Assisted hepatic resection using a toroidal HIFU device: An <i>in vivo</i> comparative study in pig

N’Djin, W. Apoutou; Melodelima, David; Schenone, F.; Rivoire, Michel; Chapelon, Jean Yves

doi:10.1118/1.3551985

Cited by 26 publications

(15 citation statements)

References 52 publications

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“…The radius of curvature of the transducer was 7 cm and the diameter was 7 cm. Compared with conventional HIFU devices, this toroidal geometry produces two focal zones allowing the precise ablation of a large volume of liver tissue (diameter of 2 cm with a major axis of 2.5 cm) in 40 seconds [20]. As shown in Fig.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study

et al. 2015

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BackgroundSurgery is the only curative treatment in patients with colorectal liver metastases (CLM), but only 10–20% of patients are eligible. High Intensity Focused Ultrasound (HIFU) technology is of proven value in several indications, notably prostate cancer. Its intra-operative use in patients with CLM has not previously been studied. Preclinical work suggested the safety and feasibility of a new HIFU device capable of ablating volumes of up to 2cm x 2cm in a few seconds.MethodsWe conducted a prospective, single-centre phase I-IIa trial. HIFU was delivered immediately before scheduled hepatectomy. To demonstrate the safety and efficacy of rapidly ablating liver parenchyma, ablations were performed on healthy tissue within the areas scheduled for resection.ResultsIn total, 30 ablations were carried out in 15 patients. These ablations were all generated within 40 seconds and on average measured 27.5mm x 21.0mm. The phase I study (n = 6) showed that use of the HIFU device was feasible and safe and did not damage neighbouring tissue. The phase IIa study (n = 9) showed both that the area of ablation could be precisely targeted on a previously implanted metallic mark (used to represent a major anatomical structure) and that ablations could be undertaken deliberately to avoid such a mark. Ablations were achieved with a precision of 1–2 mm.ConclusionHIFU was feasible, safe and effective in ablating areas of liver scheduled for resection. The next stage is a phase IIb study which will attempt ablation of small metastases with a 5 mm margin, again prior to planned resection.Trial RegistrationClinicalTrials.govNCT01489787

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Section: Patients Materials and Methodsmentioning

confidence: 99%

First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study

et al. 2015

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“…Ultrasound treatments were also simulated for poorly perfused prostates, as seen in some patients not yet treated 44 or in HIFU retreatment when the blood flow is already reduced by previous ultrasound exposures. [48][49][50] For these conditions, the optimal frequency range was very similar to that for simulations at average perfusion. In the case of no prostate perfusion, the radial targeting error could be reduced to −0.2 ± 1.0 mm.…”

Section: Iiia Parameters For Whole-prostate Treatments From Simulatsupporting

confidence: 49%

Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

et al. 2012

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Purpose:The feasibility and safety of magnetic resonance imaging (MRI)-controlled transurethral ultrasound therapy were demonstrated recently in a preliminary human study in which a small subvolume of prostate tissue was treated prior to radical prostatectomy. Translation of this technology to full clinical use, however, requires the capability to generate thermal coagulation in a volume up to that of the prostate gland itself. The aim of this study was to investigate the parameters required to treat a full 3D human prostate accurately with a multi-element transurethral applicator and multiplanar MR temperature control. Methods: The approach was a combination of simulations (to select appropriate parameters) followed by experimental confirmation in tissue-mimicking phantoms. A ten-channel, MRI-compatible transurethral ultrasound therapy system was evaluated using six human prostate models (average volume: 36 cm 3 ) obtained from the preliminary human feasibility study. Real-time multiplanar MR thermometry at 3 T was used to control the spatial heating pattern in up to nine planes simultaneously. Treatment strategies incorporated both single (4.6 or 8.1 MHz) and dual (4.6 and 14.4 MHz) frequencies, as well as maximum acoustic surface powers of 10 or 20 W cm −2 . Results: Treatments at 4.6 MHz were capable of coagulating a volume equivalent to 97% of the prostate. Increasing power from 10 to 20 W cm −2 reduced treatment times by approximately 50% with full treatments taking 26 ± 3 min at a coagulation rate of 1.8 ± 0.4 cm 3 min −1 . A dual-frequency 4.6/14.4 MHz treatment strategy was shown to be the most effective configuration for achieving full human prostate treatment while maintaining good treatment accuracy for small treatment radii. The dual-frequency approach reduced overtreatment close to the prostate base and apex, confirming the simulations. Conclusions: This study reinforces the capability of MRI-controlled transurethral ultrasound therapy to treat full prostate volumes in a short treatment time with good spatial targeting accuracy and provides key parameters necessary for the next clinical trial.

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“…Diagnostic imaging could be performed to identify target tissue and monitor tissue responses, supporting HIFU as a possible option for non‐invasive fetal therapy. We have previously developed a toroidal HIFU transducer that enables the destruction of large areas of tissue. In a recent study, we demonstrated the ability of this toroidal transducer to induce lesions in the human placenta, in an ex‐vivo model, without damaging intervening tissue.…”

Section: Introductionmentioning

confidence: 99%

Non‐invasive high‐intensity focused ultrasound treatment of the placenta: a preliminary in‐vivo study using a simian model

Caloone

Huissoud

Kocot

et al. 2017

Ultrasound in Obstet & Gyne

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Assisted hepatic resection using a toroidal HIFU device: An in vivo comparative study in pig

Abstract: This method holds promise for future clinical applications in resection of liver metastases.

Cited by 26 publications

References 52 publications

First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study

First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study

Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

Non‐invasive high‐intensity focused ultrasound treatment of the placenta: a preliminary in‐vivo study using a simian model

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