 DOI: 10.3389/fphar.2019.01299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: Acoustic Cluster Therapy (ACT) comprises coadministration of a formulation containing microbubble-microdroplet clusters (PS101) together with a regular medicinal drug and local ultrasound (US) insonation of the targeted pathological tissue. PS101 is confined to the vascular compartment and when the clusters are exposed to regular diagnostic imaging US fields, the microdroplets undergo a phase shift to produce bubbles with a median diameter of 22 µm. Low frequency, low mechanical index US is then applied to drive oscillations of the deposited ACT bubbles to induce biomechanical effects that locally enhance extravasation, distribution, and uptake of the coadministered drug, significantly increasing its therapeutic efficacy. Methods: The therapeutic efficacy of ACT with irinotecan (60 mg/kg i.p.) was investigated using three treatment sessions given on day 0, 7, and 14 on subcutaneous human colorectal adenocarcinoma xenografts in mice. Treatment was performed with three back-to-back PS101+US administrations per session with PS101 doses ranging from 0.40-2.00 ml PS101/kg body weight (n = 8-15). To induce the phase shift, 45 s of US at 8 MHz at an MI of 0.30 was applied using a diagnostic US system; low frequency exposure consisted of 1 or 5 min at 500 kHz with an MI of 0.20. Results: ACT with irinotecan induced a strong, dose dependent increase in the therapeutic effect (R2 = 0.95). When compared to irinotecan alone, at the highest dose investigated, combination treatment induced a reduction in average normalized tumour volume from 14.6 (irinotecan), to 5.4 (ACT with irinotecan, p = 0.002) on day 27. Median survival increased from 34 days (irinotecan) to 54 (ACT with irinotecan, p = 0.002). Additionally, ACT with irinotecan induced an increase in the fraction of complete responders; from 7% to 26%. There was no significant difference in the therapeutic efficacy whether the low frequency US lasted 1 or 5 min. Furthermore, there was no significant difference between the enhancement observed in the efficacy of ACT with irinotecan when PS101+US was administered before or after irinotecan. An increase in early dropouts was observed at higher PS101 doses. Both mean tumour volume (on day 27) and median survival indicate that the PS101 dose response was linear in the range investigated.
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Affiliation(s)
- Nigel Bush
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Andrew Healey
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Anant Shah
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Vladimir Kirkin
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
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Kopechek JA, McTiernan CF, Chen X, Zhu J, Mburu M, Feroze R, Whitehurst DA, Lavery L, Cyriac J, Villanueva FS. Ultrasound and Microbubble-targeted Delivery of a microRNA Inhibitor to the Heart Suppresses Cardiac Hypertrophy and Preserves Cardiac Function. Am J Cancer Res 2019; 9:7088-7098. [PMID: 31660088 PMCID: PMC6815962 DOI: 10.7150/thno.34895] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/23/2019] [Indexed: 01/08/2023] Open
Abstract
MicroRNAs (miRs) are dysregulated in pathological left ventricular hypertrophy. AntimiR inhibition of miR-23a suppressed hypertension-induced cardiac hypertrophy in preclinical models, but clinical translation is limited by a lack of cardiac-targeted delivery systems. Ultrasound-targeted microbubble cavitation (UTMC) utilizes microbubbles as nucleic acid carriers to target delivery of molecular therapeutics to the heart. The objective of this study was to evaluate the efficacy of UTMC targeted delivery of antimiR-23a to the hearts of mice for suppression of hypertension-induced cardiac hypertrophy. Methods: Cationic lipid microbubbles were loaded with 300 pmol negative control antimiR (NC) or antimiR-23a. Mice received continuous phenylephrine infusion via implanted osmotic minipumps, then UTMC treatments with intravenously injected antimiR-loaded microbubbles 0, 3, and 7 days later. At 2 weeks, hearts were harvested and miR-23a levels were measured. Left ventricular (LV) mass and function were assessed with echocardiography. Results: UTMC treatment with antimiR-23a decreased cardiac miR-23a levels by 41 ± 8% compared to UTMC + antimiR-NC controls (p < 0.01). Furthermore, LV mass after 1 week of phenylephrine treatment was 17 ± 10% lower following UTMC + antimiR-23a treatment compared to UTMC + antimiR-NC controls (p = 0.02). At 2 weeks, fractional shortening was 23% higher in the UTMC + antimiR-23a mice compared to UTMC + antimiR-NC controls (p < 0.01). Conclusions: UTMC is an effective technique for targeted functional delivery of antimiRs to the heart causing suppression of cardiac hypertrophy and preservation of systolic function. This approach could represent a revolutionary therapy for patients suffering from pathological cardiac hypertrophy and other cardiovascular conditions.
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Nyankima AG, Kasoji S, Cianciolo R, Dayton PA, Chang EH. Histological and blood chemistry examination of the rodent kidney after exposure to flash-replenishment ultrasound contrast imaging. ULTRASONICS 2019; 98:1-6. [PMID: 31121515 PMCID: PMC6710155 DOI: 10.1016/j.ultras.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/28/2019] [Accepted: 05/09/2019] [Indexed: 05/12/2023]
Abstract
The purpose of this work is to investigate whether imaging sequences of flash-replenishment contrast enhanced ultrasound (CEUS) of the kidney result in chronic or acute bioeffects. Kidneys of female Fischer 344 rats were imaged using the flash-replenishment technique. Animals were separated into four groups (N = 31). Imaging was conducted with a 4C1 probe, driven by an Acuson Sequoia system with Definity microbubbles as the ultrasound contrast agent. During the flash phase of the imaging sequence, one kidney in each animal was exposed to either a mechanical index (MI) of 1.0 or 1.9. For each MI, half of the animals were sacrificed shortly after imaging (4 h) or after 2 weeks. A blinded veterinary nephropathologist reviewed the histopathology of both the imaged and control (non-imaged) kidney. Blood urea nitrogen (BUN) was measured for each animal prior to imaging and at the time of necropsy. Histopathology assessments in both the 1.0 and 1.9 MI groups revealed no signs of hemorrhage at either the 4-h or 2-week time point. BUN showed minor but statistically significant elevations in both the 1.0 and 1.9 MI groups, but no significant difference was present at the 2-week time point in the 1.0 MI group. All BUN levels (at both time points) remained in the normal range. In conclusion, CEUS with flash-replenishment imaging sequences did not result in kidney bioeffects observable with histology at early or late time points. Increases in BUN levels were observed after imaging, but were minimized when using a moderate MI (1.0).
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Affiliation(s)
- A Gloria Nyankima
- Joint Department of Biomedical Engineering, University of North Carolina Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Sandeep Kasoji
- Joint Department of Biomedical Engineering, University of North Carolina Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Rachel Cianciolo
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Emily H Chang
- UNC Kidney Center and Division of Nephrology & Hypertension, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
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Kee ALY, Teo BM. Biomedical applications of acoustically responsive phase shift nanodroplets: Current status and future directions. ULTRASONICS SONOCHEMISTRY 2019; 56:37-45. [PMID: 31101274 DOI: 10.1016/j.ultsonch.2019.03.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 05/19/2023]
Abstract
The evolution of ultrasonic contrast agents to enhance the reflectivity of structures in the human body has consolidated ultrasound's stance as a reliable diagnostic imaging modality. A significant development within this field includes the advent of liquid nanodroplets that are capable of vaporising into gaseous microbubbles upon ultrasonic irradiation. This literature review will therefore appraise and summarise the available literature on the generation of phase-shift nanodroplets, their formulations, applications, safety issues, future developments and any implications that may inhibit their clinical implementation. The main findings of this review affirm that phase change nanodroplets do indeed demonstrate functionality in drug delivery and targeting and characterisation of tumours. Its bioeffects however, have not yet been extensively researched, prompting further exploration into how bubble size can be controlled once it has vaporised into microbubbles and the resulting complications. As such, future research should be directed towards determining the safety, longevity and suitability of phase-shift nanodroplets over contrast agents in current clinical use.
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Affiliation(s)
- Allison Loo Yong Kee
- Department of Medical Imaging and Radiation Sciences, Monash University, 10 Chancellors Walk, Clayton, Victoria 3800, Australia
| | - Boon Mian Teo
- School of Chemistry, Monash University, 19 Rainforest Walk, Clayton, Victoria 3800, Australia.
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Didier RA, Sridharan A, Lawrence K, Coleman BG, Davey MG, Flake AW. Contrast-Enhanced Ultrasound in Extracorporeal Support: In Vitro Studies and Initial Experience and Safety Data in the Extreme Premature Fetal Lamb Maintained by the Extrauterine Environment for Neonatal Development. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1971-1978. [PMID: 30560564 DOI: 10.1002/jum.14885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the effects of ultrasound contrast agent (UCA) administration on hemodynamic parameters and support equipment in in vitro and in vivo models of extracorporeal support. METHODS In vitro, incrementally increasing bolus doses of a UCA were administered proximal to a membrane oxygenator, and ultrasound cine clips were obtained. The rates of microbubble destruction across the oxygenator and over time were calculated from time-intensity-curves. Measurements across the membrane oxygenator were recorded and compared by a repeated-measures analysis of variance. In vivo, 7 premature fetal lambs were transferred from placental support to the extrauterine environment for neonatal development. Contrast agent boluses were administered for contrast-enhanced ultrasound (CEUS) examinations. Hemodynamic parameters and serum laboratory values were evaluated before and after the examinations by paired t tests. For oxygenator staining, oxygenator membranes from the in vitro circuit, study animals (n = 4), and control animals (n = 4) were stained for the adherent UCA. RESULTS In vitro, with all doses (0.1-4 mL), there was no difference in measured parameters across the oxygenator (P ≥ .09). Contrast agent destruction (3%-14%) across the oxygenator was observed at the first pass with a progressive decline in contrast intensity over time. In vivo, there was no difference in hemodynamic parameters or serum laboratory values (P ≥ .08) with any CEUS examination (n = 17). For oxygenator staining, all oxygenator membranes were negative for UCA with lipid staining. CONCLUSIONS The UCA had no detectable effect on the oxygenator or measured parameters in in vitro and in vivo studies, thus providing additional safety data to support the use of CEUS in the setting of extracorporeal support.
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Affiliation(s)
- Ryne A Didier
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anush Sridharan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kendall Lawrence
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beverly G Coleman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marcus G Davey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lu X, Dou C, Fabiilli ML, Miller DL. Capillary Hemorrhage Induced by Contrast-Enhanced Diagnostic Ultrasound in Rat Intestine. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2133-2139. [PMID: 31101449 PMCID: PMC6591078 DOI: 10.1016/j.ultrasmedbio.2019.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/21/2019] [Accepted: 04/07/2019] [Indexed: 05/25/2023]
Abstract
Contrast-enhanced diagnostic ultrasound (CEDUS) can lead to microvascular injury and petechial hemorrhage by the cavitational mechanism of ultrasonic bioeffects. Capillary hemorrhage has been noted in the heart and kidney, which are common targets of CEDUS examination. CEDUS has also become useful for monitoring intestinal inflammation. In the 1990s, the risk of intestinal microvascular hemorrhage was investigated both for incidental exposure by lithotripter shockwaves and for contrast agent microbubbles acting as cavitation nuclei with laboratory pulsed ultrasound systems. This study was initiated to update the risk assessment for intestine exposed to diagnostic imaging simulating CEDUS. The abdomens of anesthetized rats were scanned by a 1.6 MHz phased array probe during infusion of microbubble suspensions simulating Definity ultrasound contrast agent. Dual image frames were triggered intermittently, and the output power was varied to assess the exposure response. Petechiae counts in small intestine mucosa and muscle layers increased with increasing trigger interval from 2 s to 10 s, indicative of a slow refill after microbubble destruction. The counts increased with increasing output above a threshold of 1.4 MPa peak rarefactional pressure amplitude. Petechiae were also seen in Peyer's patches, and occult blood was detected in many affected segments of intestine. These results are consistent with early laboratory pulsed-ultrasound results.
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Affiliation(s)
- Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.
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Miller DL, Lu X, Fabiilli M, Dou C. Hepatocyte Injury Induced by Contrast-Enhanced Diagnostic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1855-1864. [PMID: 30548874 DOI: 10.1002/jum.14883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Contrast-enhanced diagnostic ultrasound (US) has a potential to induce localized biological effects. The potential for contrast-enhanced diagnostic US bioeffects in liver were researched, with guidance from a report by Yang et al (Ultrasonics 2012; 52:1065-1071). METHODS Contact and standoff scanning was performed for 10 minutes with a diagnostic US phased array at 1.6 MHz during bolus injection or infusion of a contrast agent at a high dose. The impact of the imaging on rat liver was investigated by measuring enzyme release, microvascular leakage, and staining of injured hepatocytes. RESULTS The results showed liver enzyme release at 30 minutes, indicating liver injury, and elevated extraction of Evans blue dye, indicating microvascular leakage. In addition, Evans blue and trypan blue vital-staining methods revealed scattered stained cells within the US scan plane. For the Evans blue method, fluorescent cell counts in frozen sections were greatest for standoff exposure with contrast infusion. The count decreased strongly with depth for bolus injection, which was probably reflective of the high attenuation noted for this agent delivery method. CONCLUSIONS The results qualitatively confirmed the report by Yang et al and additionally showed hepatocyte vital staining. Research is needed to determine the threshold for the effects and the contrast agent dose response.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mario Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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Yildirim A, Blum NT, Goodwin AP. Colloids, nanoparticles, and materials for imaging, delivery, ablation, and theranostics by focused ultrasound (FUS). Theranostics 2019; 9:2572-2594. [PMID: 31131054 PMCID: PMC6525987 DOI: 10.7150/thno.32424] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/25/2019] [Indexed: 12/15/2022] Open
Abstract
This review focuses on different materials and contrast agents that sensitize imaging and therapy with Focused Ultrasound (FUS). At high intensities, FUS is capable of selectively ablating tissue with focus on the millimeter scale, presenting an alternative to surgical intervention or management of malignant growth. At low intensities, FUS can be also used for other medical applications such as local delivery of drugs and blood brain barrier opening (BBBO). Contrast agents offer an opportunity to increase selective acoustic absorption or facilitate destructive cavitation processes by converting incident acoustic energy into thermal and mechanical energy. First, we review the history of FUS and its effects on living tissue. Next, we present different colloidal or nanoparticulate approaches to sensitizing FUS, for example using microbubbles, phase-shift emulsions, hollow-shelled nanoparticles, or hydrophobic silica surfaces. Exploring the science behind these interactions, we also discuss ways to make stimulus-responsive, or "turn-on" contrast agents for improved selectivity. Finally, we discuss acoustically-active hydrogels and membranes. This review will be of interest to those working in materials who wish to explore new applications in acoustics and those in acoustics who are seeking new agents to improve the efficacy of their approaches.
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Affiliation(s)
- Adem Yildirim
- Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO 80303 USA
- Present address: CEDAR, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97239 USA
| | - Nicholas T. Blum
- Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO 80303 USA
| | - Andrew P. Goodwin
- Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO 80303 USA
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Rojas JD, Dayton PA. In Vivo Molecular Imaging Using Low-Boiling-Point Phase-Change Contrast Agents: A Proof of Concept Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:177-191. [PMID: 30318123 DOI: 10.1016/j.ultrasmedbio.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/26/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
Sub-micron phase-change contrast agents (PCCAs) have been proposed as a tool for ultrasound molecular imaging based on their potential to extravasate and target extravascular markers and also because of the potential to image these contrast agents with a high contrast-to-tissue ratio. We compare in vivo ultrasound molecular imaging with targeted low-boiling-point PCCAs and targeted microbubble contrast agents. Both agents were targeted to the intravascular (endothelial) integrin αvß3via a cyclic RGD peptide (cyclo-Arg-Gly-Asp-D-Tyr-Cys) mechanism and imaged in vivo in a rodent fibrosarcoma model, which exhibits angiogenic microvasculature. Signal intensity was measured using two different techniques, conventional contrast-specific imaging (amplitude/phase modulation) and a droplet vaporization imaging sequence, which detects the unique signature of vaporizing PCCAs. Data indicate that PCCA-specific imaging is more sensitive to small numbers of bound agents than conventional contrast imaging. However, data also revealed that contrast from targeted microbubbles was greater than that provided by PCCAs. Both control and targeted PCCAs were observed to be retained in tissue post-vaporization, which was expected for targeted agents but not expected for control agents. The exact mechanism underlying this observation remains unknown.
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Affiliation(s)
- Juan D Rojas
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA.
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Miller DL, Lu X, Fabiilli M, Dou C. Influence of Microbubble Size and Pulse Amplitude on Hepatocyte Injury Induced by Contrast-Enhanced Diagnostic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:170-176. [PMID: 30366606 PMCID: PMC6289861 DOI: 10.1016/j.ultrasmedbio.2018.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 05/08/2023]
Abstract
Recent research has found that contrast-enhanced diagnostic ultrasound (CEDUS) has the potential to induce localized injury in the liver, with clearly observable effects for contrast agent doses higher than the recommended dose and maximal mechanical index values. This study was undertaken to assess effects with intermittent exposure at lower contrast doses of infusion and at reduced output to determine thresholds. In addition, microbubble (MB) suspensions with enhanced content of larger MBs were tested. Exposure from a phased array probe (GE Vivid 7 Dimension, GE Vingmed Ultrasound, Horten, Norway) was applied at 1.6 MHz and 1-s intermittent frame trigger for 10 min with infusion of MB suspension with normal (1.8 µm), medium (3.1 µm) and large (5.3 µm) mean MB diameters. The bio-effect endpoint was the count of hepatocytes stained with Evans blue dye in frozen sections. For the normal MBs, the count increased for clinically relevant infusion dosages, but leveled off above 20 µL/kg/min. The evidence of injury declined with time from 30 min to 4 h and was lacking at 24 h. The exposure thresholds in terms of peak rarefactional pressure amplitude, divided by the square root of frequency (in situ mechanical index) were 1.7, 1.3 and 1.2 for the normal-, medium- and large-sized MB suspensions. The enhanced efficacy for larger MBs lends support to the two-criterion model for cavitational microvascular injury during CEDUS. Overall, CEDUS in liver appears to have markedly less potential for induction of tissue injury than has been reported in other tissues, which indicates a satisfactory safety profile for CEDUS using recommended parameters in normal liver.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | - Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mario Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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Oh MT, Kim HN, Ko HS, Lee S, Kim JH, Lee BC. Real-time Optical Imaging of Microbubble Destruction with an Acoustic Lens Attached Ultrasonic Diagnostic Probe in Microfluidic Capillary Models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:6068-6071. [PMID: 30441720 DOI: 10.1109/embc.2018.8513590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this work, an ultrasonic diagnostic system with an attachable acoustic lens was demonstrated for real-time optical imaging of ultrasound-mediated microbubble destruction in a microfluidic capillary model using an inverted microscope. Microbubble destruction under ultrasonic pressure was monitored via an EM-CCD camera with the frame rate of 70 fps. The acoustic field distribution of the transducer with the attachable acoustic lens was simulated via a finite element method (FEM) and measured by a hydrophone. The result of acoustic field distribution shows unfocused beam profiles with 50% decreased pressure of original focal area. With the unfocused beam, inertial cavitation of the microbubbles as a function of transducer input voltages of 30-60 Vpp was studied. In addition, the acoustic cavitation parameters such as frequency of 2 MHz, pulse length of 16 μs, and pulse repetition frequency (PRF) of 1 kHz were investigated under static and dynamic flow conditions in the microfluidic model. In our system, above 45 Vpp, the microbubbles were destroyed more than 50% within 20 seconds so that the threshold for the inertial cavitation was determined to be 45 Vpp in the channel without flow. In the microfluidic capillary model with fluidic flow, it is investigated that shape of microbubble mass continuously changed with acoustic pressure with 60 Vpp.
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