In the conventional ultrasonic monitoring of high-intensity focused ultrasound (HIFU) treatment, a significant interval between HIFU shots is required when monitoring target tissue to avoid interference between HIFU noise and RF echo signals. In our previous study, a new filtering method to eliminate only HIFU noise while maintaining tissue signals intact was proposed, and it was shown that the thermal coagulation could be detected during simultaneous HIFU irradiation through off-line processing. In this study, the filtering method and a real-time coagulation detection algorithm were implemented in an ultrasound imaging system, whose use for sequential exposure with multiple foci was demonstrated similarly to a commercial HIFU ablation system. The coagulation was automatically detected by the proposed method during real-time simultaneous HIFU irradiation, and the HIFU exposure time was controlled according to the changes in the tissue. The results imply that ultrasonic monitoring with the filtering and detection methods is useful for true real-time detection of changes in the tissue due to thermal coagulation during HIFU exposure.

In conventional ultrasonic monitoring of high-intensity focused ultrasound (HIFU) treatment, a significant interval between consecutive HIFU shots is set for monitoring target tissue to avoid the interference of HIFU noise with RF echo signals. Thus, it is difficult to detect changes in tissue on the order of milliseconds, which are required to dynamically control the HIFU exposure. In this study, a new filtering method to eliminate the HIFU noise in the RF signals before beamforming is proposed. The CW response was estimated from RF signals with no pulse response to the imaging exposure, and the estimated CW response was subtracted from the entire RF signal to selectively eliminate the HIFU noise for each channel of the array probe before dynamic focusing was applied. The HIFU noise was selectively eliminated by this method when it existed. The results imply that the proposed filtering method is useful for true real-time detection of changes in tissue due to thermal coagulation during HIFU exposure.

High-intensity focused ultrasound (HIFU) therapy is a less invasive method of cancer treatment, in which ultrasound is generated outside the body and focused at the tumor tissue to be thermally coagulated. To enhance the safety, accuracy, and efficiency of HIFU therapy, “multiple-triggered HIFU” has been proposed as a method of cavitation-enhanced heating to shorten treatment time. In this study, we also propose shear wave elastography (SWE) to noninvasively monitor the cavitation-enhanced heating. Results show that the increase in shear wave velocity was observed in the coagulation area, but it was significantly slower when cavitation occurred. This suggests that the cavitation-enhanced heating requires a significantly longer cooling time before the accurate measurement of shear modulus than heating without generating bubbles.

Shear wave elastography (SWE) is expected to be a noninvasive monitoring method of high-intensity focused ultrasound (HIFU) treatment. However, conventional SWE techniques encounter difficulty in inducing shear waves with adequate displacements in deep tissue. To observe tissue coagulation at the HIFU focal depth via SWE, in this study, we propose using a two-dimensional-array therapeutic transducer for not only HIFU exposure but also creating shear sources. The results show that the reconstructed shear wave velocity maps detected the coagulated regions as the area of increased propagation velocity even in deep tissue. This suggests that “HIFU-push” shear elastography is a promising solution for the purpose of coagulation monitoring in deep tissue, because push beams irradiated by the HIFU transducer can naturally reach as deep as the tissue to be coagulated by the same transducer.

High-intensity focused ultrasound is a noninvasive treatment applied by externally irradiating ultrasound to the body to coagulate the target tissue thermally. Recently, it has been proposed as a noninvasive treatment for vascular occlusion to replace conventional invasive treatments. Cavitation bubbles generated by the focused ultrasound can accelerate the effect of thermal coagulation. However, the tissues surrounding the target may be damaged by cavitation bubbles generated outside the treatment area. Conventional methods based on Doppler analysis only in the time domain are not suitable for monitoring blood flow in the presence of cavitation. In this study, we proposed a novel filtering method based on the differences in spatiotemporal characteristics, to separate tissue, blood flow, and cavitation by employing singular value decomposition. Signals from cavitation and blood flow were extracted automatically using spatial and temporal covariance matrices.