Abstract
Purpose
To determine whether histotripsy can create human-scale transcostal ablations in porcine liver without causing severe thermal wall injuries along the beam path.
Materials and Methods
Histotripsy was applied to the liver using a preclinical prototype robotic system through a transcostal window in six female swine. A 3.0 cm spherical ablation zone was prescribed. Duration of treatment (75 min) was longer than a prior subcostal treatment study (24 min, 15 s) to minimize beam path heating. Animals then underwent contrast-enhanced MRI, necropsy, and histopathology. Images and tissue were analyzed for ablation zone size, shape, completeness of necrosis, and off-target effects.
Results
Ablation zones demonstrated complete necrosis with no viable tissue remaining in 6/6 animals by histopathology. Ablation zone volume was close to prescribed (13.8 ± 1.8 cm3 vs. prescribed 14.1 cm3). Edema was noted in the body wall overlying the ablation on T2 MRI in 5/5 (one animal did not receive MRI), though there was no gross or histologic evidence of injury to the chest wall at necropsy. At gross inspection, lung discoloration in the right lower lobe was present in 5/6 animals (mean size: 1 × 2 × 4 cm) with alveolar hemorrhage, preservation of blood vessels and bronchioles, and minor injuries to pneumocytes noted at histology.
Conclusion
Transcostal hepatic histotripsy ablation appears feasible, effective, and no severe injuries were identified in an acute porcine model when prolonged cooling time is added to minimize body wall heating.
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Acknowledgements
The authors of this study would like to acknowledge the HistoSonics R&D team (Josh Stopek PhD, Jon Cannata PhD, Ryan Miller PhD, and Alex Duryea PhD) and the animal anesthesia and care team.
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This study has received funding from HistoSonics, Inc. (Ann Arbor, MI). Author EV is a consultant, stockholder, and receives research support from HistoSonics, Inc. Author ZX is a stockholder and receives research support from HistoSonics, Inc. Author PL is a consultant and stockholder with HistoSonics, Inc., a consultant with NeuWave/Ethicon, Inc., and receives research support from Siemens Healthineers. Author TH is a consultant, stockholder, and receives research support from Histosonics, Inc. Author FL is a consultant, stockholder, receives research support, and is on the board of directors at HistoSonics, Inc., is a consultant with Ethicon, Inc., and has patents and royalties with Medtronic, Inc. Author TZ is a consultant, stockholder, receives research support from HistoSonics, Inc. and is a consultant with Ethicon, Inc.)
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Knott, E.A., Longo, K.C., Vlaisavljevich, E. et al. Transcostal Histotripsy Ablation in an In Vivo Acute Hepatic Porcine Model. Cardiovasc Intervent Radiol 44, 1643–1650 (2021). https://doi.org/10.1007/s00270-021-02914-1
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DOI: https://doi.org/10.1007/s00270-021-02914-1