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A comparison study of microwave ablation vs. histotripsy for focal liver treatments in a swine model

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Abstract

Objective

To compare the acute and chronic safety and treatment effects of non-invasive hepatic histotripsy vs. percutaneous microwave (MW) ablation in a healthy porcine model.

Methods

This was a dual-arm study in which each animal (n = 14) received either a single hepatic microwave (n = 6) or histotripsy (n = 6 single treatment; n = 2 double treatment) under ultrasound guidance. The goal was to create 2.5–3.0 cm short-axis treatments in similar locations across modalities. Animals were survived for 1 month with contrast-enhanced CT imaging on days 0, 2, 7, 14, and 28. On day 28, necropsy and histopathology were performed.

Results

All procedures were well-tolerated. MW ablation zones were longer and more oblong, but equivalent in the short axes to histotripsy zones on immediate post-procedure CT (p < 0.001 and p = 0.45, respectively). Overall, MW volumes were larger (21.4 cm3 vs. 13.4 cm3; p = 0.001) and histotripsy treatment zones were more spherical (p = 0.007). Histotripsy zones were close to the prescribed size (p < 0.001). Over the study period, histotripsy treatment zones decreased in volume while microwave ablation zones slightly increased (−83% vs. +17%, p = 0.001). There were several imaging-only findings: Branch portal vein thrombus with both histotripsy (7/8) and MW (6/6), hematoma in 2/6 MW only, and a gallbladder injury in 1/6 MW animals. The ablation zones demonstrated complete cellular destruction for both modalities.

Conclusion

Histotripsy was associated with more spherical treatments, fewer biliary complications, and greater treatment zone involution. Hepatic MW and histotripsy treatment in a normal porcine model appear at least equally effective for creating treatment zones with a similar safety profile.

Key Points

• Microwave ablation and histotripsy for liver treatment in a healthy porcine model yield equivalent procedural tolerance and cellular destruction.

• Histotripsy was associated with more spherical treatments, fewer biliary complications, and greater treatment zone involution over the 28-day follow-up period.

• These findings confirm the safety and efficacy of hepatic histotripsy and support the pursuit of clinical trials to further evaluate the translatability of these results.

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Abbreviations

CECT:

Contrast-enhanced computed tomography

CK:

Creatine kinase

CT:

Computed tomography

FDA:

U.S. Food and Drug Administration

MW:

Microwave

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Acknowledgements

The authors would like to acknowledge the contributions of Ryan Miller, PhD; Alex Duryea, PhD; Jon Cannata, PhD; William Stoffregen, DMV, PhD; and Mike Bravo.

Funding

This study was sponsored in part by HistoSonics, Inc., Ann Arbor, MI.

Author information

Authors and Affiliations

  1. The Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Emily A. Knott

  2. Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA

    Annie M. Zlevor, J. Louis Hinshaw, Paul F. Laeseke, Allison B. Couillard, Annika E. Rossebo, Fred T. Lee Jr & Timothy J. Ziemlewicz

  3. Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    J. Louis Hinshaw & Fred T. Lee Jr

  4. Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Colin Longhurst

  5. College of Agriculture and Life Sciences, University of Wisconsin-Madison, Madison, WI, USA

    Jenifer Frank

  6. Department of Pathobiology, University of Pennsylvania: School of Veterinary Medicine, Philadelphia, PA, USA

    Charles W. Bradley

  7. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Zhen Xu

  8. College of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Fred T. Lee Jr

Authors
  1. Emily A. Knott
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  12. Timothy J. Ziemlewicz
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Corresponding author

Correspondence to Timothy J. Ziemlewicz.

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Guarantor

The scientific guarantor of this publication is TJZ.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: JLH (Consultant, Ethicon, Inc.; Shareholder, Elucent; Shareholder, Accure; Shareholder, HistoSonics, Inc.; Shareholder, Cellectar), PFL (Advisor, Shareholder, Research Support, HistoSonics, Inc.; Consultant, Ethicon, Inc.; Research Support, Siemens; Advisor, Shareholder, Elucent Medical; Shareholder, McGinley Orthopedic Innovations), CWB (Consultant, HistoSonics, Inc.), ZX (Shareholder, Consultant, Research Support, HistoSonics, Inc.), FTL (Consultant, Ethicon, Inc.; Patents, Royalties, Medtronic, Inc.; Board of Directors, Shareholder, Research Support, Histosonics, Inc.), TJZ (Shareholder, Research Support, HistoSonics, Inc.; Consultant, Research Support, Ethicon, Inc.).

Statistics and biometry

CL kindly provided statistical advice for this manuscript.

Informed consent

Approval from the institutional animal care committee was obtained.

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Institutional Review Board approval was obtained.

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• performed at one institution

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Knott, E.A., Zlevor, A.M., Hinshaw, J.L. et al. A comparison study of microwave ablation vs. histotripsy for focal liver treatments in a swine model. Eur Radiol 33, 1050–1062 (2023). https://doi.org/10.1007/s00330-022-09112-8

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