In vitro comminution of model renal calculi using histotripsy.
In vitro comminution of model renal calculi using histotripsy.
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DOI：
10.1109/tuffc.2011.1898
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发表时间：
2011-05
期刊：
影响因子：
--
通讯作者：
Cain CA
中科院分区：
文献类型：
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作者：
Duryea AP;Maxwell AD;Roberts WW;Xu Z;Hall TL;Cain CA
冲击波碎石术（SWL）的缺点在于它可以产生显著尺寸（>2 mm）的残余结石碎片。从机械学上讲，空化现象已被证明在将这种碎片减少为较小碎片方面发挥重要作用。在这项研究中，我们评估了使用基于空化的脉冲超声治疗（组织碎石术）侵蚀肾结石的可行性。以前的工作表明，组织摧毁术能够机械地将软组织分离成细小的无细胞碎片。在这里，我们研究了通过使用普遍接受的结石模型Ultracal-30骨水泥将该技术转化为肾结石的可能性。使用1 MHz聚焦换能器对结石进行超声处理，以1 kHz的速率提供5个周期的脉冲。测试了峰值负压范围为3-21 MPa的脉冲。结果表明，组织碎石术能够有效侵蚀Ultracal-30模型，在最大治疗压力下实现26 mg/min的平均结石侵蚀速率;仅在存在密集空化气泡云的情况下观察到大量结石侵蚀。残留结石碎片的连续筛选表明，组织碎石术产生的碎片尺寸小于100 μm，治疗监测显示，空化气泡云和模型结石在B型成像上均显示为高回声区域。这些初步结果表明，组织碎石术在其用于结石粉碎方面显示出希望，并且优化的侵蚀过程可能为传统的SWL程序提供潜在的辅助。
Shock wave lithotripsy (SWL) suffers from the fact that it can produce residual stone fragments of significant size (>2 mm). Mechanistically, cavitation has been shown to play an important role in the reduction of such fragments to smaller debris. In this study we assessed the feasibility of using cavitationally-based pulsed ultrasound therapy (histotripsy) to erode kidney stones. Previous work has shown that histotripsy is capable of mechanically fractionating soft tissue into fine, acellular debris. Here, we investigated the potential for translating this technology to renal calculi through the use of a commonly accepted stone model, Ultracal-30 cement. Stones were sonicated using a 1-MHz focused transducer, with 5-cycle pulses delivered at a rate of 1 kHz. Pulses having peak negative pressures ranging from 3–21 MPa were tested. Results indicate that histotripsy is capable of effectively eroding the Ultracal-30 model, achieving an average stone erosion rate of 26 mg/min at maximum treatment pressure; substantial stone erosion was only observed in the presence of a dense cavitational bubble cloud. Sequential sieving of residual stone fragments indicated that debris produced by histotripsy was smaller than 100 μm in size, and treatment monitoring showed that both the cavitational bubble cloud and model stone appear as hyperechoic regions on B-mode imaging. These preliminary results indicate that histotripsy shows promise in its use for stone comminution, and an optimized erosion process may provide a potential adjunct to conventional SWL procedures.