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Thermal ablation of a confluent lesion in the porcine kidney with magnetic resonance guided high intensity focused ultrasound

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Alternatively, recent preclinical studies have demonstrated the feasibility of magnetic resonance guided high intensity focused ultrasound (MR-HIFU) interventions on the kidney with respect to motion compensated real-time thermometry and acoustic energy delivery... Here, we extend this prior work to investigate in an animal study if MR-HIFU can deliver a reliable confluent volumetric lesion in the renal cortex in a clinically relevant time-frame... Both acoustic energy delivery and MR-thermometry were respiratory gated (3mm gating window, ~70% duty cycle) and active surface cooling was employed to prevent undesired near-field damage... A honeycomb pattern of seven ablation cells (12-17s, 450W acoustic power, 4x4x10 mm3) was positioned in the cortex of the kidney as shown in figure 1... Subsequently, the animal was euthanized and the extent of the induced necrosis examined using a cellular viability staining (nicotinamide adenine dinucleotide, NADH)... All ablation cells reached peak temperatures > 80°C during the sonications, resulting in a lethal thermal dose over the entire delineated target area... DCE-MRI displayed a confluent non-perfused volume within the cortex and partly within the medulla with a volume of ±2 ml as shown in figure 2... NADH staining reconfirmed a confluent non-viable volume of approximately (12 x 16 x 10 mm3) (Figure 3)... No undesired tissue damage in adjacent areas has been observed... These first results indicate that current MR-guided clinical HIFU equipment might be suitable for non invasive therapy of renal masses... Future work will need to demonstrate the reproducibility of the findings and investigate potential adverse effects (cutaneous and subcutaneous damage) as a preparation for a clinical study.

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Planning of 7 treatment cells in the cortex of the kidney
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Figure 1: Planning of 7 treatment cells in the cortex of the kidney

Mentions: An anesthetized Dalland land pig was placed on its right side on a clinical Sonalleve MR-HIFU therapy system, which is integrated with a 1.5T Achieva MRI (Philips Healthcare) with minor modifications. Both acoustic energy delivery and MR-thermometry were respiratory gated (3mm gating window, ~70% duty cycle) and active surface cooling was employed to prevent undesired near-field damage. A honeycomb pattern of seven ablation cells (12-17s, 450W acoustic power, 4x4x10 mm3) was positioned in the cortex of the kidney as shown in figure 1. The therapeutic endpoint was evaluated non-invasively at the end of the intervention. Hereto, lethal thermal dose estimates based on MR-thermometry and a non-perfused volume (NPV) measurement using dynamic contrast enhanced T1-weighted MRI (DCE-MRI) were performed. Subsequently, the animal was euthanized and the extent of the induced necrosis examined using a cellular viability staining (nicotinamide adenine dinucleotide, NADH).


Thermal ablation of a confluent lesion in the porcine kidney with magnetic resonance guided high intensity focused ultrasound
Planning of 7 treatment cells in the cortex of the kidney
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489614&req=5

Figure 1: Planning of 7 treatment cells in the cortex of the kidney
Mentions: An anesthetized Dalland land pig was placed on its right side on a clinical Sonalleve MR-HIFU therapy system, which is integrated with a 1.5T Achieva MRI (Philips Healthcare) with minor modifications. Both acoustic energy delivery and MR-thermometry were respiratory gated (3mm gating window, ~70% duty cycle) and active surface cooling was employed to prevent undesired near-field damage. A honeycomb pattern of seven ablation cells (12-17s, 450W acoustic power, 4x4x10 mm3) was positioned in the cortex of the kidney as shown in figure 1. The therapeutic endpoint was evaluated non-invasively at the end of the intervention. Hereto, lethal thermal dose estimates based on MR-thermometry and a non-perfused volume (NPV) measurement using dynamic contrast enhanced T1-weighted MRI (DCE-MRI) were performed. Subsequently, the animal was euthanized and the extent of the induced necrosis examined using a cellular viability staining (nicotinamide adenine dinucleotide, NADH).

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Alternatively, recent preclinical studies have demonstrated the feasibility of magnetic resonance guided high intensity focused ultrasound (MR-HIFU) interventions on the kidney with respect to motion compensated real-time thermometry and acoustic energy delivery... Here, we extend this prior work to investigate in an animal study if MR-HIFU can deliver a reliable confluent volumetric lesion in the renal cortex in a clinically relevant time-frame... Both acoustic energy delivery and MR-thermometry were respiratory gated (3mm gating window, ~70% duty cycle) and active surface cooling was employed to prevent undesired near-field damage... A honeycomb pattern of seven ablation cells (12-17s, 450W acoustic power, 4x4x10 mm3) was positioned in the cortex of the kidney as shown in figure 1... Subsequently, the animal was euthanized and the extent of the induced necrosis examined using a cellular viability staining (nicotinamide adenine dinucleotide, NADH)... All ablation cells reached peak temperatures > 80°C during the sonications, resulting in a lethal thermal dose over the entire delineated target area... DCE-MRI displayed a confluent non-perfused volume within the cortex and partly within the medulla with a volume of ±2 ml as shown in figure 2... NADH staining reconfirmed a confluent non-viable volume of approximately (12 x 16 x 10 mm3) (Figure 3)... No undesired tissue damage in adjacent areas has been observed... These first results indicate that current MR-guided clinical HIFU equipment might be suitable for non invasive therapy of renal masses... Future work will need to demonstrate the reproducibility of the findings and investigate potential adverse effects (cutaneous and subcutaneous damage) as a preparation for a clinical study.

No MeSH data available.