Physics Faculty, Lomonosov Moscow State University, Moscow, Russia.
Physics Faculty, Lomonosov Moscow State University, Moscow, Russia.
Ultrasound Med Biol. 2024 Aug;50(8):1255-1261. doi: 10.1016/j.ultrasmedbio.2024.05.002. Epub 2024 May 17.
As an alternative to surgical excision and magnetic resonance-guided thermal high-intensity focused ultrasound ablation of uterine leiomyoma, this work was aimed at pilot feasibility demonstration of use of ultrasound-guided boiling histotripsy for non-invasive non-thermal fractionation of human uterine leiomyoma ex vivo.
A custom-made sector ultrasound transducer of 1.5-MHz operating frequency and nominal f-number F# = 0.75 was used to produce a volumetric lesion (two layers of 5 × 5 foci with a 1 mm step) in surgically resected human leiomyoma ex vivo. A sequence of 10 ms pulses (P+/P-/A = 157/-25/170 MPa in situ) with 1% duty cycle was delivered N = 30 times per focus under B-mode guidance. The treatment outcome was evaluated via B-mode imaging and histologically with hematoxylin and eosin and Masson's trichrome staining.
The treatment was successfully performed in less than 30 min and resulted in formation of a rectangular lesion visualized on B-mode images during the sonication as an echogenic region, which sustained for about 10 min post-treatment. Histology revealed loss of cellular structure, necrotic debris and globules of degenerated collagen in the target volume surrounded by injured smooth muscle cells.
The pilot experiment described here indicates that boiling histotripsy is feasible for non-invasive mechanical disintegration of human uterine leiomyoma ex vivo under B-mode guidance, encouraging further investigation and optimization of this potential clinical application of boiling histotripsy.
作为手术切除和磁共振引导热高强度聚焦超声消融子宫肌瘤的替代方法，本研究旨在初步验证超声引导沸腾空化爆破用于离体人子宫肌瘤无创非热分割的可行性。
使用工作频率为 1.5MHz、标称 f 数 F#=0.75 的定制扇形超声换能器在离体手术切除的子宫肌瘤中产生一个容积性病变（两层 5×5 焦点，间隔 1mm）。在 B 模式引导下，每个焦点以 1%的占空比连续发射 10ms 脉冲（原位 P+/P-/A=157/-25/170MPa），每个焦点发射 30 次。通过 B 模式成像和苏木精-伊红及 Masson 三色染色的组织学评估治疗效果。
治疗在 30 分钟内成功完成，在超声过程中形成了一个矩形病变，在 B 模式图像上显示为一个强回声区域，治疗后约 10 分钟内持续存在。组织学显示目标体积内的细胞结构丧失、坏死碎片和变性胶原小球，周围是受损的平滑肌细胞。
本文描述的初步实验表明，沸腾空化爆破在 B 模式引导下用于离体人子宫肌瘤的无创机械分解是可行的，这鼓励进一步研究和优化沸腾空化爆破在这一潜在临床应用中的优化。
