Large Thermal Lesions Research Articles

Thermo-Visco-Elastometry of RF-Wave-Heated and Ablated Flesh Tissues Containing Au Nanoparticles.

We report non-contact laser-based Brillouin light-scattering (BLS) spectroscopy measurements of the viscoelastic properties of hyperthermally radiofrequency (RF)-heated and ablated bovine liver and chicken flesh tissues with embedded gold nanoparticles (AuNPs). The spatial lateral profile of the local surface temperature in the flesh samples during their hyperthermia was measured through optical backscattering reflectometry (OBR) using Mg-silica-NP-doped sensing fibers distributed with an RF applicator and correlated with viscoelastic variations in heat-affected and ablated tissues. Substantial changes in the tissue stiffness after heating and ablation were directly related to their heat-induced structural modifications. The main proteins responsible for muscle elasticity were denatured and irreversibly aggregated during the RF ablation. At T > 100 °C, the proteins constituting the flesh further shrank and became disorganized, leading to substantial plastic deformation of biotissues. Their uniform destruction with larger thermal lesions and a more viscoelastic network was attained via AuNP-mediated RF hyperthermal ablation. The results demonstrated here pave the way for simultaneous real-time hybrid optical sensing of viscoelasticity and local temperature in biotissues during their denaturation and gelation during hyperthermia for future applications that involve mechanical- and thermal-property-controlled theranostics.

Radiofrequency Coil for the Creation of Large Ablations: Ex Vivo and In Vivo Testing

PurposeVarious radiofrequency (RF) ablation electrode designs have been developed to increase ablation volume. Multiple heating cycles and electrode positions are often required, thereby increasing treatment time. The objective of this study was to evaluate the performance of a high-frequency monopolar induction coil designed to produce large thermal lesions (>3cm) with a single electrode insertion in a treatment time of less than 10minutes. Materials and MethodsA monopolar nitinol interstitial coil operated at 27.12MHz and 200W was evaluated. Ex vivo performance was tested in excised bovine liver (n=22). In vivo testing (n=10) was conducted in livers of seven Yorkshire pigs. Visual inspection, contrast-enhanced computed tomography (CT), and pathologic evaluation of ablation zones were performed. ResultsAverage ablation volumes in ex vivo and in vivo tests were 60.5cm3±14.1 (5.9×4.4×4.4cm) and 57.1cm3±13.8 (6.1×4.5×4.1cm), with average treatment times of 9.0minutes±3.0 and 8.4minutes±2.7, respectively. Contrast-enhanced CT ablation volume measurements corresponded with findings of gross inspection. Pathologic analysis showed morphologic and enzymatic changes suggestive of tissue death within the ablation zones. ConclusionsThe RF ablation coil device successfully produced large, uniform ablation volumes in ex vivo and in vivo settings in treatment times of less than 10minutes. Ex vivo and in vivo lesion sizes were not significantly different (P=.53), suggesting that the heating efficiency of this higher-frequency coil device may help to minimize the heat-sink effect of perfusion.

Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry

A volumetric sonication method is proposed that produces volume ablations by steering the focal point along a predetermined trajectory consisting of multiple concentric outward-moving circles. This method was tested in vivo on pig thigh muscle (32 ablations in nine animals). Trajectory diameters were 4, 12, and 16 mm with sonication duration depending on the trajectory size and ranging from 20 to 73 s. Despite the larger trajectories requiring more energy to reach necrosis within the desired volume, the ablated volume per unit applied energy increased with trajectory size, indicating improved treatment efficiency for larger trajectories. The higher amounts of energy required for the larger trajectories also increased the risk of off-focus heating, especially along the beam axis in the near field. To avoid related adverse effects, rapid volumetric multiplane MR thermometry was introduced for simultaneous monitoring of the temperature and thermal dose evolution along the beam axis and in the near field, as well as in the target region with a total coverage of six slices acquired every 3 s. An excellent correlation was observed between the thermal dose and both the nonperfused (R=0.929 for the diameter and R=0.964 for the length) and oedematous (R=0.913 for the diameter and R=0.939 for the length) volumes as seen in contrast-enhanced T1-weighted difference images and T2-weighted postsonication images, respectively. Histology confirmed the presence of a homogeneous necrosis inside the heated volumes. These results show that volumetric high-intensity focused ultrasound (HIFU) sonication allows for efficiently creating large thermal lesions while reducing treatment duration and also that the rapid multiplane MR thermometry improves the safety of the therapeutic procedure by monitoring temperature evolution both inside as well as outside the targeted volume.

Ultrasound interstitial applicators for thermal ablation in liver

Aggressive treatment of localized hepatic metastases, by surgery or other means, was proven to be a viable strategy for improving the prognoses of many patients. In that context, thermal ablation by high intensity ultrasound was proposed and used in clinics. However, for treating deep-seated tumors and in most cases, radiofrequency and cryotherapy probes are applied interstitially. Interstitial ultrasound applicators were proposed as an intermediate solution. The treatment can be focused, deeper than with other physical agents, and the transducer can eventually both treat and image tissues. In our experience, two approaches were investigated: percutaneous and intratissular, or endo vascular. The active element was a miniature flat transducer operating at a frequency of 5 MHz, for a satisfactory tradeoff between beam penetration and energy absorption. In vivo trials on a porcine model demonstrated that both procedures are minimally invasive and that large thermal lesions, up to 20 mm deep, can be obtained. Technological improvements such as the use of dual mode transducers (for imaging and therapy) or the performance under MRI guidance allowed monitoring the treatment in real-time.

Transurethral ultrasound applicators with dynamic multi‐sector control for prostate thermal therapy: In vivo evaluation under MR guidance

The purpose of this study was to explore the feasibility and performance of a multi-sectored tubular array transurethral ultrasound applicator for prostate thermal therapy, with potential to provide dynamic angular and length control of heating under MR guidance without mechanical movement of the applicator. Test configurations were fabricated, incorporating a linear array of two multi-sectored tubular transducers (7.8-8.4 MHz, 3 mm OD, 6 mm length), with three 120 degrees independent active sectors per tube. A flexible delivery catheter facilitated water cooling (100 ml min(-1)) within an expandable urethral balloon (35 mm long x 10 mm diameter). An integrated positioning hub allows for rotating and translating the transducer assembly within the urethral balloon for final targeting prior to therapy delivery. Rotational beam plots indicate approximately 90 degrees-100 degrees acoustic output patterns from each 120 degrees transducer sector, negligible coupling between sectors, and acoustic efficiencies between 41% and 53%. Experiments were performed within in vivo canine prostate (n = 3), with real-time MR temperature monitoring in either the axial or coronal planes to facilitate control of the heating profiles and provide thermal dosimetry for performance assessment. Gross inspection of serial sections of treated prostate, exposed to TTC (triphenyl tetrazolium chloride) tissue viability stain, allowed for direct assessment of the extent of thermal coagulation. These devices created large contiguous thermal lesions (defined by 52 degrees C maximum temperature, t43 = 240 min thermal dose contours, and TTC tissue sections) that extended radially from the applicator toward the border of the prostate (approximately15 mm) during a short power application (approximately 8-16 W per active sector, 8-15 min), with approximately 200 degrees or 360 degrees sector coagulation demonstrated depending upon the activation scheme. Analysis of transient temperature profiles indicated progression of lethal temperature and thermal dose contours initially centered on each sector that coalesced within approximately 5 min to produce uniform and contiguous zones of thermal destruction between sectors, with smooth outer boundaries and continued radial propagation in time. The dimension of the coagulation zone along the applicator was well-defined by positioning and active array length. Although not as precise as rotating planar and curvilinear devices currently under development for MR-guided procedures, advantages of these multi-sectored transurethral applicators include a flexible delivery catheter and that mechanical manipulation of the device using rotational motors is not required during therapy. This multi-sectored tubular array transurethral ultrasound technology has demonstrated potential for relatively fast and reasonably conformal targeting of prostate volumes suitable for the minimally invasive treatment of BPH and cancer under MR guidance, with further development warranted.

Effect of Hyperbarism on Radiofrequency Ablation Outcome

Our objective was to investigate whether increases in atmospheric or local tissue pressure would affect the outcome of radiofrequency ablation procedures and the size of the created thermal lesions. Thermal lesions were produced in specimens of explanted bovine liver inside a hyperbaric chamber at 101 (atmospheric), 141, 202, 273, and 364 kPa using radiofrequency power settings of 20, 30, 40, and 50 W. In subsequent in vivo experiments, thermal lesions were produced in the livers of anesthetized pigs with or without occlusion of the hepatic vein draining the ablation site. At each radiofrequency power setting, progressive increases in applied pressure were paralleled by decreases in minimum impedance and increases in maximum tissue temperatures at the electrode tip (reflecting tissue-fluid boiling points), delivery time, total energy delivered, and thermal lesion volumes. Similar increases were observed in radiofrequency ablation procedures performed in vivo under occlusion of the vein draining the ablation site. By elevating the tissue-fluid boiling point, increased pressure delays the desiccation of tissue in contact with the radiofrequency electrode tip and the related sharp increase in impedance. The result is prolonged delivery of larger amounts of radiofrequency energy and larger thermal lesions.

A fast and conformal heating scheme for producing large thermal lesions using a 2D ultrasound phased array

The treatment conformability and the total treatment time of large tumors are both important issues in ultrasound thermal therapy. Previous heating strategies all show their restrictions in achieving these two issues to satisfactory levels simultaneously. This work theoretically presents a new heating strategy which is capable of both increasing the treatment conformability and shortening the treatment time, when using a 2D ultrasound phased array transducer. To perform this, a set of the multiple-foci patterns (considered the basic heating units) were temporally switched to steer the beam at different focal planes with the lesion length being well-controlled. Then, to conformally cover an irregular target volume, the 2D phased array was laterally shifted by a positioning system to deposit a suitable heating unit to cover a subvolume part. Results demonstrated that the totally treatment time can be largely reduced. The heating rate can be increased up to 0.96 cm3/min compared to the previously reported 0.26 cm3/min. Also, the proposed scheme showed that the tumor regions can be completely treated with the normal tissue damage at satisfactory level. The feasibility of the proposed strategy for irregular tumor treatment was also demonstrated. This study offers useful information in large tumor treatment in ultrasound thermal therapy.

Cavitation-enhanced ultrasound thermal therapy by combined low- and high-frequency ultrasound exposure

This paper demonstrates a novel approach for enhancing ultrasound-induced heating by the introduction of acoustic cavitation using simultaneous sonication with low- and high-frequency ultrasound. A spherical focused transducer (566 or 1155 kHz) was used to generate the thermal lesions, and a low-frequency planar transducer (40 or 28 kHz) was used to enhance the bubble activity. Ex vivo fresh porcine muscles were used as the target of ultrasound ablation. The emitted signals and the signals backscattered from the bubble activity were also recorded during the heating process by a PVDF-type needle hydrophone, and thermocouples were inserted to measure temperatures. Compared with the lesions formed by a single focused transducer, the size of the lesions generated by this approach were as much as 140% larger along the axial direction and 200% larger along the radial direction for combined 566- and 40-kHz sonication. They were 47% and 66% larger along the axial and radial directions, respectively, for combined 1155- and 28-kHz sonication. Cavitation activities enhanced by low-frequency ultrasound were confirmed by the presence of subharmonics in the spectrum and temperature increase as a result of increased tissue absorption. These observations imply that cavitation-enhanced lesions can be generated without reducing the penetration ability; they also show the advantage of producing larger and more uniform thermal lesions by multiple sonications. This technique provides an easy and effective way to achieve cavitation-enhanced heating, and may be useful for generating large and deep-seated thermal lesions. (E-mail: yychen@cc.ee.ntu.edu.tw)

Evolving technology in bipolar perfused radiofrequency ablation: assessment of efficacy, predictability and safety in a pig liver model

Bipolar radiofrequency (RF) ablation, especially with perfusion of saline, has been shown to increase volume over monopolar conventional methods. The aims of this study are to study whether this method is linked to too flattened thermal lesions and premature rise of impedance and to elucidate some safety concerns. Eighteen RF ablations were performed using a 1.8-mm-diameter bipolar applicator in the liver of nine healthy pigs through laparotomy with or without temporary vascular occlusion [the Pringle maneuver (PGM)]: group A (n=9), without PGM; group B (n=9), with PGM. Hypertonic saline solutions (3% and 20 %) were injected through the applicator at a rate of 400 ml/h during the procedure. The pigs were followed up and they were euthanased on the 15th day. Impedance, current, power output, energy output, temperatures, diameters of thermal lesion, volume, sphericity ratio of thermal lesion were correlated among groups. Impedance at the end of the procedure (50.00 Omega+/-28.39 and 52.88 Omega+/-26.77, for groups A and B, respectively) was very similar to the starting impedance (50 Omega). In a median of 1 (range, 0-6) time per RF ablation procedure a reduction of 30 W from the selected power supply was observed during the RF ablation procedure linked to a slight increase of impedance. Volume and short diameter of thermal lesion were 21.28 cm3+/-11.78 and 2.85 cm+/-0.87 for group A, 87.51 cm3+/-25.20 and 4.31 cm+/-0.65 for group B. Continuous thermal between both electrodes were described with a global sphericity ratio of 1.91. One major complication (thermal injury to the stomach) was encountered in a case of cross-sectional necrosis of the targeted liver and attributed to heat diffusion after the procedure. This method has been shown to determine: (1) the relative control of impedance during the procedure; (2) ovoid and relatively large thermal lesions with less dependence upon closest vessels.

Large-Volume Radiofrequency Ablation of ex Vivo Bovine Liver with Multiple Cooled Cluster Electrodes

Three methods of creating large thermal lesions with cool-tip cluster electrodes were compared. Three cluster electrodes were arranged 4 cm apart in a triangular array. Eight lesions were created ex vivo in fresh bovine liver (from a butcher) with each method: sequential ablation (three electrodes, 12 minutes each); simultaneous activation of electrodes (12 minutes); and rapid switching of power between electrodes (12 minutes), for which an electronic computer-controlled switch was developed. For sequential, rapid switching, and simultaneous methods, lesion volumes were 137.5 cm(3)+/- 22.2, 116.4 cm(3)+/- 15.2, and 22.3 cm(3)+/- 6.4 (P < .05), respectively, and final temperatures at lesion center were 80 degrees C +/- 5, 97 degrees C +/- 8, and 41 degrees C +/- 3 (P < .001), respectively. Because of electrical interference between electrodes, simultaneous method led to little heating at the center between the electrodes and created small discontinuous lesions. Rapid switching created large round lesions by employing multiple electrodes concurrently, which substantially reduced treatment time and resulted in more effective heating between electrodes.

Effects of Perfusion on Radiofrequency Ablation in Swine Kidneys

To evaluate the effect of vascular occlusion on the size of radiofrequency (RF) ablation lesions and to evaluate embolization as an occlusion method. The kidneys of six swine were surgically exposed. Fifteen RF ablation lesions were created in nine kidneys by using a 2-cm-tip single-needle ablation probe in varying conditions: Seven lesions were created with normal blood flow and eight were created with blood flow obstructed by means of vascular clamping (n = 5) or renal artery embolization (n = 3). The temperature, applied voltage, current, and impedance were recorded during RF ablation. Tissue-cooling curves acquired for 2 minutes immediately after the ablation were compared by using regression analysis. Lesions were bisected, and their maximum diameters were measured and compared by using analysis of variance. The mean diameter of ablation lesions created when blood flow was obstructed was 60% greater than that of lesions created when blood flow was normal (1.38 cm +/- 0.05 [standard error of mean] vs 0.86 cm +/- 0.07, P <.001). The two methods of flow obstruction yielded lesions of similar mean sizes: 1.40 cm +/- 0.06 with vascular clamping and 1.33 cm +/- 0.07 with embolization. The temperature at the probe tip when lesions were ablated with normal blood flow decreased more rapidly than did the temperature when lesions were ablated after flow obstruction (P <.001), but no significant differences in tissue-cooling curves between the two flow obstruction methods were observed. Obstruction of renal blood flow before and during RF ablation resulted in larger thermal lesions with potentially less variation in size compared with the lesions created with normal nonobstructed blood flow. Selective arterial embolization of the kidney vessels may be a useful adjunct to RF ablation of kidney tumors.

Real-time motion correction combined with electronic beam steering strategies optimized for large tumors: First in-vitro HIFU experiments in large moving targets

A method for tracking in realtime the 3D motion of tissues is combined with a 2D high-intensity focused ultrasound (HIFU) multichannel system in order to correct for respiratory motion during HIFU therapy. Displacements estimation is based on an accurate 3D ultrasonic speckle tracking technique. A correction is achieved in real time by adjusting the transmit delays of each channel of the HIFU system. In vitro HIFU experiments combined with motion correction are performed in fresh biological tissues. The accuracy of the HIFU targeting is clearly improved. Moreover, this technique permits an important reduction of the treatment time for moving tumors. To generate large thermal lesions, the focus is scanned electronically over a large region. Different heating strategies are investigated in moving tissues: the shot-by-shot treatment interleaved with cooling periods, and the continuously scanned treatment of the whole region. The temperature distribution and the thermal dose are computed using a 3D thermal diffusion code combined with a 3D wave diffraction algorithm and compared to experimental results. Using motion correction, the necrosis threshold is achieved 3 times faster than without motion correction. This should lead to an important time reduction for the treatment of abdominal tumors.

Technical developments for cerebral thermal treatment: water-cooled diffusing laser fibre tips and temperature-sensitive MRI using intersecting image planes

The aim was to determine if water-cooled diffusing tips could produce larger and safer (better controlled) thermal lesions than non-cooled diffusing tips at 980 nm. Thermal lesions were induced in beef myocardium in vitro with and without water cooling using a 980 nm diode laser at various power levels. Seven intracerebral treatments were performed in six canines using water-cooled diffusing tips with four animals having intracerebral transmissible venereal tumours grown from inoculate. Magnetic resonance thermal imaging (MRTI)-based feedback software using a fast, radio frequency-spoiled gradient echo acquisition with two intersecting image planes was used for on-line monitoring and control of treatment and for the evaluation of in vivo laser lesion production. In cases where two-plane MRTI was employed, the maximum calculated temperature was compared in each plane. Using water-cooled tips and 400 µm core diameter laser diffusing fibres in in vitro beef myocardium, power of up to 9.5 W was applied for 8 min without tip failure. Without cooling, tip failure occurred in under 4 min at 6 W, in under 2 min at 7 W and instantaneously at 8 W. Additionally, char accompanied lesions made with uncooled tips while cooled application resulted in only minimal char at only the highest thermal dose. Achieved lesion cross-sectional diameters in in vitro samples were up to 26.5 × 23.3 mm when water cooling was used. In canine brain and transmissible venereal tumours, up to 18.1 × 21.4 mm lesions were achieved. It is concluded that water cooling allows safe application of higher power to small core diameter diffusing tip fibres, which results in larger thermal lesions than can be achieved without cooling. Two-plane MRTI enhances on-line monitoring and feedback of thermal treatment.

Treatment time reduction for large thermal lesions by using a multiple 1D ultrasound phased array system

To generate large thermal lesions in ultrasound thermal therapy, cooling intermissions are usually introduced during the treatment to prevent near-field heating, which leads to a long treatment time. A possible strategy to shorten the total treatment time is to eliminate the cooling intermissions. In this study, the two methods, power optimization and acoustic window enlargement, for reducing power accumulation in the near field are combined to investigate the feasibility of continuously heating a large target region (maximally 3.2 × 3.2 × 3.2 cm3). A multiple 1D ultrasound phased array system generates the foci to scan the target region. Simulations show that the target region can be successfully heated without cooling and no near-field heating occurs. Moreover, due to the fact that there is no cooling time during the heating sessions, the total treatment time is significantly reduced to only several minutes, compared to the existing several hours.

Radiofrequency Ablation with and without Balloon Occlusion of the Renal Artery: An Experimental Study in Porcine Kidneys

To compare thermal lesion volumes and associated renal damage (other than thermal lesions) when radiofrequency (RF) ablation is performed with and without balloon occlusion of the renal artery in normal porcine kidneys. RF ablation was performed in six pigs. An electrode with eight circumferential prongs arranged in a circle 20 mm in diameter was inserted into the lower pole of the kidney. In each animal, renal ablation was performed with balloon occlusion of the renal artery in one kidney and without balloon occlusion in the contralateral kidney. The volume of the thermal lesion and associated renal damage other than the thermal lesion were compared by angiography and histology between the groups of kidneys ablated with and without arterial occlusion. The volume of thermal lesion was measured by tracing the thermal lesions of sliced kidneys and multiplying each area by the slice thickness (5 mm). Renal ablation with arterial occlusion consistently created nearly spherical thermal lesions with a mean volume of 5,399 mm(3) +/- 902. RF ablation without arterial occlusion, conversely, created irregular, mushroom-shaped thermal lesions limited to the region around the prongs and shaft of the electrode, with a mean volume of 2,759 mm(3) +/- 1,069 (P <.001). Renal arteriography showed occlusion of interlobar arteries penetrating the thermal lesions and perfusion defects peripheral to the thermal lesions immediately after RF ablation. Perfusion defects were larger in kidneys ablated with arterial occlusion than in those ablated without arterial occlusion (1,499 cm(2) +/- 354 vs 499 cm(2) +/- 352; P <.001). Renal RF ablation with arterial occlusion consistently provides larger thermal lesions than ablation without arterial occlusion does, but it induces renal infarction peripheral to the thermal lesion.

Creating larger thermal lesions in less time: Evaluation of a novel 200-watt radiofrequency generator and 4.0 cm multiple array needle electrode

Creating larger thermal lesions in less time: Evaluation of a novel 200-watt radiofrequency generator and 4.0 cm multiple array needle electrode

Creating larger thermal lesions in less time: Evaluation of a novel 200-watt radiofrequency generator and 4.0 cm multiple array needle electrode

Creating larger thermal lesions in less time: Evaluation of a novel 200-watt radiofrequency generator and 4.0 cm multiple array needle electrode