Opening the Blood-Brain Barrier with MR Imaging-guided Focused Ultrasound: Preclinical Testing on a Trans-Human Skull Porcine Model.

Opening the Blood-Brain Barrier with MR Imaging-guided Focused Ultrasound: Preclinical Testing on a Trans-Human Skull Porcine Model.
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DOI:
10.1148/radiol.2016152154
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发表时间:
2017-01
期刊:
影响因子:
19.7
通讯作者:
Hynynen K
Hynynen K
中科院分区:
医学1区
文献类型:
--
作者:
Huang Y;Alkins R;Schwartz ML;Hynynen K

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开发和测试一项方案,为通过磁共振引导聚焦超声(MRgFUS)打开血脑屏障(BBBO)进行脑肿瘤化疗药物递送的临床试验做准备。该程序已获机构动物护理委员会批准。设计了跨人头颅猪模型进行临床前试验。对11头体重约15公斤的猪进行了宽开颅手术。在这只动物的大脑上放置了一部分人类头骨。改良的临床MRgFUS脑系统(ExAblate 4000, 230 kHz)与3T MR扫描仪(Signa MR750, GE Healthcare)一起使用。超声波束在超声过程中以3毫米的间隔在3×3网格上被操纵。测试了3 ~ 20 W的声功率级。每次超声均以4 ul/kg的剂量注射Definity微泡。分别采用磁共振成像、组织学和空化受体检测血脑屏障开放水平、出血水平和空化信号水平。根据测量结果的逻辑回归,开发了一种空化安全算法,并进行了测试,以尽量减少出血的风险。声波功率约为5w的gd增强MR成像显示体积约为1cm3的BBBO。组织学大体检查证实Evans蓝(与大分子白蛋白结合)外渗,H&E染色仅检出分散的红细胞外渗。在空化信号高于阈值的情况下,立即终止超声而不会引起出血。通过跨人猪颅骨模型,本研究展示了230 kHz ExAblate系统的BBBO,为临床试验做准备。
To develop and test a protocol in preparation for a clinical trial on blood-brain-barrier opening (BBBO) by magnetic resonance-guided focused ultrasound (MRgFUS) for chemo-drug delivery to brian tumors. The procedures were approved by the Institutional Animal Care Committee. A trans-human skull porcine model was designed for the preclinical testing. Wide craniotomies were applied on 11 porcine subjects (~15 kg). A partial human skull was positioned over the animal’s brain. A modified clinical MRgFUS brain system (ExAblate 4000, 230 kHz) was used with a 3T MR scanner (Signa MR750, GE Healthcare). The ultrasound beam was steered during sonications over a 3×3 grid at 3 mm spacing. Acoustic power levels from 3 to 20 W were tested. Bolus injections of Definity microbubble at 4 ul/kg were tested for each sonication. Levels of BBB opening, hemorrhage and cavitation signal were measured by MR imaging, histology and cavitation receivers, respectively. A cavitation safety algorithm was developed based on logistic regression of the measurements and tested to minimize risks of hemorrhage. BBBO of approximately 1 cm3 in volume were visualized by Gd-enhanced MR imaging post sonication at ~5 W acoustic powers. Gross examination of histology confirmed Evans blue (bound to macromolecule albumin) extravasation, and H&E staining detected only scattered extravasation of red blood cells. In cases where cavitation signals were above thresholds, sonications were terminated immediately without causing hemorrhage. With a trans-human skull porcine model, this study demonstrated BBBO with the 230 kHz ExAblate system in preparation for a clinical trial.
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