Noninvasive release of tendons using MRI guided focused ultrasound: a hybrid therapy using long-pulse focused ultrasound followed by thermal ablation.

IF 3 3区 医学 Q2 ONCOLOGY International Journal of Hyperthermia Pub Date : 2024-01-01 Epub Date: 2024-05-08 DOI:10.1080/02656736.2024.2350759
William Chu Kwan, Imogen den Otter-Moore, Ari Partanen, Karolina Piorkowska, Unni Narayanan, Adam C Waspe, James M Drake
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Abstract

Introduction: Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thermal ablation is an effective noninvasive ultrasonic therapy to disrupt in vivo porcine tendon but is prone to inducing skin burns. We evaluated the safety profile of a novel hybrid protocol that minimizes thermal spread by combining long-pulse focused ultrasound followed by thermal ablation.

Methods: In-vivo Achilles tendons (hybrid N = 15, thermal ablation alone N = 21) from 15 to 20 kg Yorkshire pigs were randomly assigned to 6 treatment groups in two studies. The first (N = 21) was ablation (600, 900, or 1200 J). The second (N = 15) was hybrid: pulsed FUS (13.5 MPa peak negative pressure) followed by ablation (600, 900, or 1200 J). Measurements of ankle range of motion, tendon temperature, thermal dose (240 CEM43), and assessment of skin burn were performed in both groups.

Results: Rupture was comparable between the two protocols: 1/5 (20%), 5/5 (100%) and 5/5 (100%) for hybrid protocol, compared to 2/7 (29%), 6/7 (86%) and 7/7 (100%) for the ablation-only protocol with energies of 600, 900, and 1200 J, respectively. The hybrid protocol produced lower maximum temperatures, smaller areas of thermal dose, fewer thermal injuries to the skin, and fewer full-thickness skin burns. The standard deviation for the area of thermal injury was also smaller for the hybrid protocol, suggesting greater predictability.

Conclusion: This study demonstrated a hybrid MRgFUS protocol combining long-pulse FUS followed by thermal ablation to be noninferior and safer than an ablation-only protocol for extracorporeal in-vivo tendon rupture for future clinical application for noninvasive release of contracted tendon.

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利用核磁共振成像引导的聚焦超声对肌腱进行无创松解:使用长脉冲聚焦超声和热消融的混合疗法。
导言:磁共振引导聚焦超声(MRgFUS)热消融是一种有效的非侵入性超声疗法,可破坏体内猪肌腱,但容易引起皮肤灼伤。我们对一种新型混合疗法的安全性进行了评估,这种疗法结合了长脉冲聚焦超声和热消融,能最大限度地减少热扩散:在两项研究中,15 至 20 千克约克夏猪的跟腱(混合疗法 N = 15,单纯热消融疗法 N = 21)被随机分配到 6 个治疗组。第一组(N = 21)进行消融(600、900 或 1200 J)。第二组(N = 15)为混合组:脉冲 FUS(13.5 兆帕峰值负压)后进行消融(600、900 或 1200 焦耳)。两组患者都进行了踝关节活动范围、肌腱温度、热剂量(240 CEM43)和皮肤灼伤评估:结果:两种方案的断裂率相当:结果:两种方案的断裂率相当:混合方案为 1/5(20%)、5/5(100%)和 5/5(100%),而单纯消融方案为 2/7(29%)、6/7(86%)和 7/7(100%),能量分别为 600、900 和 1200 J。混合方案产生的最高温度较低,热剂量区域较小,皮肤热损伤较少,全厚皮肤灼伤较少。混合方案的热损伤面积标准偏差也更小,表明其可预测性更高:这项研究表明,在体外活体肌腱断裂的临床应用中,结合长脉冲 FUS 和热消融的混合 MRgFUS 方案比单纯消融方案更安全、效果更好,可用于挛缩肌腱的无创松解。
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来源期刊
CiteScore
5.90
自引率
12.90%
发文量
153
审稿时长
6-12 weeks
期刊介绍: The International Journal of Hyperthermia
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