Prevention of post-focal thermal damage by formation of bubbles at the focus during high intensity focused ultrasound therapy

摘要

Safety concerns exist for potential thermal damage at tissue-air or tissue-bone interfaces located in the post-focal region during high intensity focused ultrasound (HIFU) treatments. We tested the feasibility of reducing thermal energy deposited at the post-focal tissue-air interfaces by producing bubbles (due to acoustic cavitation and∕or boiling) at the HIFU focus. HIFU (in-situ intensities of 460–3500 W∕cm², frequencies of 3.2–5.5 MHz) was applied for 30 s to produce lesions (in turkey breast in-vitro (n=37), and rabbit liver (n=4) and thigh muscle in-vivo (n=11)). Tissue temperature was measured at the tissue-air interface using a thermal (infrared) camera. Ultrasound imaging was used to detect bubbles at the HIFU focus, appearing as a hyperechoic region. In-vitro results showed that when no bubbles were present at the focus (at lower intensities of 460–850 W∕cm²), the temperature at the interface increased continuously, up to 7.3±4.0 °C above the baseline by the end of treatment. When bubbles formed immediately after the start of HIFU treatment (at the high intensity of 3360 W∕cm²), the temperature increased briefly for 3.5 s to 7.4±3.6 °C above the baseline temperature and then decreased to 4.0±1.4 °C above the baseline by the end of treatment. Similar results were obtained in in-vivo experiments with the temperature increases (above the baseline temperature) at the muscle-air and liver-air interfaces at the end of the high intensity treatment lower by 7.1 °C and 6.0 °C, respectively, as compared to the low intensity treatment. Thermal effects of HIFU at post-focal tissue-air interfaces, such as in bowels, could result in clinically significant increases in temperature. Bubble formation at the HIFU focus may provide a method for shielding the post-focal region from potential thermal damage.