Multi-parametric monitoring of high intensity focused ultrasound (HIFU) treatment using harmonic motion imaging for focused ultrasound (HMIFU)

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Harmonic Motion Imaging for Focused Ultrasound (HMIFU) is a recently developed high-intensity focused ultrasound (HIFU) treatment monitoring method with feasibilities demonstrated in vitro and in vivo. Here, a multi-parametric study is performed to investigate both elastic and acoustics-independent viscoelastic tissue changes using the Harmonic Motion Imaging (HMI) displacement, axial compressive strain and relative phase-shift during high energy HIFU where tissue boiling occurs. Forty three (n=18) thermal lesions were formed in ex vivo canine liver specimens. Two dimensional (2D) transverse HMI displacement maps were also obtained before and after lesion formation. The same method was repeated in 10-, 20-and 30-s HIFU durations at three different acoustic powers of 8, 10, and 11W. For the 10-, 20-, and 30-s treatment cases, a steady decrease in the displacement (−8.67±4.80, −14.44±7.77, 24.03±12.11μm), compressive strain −0.16±0.06, −0.71±0.30, −0.68±0.36 %, and phase shift +1.80±6.80, −15.80±9.44, −18.62±13.14 ° were obtained, respectively, indicating overall increase of relative stiffness and decrease of the viscosity-to-stiffness ratio during heating. After treatment, 2D HMI displacement images of the thermal lesions showed an increased lesion-to-background contrast of 1.34±0.19, 1.98±0.30, 2.26±0.80 and lesion size of 40.95±8.06, 47.6±4.87, and 52.23±2.19 mm2, respectively, which was validated again with pathology 25.17±6.99, 42.17±1.77, 47.17±3.10 mm2. Additionally, studies also investigated the performance of mutli-parametric monitoring under the influence of boiling and attenuation change due to tissue boiling, where discrepancies were found such as deteriorated displacement SNR and reversed lesion-to-background displacement contrast with indication on possible increase in attenuation and tissue gelatification or pulverization. Despite the challenge of the boiling mechanism, the relative phase shift served as consist biomechanical tissue response independent of changes in acoustic properties throughout the HIFU treatment. In addition, the 2D HMI displacement images were able to confirm and quantify the change in dimensions of the thermal lesion site. Therefore, the multi-parametric HMIFU was shown capable of monitoring and mapping tissue viscoelastic response changes during and after HIFU treatment.