Wagner Martin G, Minesinger Grace M, Falk Katrina L, Kutlu Ayca Z, Kisting Meridith A, Speidel Michael A, Ziemlewicz Timothy J, Hinshaw J Louis, Swietlik John F, Lee Fred T, Laeseke Paul F
Department of Radiology, University of Wisconsin, Madison, WI, USA.
Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
Int J Hyperthermia. 2025 Dec;42(1):2455138. doi: 10.1080/02656736.2025.2455138. Epub 2025 Jan 22.
The application of histotripsy, an emerging noninvasive, non-ionizing, and non-thermal tumor treatment, is currently limited by the inherent limitations of diagnostic ultrasound as the sole targeting modality. This study evaluates the feasibility and accuracy of cone beam computed tomography (CBCT) guidance for histotripsy treatments in an porcine model.
Histotripsy treatments were performed in the liver of seven healthy swine under the guidance of a C-arm CBCT system that was calibrated to the robotic arm of the histotripsy system. For each treatment, pseudotumors (small histotripsy treatments of 15 mm) were created using conventional US guidance to serve as targets for subsequent CBCT guided treatments. A pretreatment CBCT with intravenous contrast was acquired for each swine and the center of the pseudotumor was selected as the target. The robotic arm automatically aligned the transducer to the selected target location. Ultrasound based aberration offset correction was performed when possible, and a 25 mm diameter treatment was performed. A post-treatment CBCT with intravenous contrast was then acquired to evaluate coverage, treatment size, and distance between the pseudotumor target and actual treatment zone center.
Treatments were technically successful and pseudotumors were completely covered in all seven treatments (7/7). The average treatment diameter was 39.3 ± 4.2 mm. The center-to-center distance between pseudotumor and actual treatments was 3.8 ± 1.3 mm.
CBCT provides accurate targeting for histotripsy treatment . While future work is required to assess safety and efficacy in the presence of obstructions, the proposed approach could supplement ultrasound imaging for targeting.
组织粉碎术是一种新兴的非侵入性、非电离且非热的肿瘤治疗方法，目前其应用受到作为唯一靶向方式的诊断超声固有局限性的限制。本研究评估在猪模型中锥束计算机断层扫描（CBCT）引导组织粉碎术治疗的可行性和准确性。
在一台校准至组织粉碎术系统机械臂的C型臂CBCT系统引导下，对7头健康猪的肝脏进行组织粉碎术治疗。对于每次治疗，使用传统超声引导创建假肿瘤（15毫米的小型组织粉碎术治疗区域），作为后续CBCT引导治疗的靶点。为每头猪采集静脉注射造影剂后的预处理CBCT，并选择假肿瘤中心作为靶点。机械臂自动将换能器对准选定的靶点位置。尽可能进行基于超声的像差偏移校正，然后进行直径25毫米的治疗。随后采集静脉注射造影剂后的治疗后CBCT，以评估覆盖范围、治疗大小以及假肿瘤靶点与实际治疗区域中心之间的距离。
治疗在技术上成功，所有7次治疗（7/7）中假肿瘤均被完全覆盖。平均治疗直径为39.3±4.2毫米。假肿瘤与实际治疗区域中心之间的中心距为3.8±1.3毫米。
CBCT为组织粉碎术治疗提供了准确的靶向。虽然未来需要开展工作以评估在存在障碍物情况下的安全性和有效性，但所提出的方法可补充超声成像用于靶向。
