Ultrasound monitoring of temperature and coagulation change during tumor treatment with microwave ablation

Microwave ablation therapy has become an important method for tumor treatment in recent years. The temperature and the coagulation region need real-time noninvasive monitoring to ensure the safety and effective-ness during the treatment. The authors reviewed the ultrasonic monitoring methods for tumor microwave ablation therapy both at home and abroad. In addition, the authors also prospected this technique in the future.     

The effects of fat layer on temperature distribution during microwave atrial fibrillation catheter ablation

Abstract

To investigate the effects of fat layer on the temperature distribution during microwave atrial fibrillation catheter ablation in the conditions of different ablation time; 3D finite element models (fat layer and no fat layer) were built, and temperature distribution was obtained based on coupled electromagnetic-thermal analysis at 2.45?GHz and 30?W of microwave power. Results shown: in the endocardial ablation, the existence of the fat layer did not affect the shape of the 50?°C contour before 30?s. The increase speed of depth became quite slowly in the model with fat layer after 30?s. When ablation depth needed fixed, there are no significant effect on effectively ablation depth whether fat layer over or not. However, the existence of fat layer makes the temperature lower in the myocardium, and maximum temperature point closer to the myocardium surface. What is more, in the model with fat layer, effective ablation reach lower maximum temperature and the shallower depth of 50?°C contour. But there are larger ablation axial length and transverse width. In this case, doctor should ensure safety of normal cardiac tissue around the target tissue. In the epicardial ablation, the existence of fat layer seriously affects result of the microwave ablation. The epicardial ablation needs more heating time to create lesion. But epicardial ablation can be better controlled in the shape of effective ablation area because of the slowly increase of target variables after the appearing of 50?°C contour. Doctor can choose endocardial or epicardial ablation in different case of clinic requirement.     

Numerical study to establish relationship between coagulation volume and target tip temperature during temperature-controlled radiofrequency ablation

The present study aims at proposing a relationship between the coagulation volume and the target tip temperature in different tissues (viz., liver, lung, kidney, and breast) during temperature-controlled radiofrequency ablation (RFA). A 20-min RFA has been modelled using commercially available monopolar multi-tine electrode subjected to different target tip temperatures that varied from 70°C to 100°C with an increment of 10°C. A closed-loop feedback proportional-integral-derivative (PID) controller has been employed within the finite element model to perform temperature-controlled RFA. The coagulation necrosis has been attained by solving the coupled electric field distribution, the Pennes bioheat and the first-order Arrhenius rate equations within the three-dimensional finite element model of different tissues. The computational study considers temperature-dependent electrical and thermal conductivities along with the non-linear piecewise model of blood perfusion. The comparison between coagulation volume obtained from the numerical and in vitro experimental studies has been done to evaluate the aptness of the numerical models. In the present study, a total of 20 numerical simulations have been performed along with 12 experiments on tissue-mimicking phantom gel using RFA device. The study revealed a strong dependence of the coagulation volume on the pre-set target tip temperature and ablation time during RFA application. Further, the effect of target tip temperature on the applied input voltage has been studied in different tissues. Based on the results attained from the numerical study, statistical correlations between the coagulation volume and treatment time have been developed at different target tip temperatures for each tissue.     

Resection of meningiomas with implantable microwave coagulation

Implantable microwave coagulation was used to perform resection on 62 patients that had intracranial meningiomas. When 20–60 W microwave power was applied for 15 s, the temperature at the center of the tumor tissue was 43–63°C; 30 mm from the center, the temperature was under 40°C. Histological changes in the center of the tumor showed coagulative necrosis, diminished nuclei, and obliterated blood vessels. The changes at 10–20 mm from the center of the tumor showed coagulative necrosis and degeneration and, 30–50 mm from the center of the tumor, showed normal cell morphology after microwave coagulation. The thermal field in brain tumor has an effective diameter of about 40 mm. No side effects on the normal brain tissues were observed. The amount of blood loss during the operation was minimal while the meningioma was coagulated, especially when the meningioma was located at the skull base or in the parasagittal or cerebral convexity region. After microwave coagulation, the entire tumor could easily be removed. Among the 62 surgically treated cases, gross total tumor excision was 85%. No postoperative complications occurred after microwave coagulation, and there was no operative mortality in the series. We believe that this new technique has the advantage of simplicity, less blood loss, and smooth postoperative procedures. Hemostatic effects during the operation are satisfactory, and blood transfusion can be reduced by 50–60%. © 1996 Wiley-Liss, Inc.     

Brain temperature measurements in rats: a comparison of microwave and ambient temperature exposures

In an effort to understand microwave heating better, regional brain and core temperatures of rats exposed to microwave radiation (2450 MHz) or elevated air temperatures were measured in two studies. In general, we have found no substantial evidence for temperature differentials, or "hot spots," in the brain of these animals. In the first study, after a 30-min exposure, no temperature differences between brain regions either after microwave or ambient air exposure were found. However, a highly significant correlation between brain and core temperatures was found and this correlation was the same for both microwave and ambient air heating. In the second study, time-temperature profiles were measured in rats exposed to either 30 mW/cm2 or 36.2 degrees C. In this study, the 30-min exposure period was divided into seven intervals and the change in temperature during each period was analyzed. Only the cortex showed significantly different heating rates between the air heating and microwave heating; however, this difference disappeared after the initial 5 min of exposure.     

超声造影引导下行微波消融术治疗肝癌的临床效果分析

目的：评估超声造影（CEUS）gl导下微波消融（MwA）治疗肝癌的有效性及应用价值。方法：108例肝癌患者,共147个病灶经MWA治疗。根据患者在做常规超声检查时,是否有扫查不清晰的结节或其他影像学检查提示可能存在多发结节等,分成CEUS族和对照组。CEUS组41名患者,年龄（57．9±7．8）岁,共57个病灶,平均直径（2．4±1．5）cm,经超声造影引导下行微波消融治疗。对照组67名患者,年龄（55．5±8．9）岁,共90个病灶,平均直径（2．6±1．7）cm,常规超声引导下同种条件行微波消融治疗。治疗后对两组患者进行6～12个月随访。结果：CEUS组的57个病灶均清晰显示其位置、数目、大小、边界、形态,完全消融的结节为55个,未完全消融的结节为2个。对照组67名患者的90个病灶,完全消融的病灶78个;未完全消融的结节12个。CEUS组完全消融率高于病例对照组（96．49％VS86．67％;P〈0．05）。随访6～12个月后发现,CEUS组完全消融率高于病例对照组（P〈0．05）,差异有统计学意义。结论：CEUS能更好的显示病灶的位置、数目、大小,更精确显示病灶边界、范围,造影引导下MWA是一种有效提高完全消融效率的方法,具有较大应用价值。     

Comparison of percutaneous cryoablation with microwave ablation in a porcine liver model

We compared imaging and pathological changes between argon–helium cryosurgical (AH) and microwave (MW) ablation in a porcine liver model. Immediately after ablation, computed tomography (CT) imaging showed that the area affected by MW ablation was considerably greater than that affected by AH ablation; moreover, the surface area of necrotic tissue was considerably greater in the AH group, whereas the depth of the necrotic area was similar. Seven days after ablation, the affected area had not changed much in the AH group, but it had significantly increased in the MW group; similarly, the surface and depth of the necrotic areas had not changed much in the AH group, but they had increased significantly in the MW group. The pathological findings showed similar definitive areas for both groups at both time points. The findings indicated that long time after both therapies, complete tissue necrosis can be achieved, but the extent and depth of necrosis differ: necrosis foci after AH ablation could be predicted by ice ball under CT image, and necrosis foci after MW ablation will increase obviously. MW ablation might therefore be suitable for tumors with a larger volume and simple anatomical structures, and AH ablation might be suitable for tumors with complex anatomical structures or those located near important organs. These two methods could therefore be used in combination in clinical settings, but details of the procedure need to be studied.     

Responses of human skin temperature and thermal sensation to step change of air temperature

1. 1. The purpose of this paper is to clarify the non-linearity of the human physiological and psychological responses to step change of air temperature by impulse response analysis using Discrete Fourier Transformation.

2. 2. Experiments were conducted to investigate the effect of thermal transients on human responses.

3. 3. Experimental conditions were as follows: lowering air temperature from 30 to 20°C and raising air temperature from 20 to 30°C.

4. 4. The responses of local skin temperature on lowering air temperature from 30 to 20°C are not necessarily opposite to the responses found on raising air temperature from 20 to 30°C.

5. 5. From impulse response analysis using Discrete Fourier Transformation, skin temperature responses to the opposite air temperature change do not necessarily coincide with each other whenever the same temperature stimulus is occurred.

Effects of 2.45-GHz microwave and 100-MHz radiofrequency radiation on liposome permeability at the phase transition temperature

Large unilamellar dipalmitoylphosphatidylcholine (DPPC) and dipalmitoylphosphatidylglycerol (DPPG) liposomes loaded with an aqueous chemotherapeutic drug, cytosine arabinofuranoside (ARA-C), were exposed for 30 min to 60 W/kg continuous-wave (CW) 100-MHz or 2.45-GHz radiation in vitro at temperatures between 37 degrees C and 43 degrees C. Liposomes were exposed in HEPES buffer or in HEPES buffer supplemented with 44% by volume fetal calf serum (FCS). Characteristic phase transition responses were detected in the range of 39 degrees C to 40 degrees C with the presence of FCS, increasing maximum % release of 3H-ARA-C by 20% relative to HEPES suspension. Neither frequency of electromagnetic radiation had any detectable effect on liposome permeability or the location of the phase transition in the presence or absence of FCS.     

Destruction and injury of Escherichia coli during microwave heating under vacuum

AIMS: To study the effect of 2450 MHz microwave radiation under vacuum (vacuum microwave or VM) on survival and injury of Escherichia coli and to search for possible nonthermal effects associated with VM. METHODS AND RESULTS: Destruction kinetics of E. coli in peptone water were determined in a continuous-flow vacuum system, heated by convection heating in a water bath or with microwaves (VMs). Vacuum was used to control the boiling point of water and to maintain temperature in the bacterial suspensions at specified levels (49-64 degrees C). CONCLUSIONS: z-Value in the water bath treatment was 9.1 degrees C while for VM at 510 and 711 W it was 6.2 and 5.9 degrees C, suggesting that E. coli is more sensitive to temperature changes under microwave heating. Arrhenius calculations of the activation energies of the destruction reactions suggest that the mechanism of destruction in VM may be different from that of conventional heat. The number of injured micro-organisms showed no significant differences among treatments. SIGNIFICANCE AND IMPACT OF THE STUDY: The impact of temperature on E. coli destruction was different when microwaves were the medium of heat transfer, suggesting the existence of factors other than heat contributing to the lethal effect of VM.     

Stable and efficient immobilization technique of aldolase under consecutive microwave irradiation at low temperature

To establish a stable and efficient immobilization technique under microwave irradiation, a focused microwave reaction system was used, where the temperature was set appropriately in the microwave system and cooling module to produce consecutive microwave irradiation. 2-Deoxy-D-ribose-5-phosphate aldolase (DERA) was rapidly and efficiently immobilized in mesocellular siliceous foams (MCFs) under microwave irradiation. When the output power in the microwave system was set to 30 W, after 3 min, 88.4% of the enzyme protein was coupled to the wall of the support pores and the specific activity of the immobilized enzyme was 2.24 U mg⁻¹, 149.2% higher than that of the free enzyme and 157.0% higher than that of the non-microwave-assisted immobilized enzyme. In catalysis, microwave-assisted immobilized DERA tolerated a wider range of both pH and temperature than other DERA preparations. The thermal and storage stabilities were also significantly improved. This focused; microwave-assisted immobilization technique has proven to be simple, stable and highly efficient. This technique could also be applied to other enzyme immobilizations.     

First Dutch experience with the endoscopic laser balloon ablation system for the treatment of atrial fibrillation

IntroductionThe endoscopic laser balloon ablation system (EAS) is a relatively novel technique to perform pulmonary vein isolation (PVI) in the treatment of atrial fibrillation (AF). The present study aimed to report the results of the first 50 patients treated in the Netherlands with the EAS in terms of procedural characteristics and AF-free survival.MethodsFifty patients successfully underwent EAS PVI. Median follow-up was 17 months. Mean age was 56 years, 82 % had paroxysmal AF.Results99 % of the pulmonary veins were successfully isolated with the EAS. Mean procedure time was 171 min and mean fluoroscopy time was 36 min. One procedure was complicated by a temporary phrenic nerve palsy (2 %). During follow-up, 58 % of patients remained free of AF without the use of antiarrhythmic drugs.ConclusionPVI with EAS is associated with a low risk of complications and a medium-term AF-free survival comparable with other PVI techniques.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-014-0624-y) contains supplementary material, which is available to authorized users.     

Balloon Catheter Position and its Relationship with Esophageal Temperature during Pulmonary Vein Isolation using High-Intensity Focused Ultrasound

BackgroundHIFU can achieve PVI, but severe esophageal complications have happened. We analyzed relative position of HIFU balloon catheter (BC) to esophageal temperature (ET) probe and correlated it to ET changes.Methods and ResultsBefore each ablation relative position of HIFU BC to ET probe was recorded in RAO 30° and LAO 40°. We compared ablations where ET at end of ablation was < 38.5°C or ≥ 38.5°C and < 40.0°C or ≥ 40.0°C.A total of 600 images from 311 ablations in 28 patients (18 male, age 63 ± 7 years), were analyzed. ET ≥ 38.5°C was reached when distance from BC to ET probe was: < 20 mm in LAO for RSPV and < 29 mm in LAO for RIPV. For RIPV ET ≥ 38.5°C was reached when angle between BC and ET probe was significantly smaller in LAO and RAO. ET ≥ 40.0°C was reached when distance of BC to ET probe was: < 20 mm in LAO for RIPV, < 14 mm in RAO for RIPV, < 18 mm in RAO for LIPV. ET increased to ≥ 40.0°C when distance from BC to ET probe was significantly longer in LAO for LIPV. For RIPV ET ≥ 40.0°C was reached when angle between BC and ET probe was significantly smaller in LAO.ConclusionsThere is a relationship between distance/angle of HIFU BC to ET probe and ET: shorter distances and smaller angles can cause higher ET.     

经阴道彩超联合腹部超声在异位妊娠中的诊治分析

目的：与经阴道彩超检查相比较探讨经阴道彩超联合腹部超声检查在异位妊娠中的诊治价值。方法：选取我院2009 年3月至2012 年12 月之间诊治的136 例疑为异位妊娠患者,其中70 例经阴道彩超联合腹部超声诊断,66 例经阴道彩超诊断,采用SPSS13.0 统计学软件对数据进行统计学分析,所有计数资料均行x2检验,以P〈0.05 为差异有统计学意义。结果：在70 例经阴道彩超联合腹部超声检查的病例中,有68 人与手术结果相符合,诊断符合率达97.10%,1 例误诊,1 例漏诊;在另外66 例经阴道彩超检查患者中,有59例与手术结果相符合,诊断符合率为89.40%,6 例误诊,1 例漏诊。结论：经阴道彩超与经腹部超声的联合相对于经阴道彩超而言,诊断的准确率有所提高,决定这一结果的关键因素在于腹部超声减少了误诊例数。     

The effect of change in skin temperature due to evaporative cooling on sweating response during exercise

 The purpose of this study was to investigate whether there are any effects of skin temperature changes on sweating response in the first few minutes of mild exercise. Six healthy males performed a bicycle exercise at 100 W (50 rpm) for 30 min under an ambient temperature of 23° C (40% RH). Esophageal temperature (T _es), mean skin temperature (T– _sk), local skin temperature at the lower left scapula (T _sl), local sweating rate (M. _sw), and cutaneous blood flow by laser-Doppler flowmetry (LDF) were measured continuously. Although T _sl decreased markedly just after the onset of sweating, T– _sk did not change. M. _sw did not increase constantly in the early stages of exercise, and there was a temporary interruption in the increase of M. _sw. This interruption in sweating was affected by the rate of change in T _sl rather than by the absolute value of T _sl, since there was a positive and significant correlation between the time of the interruption in the increase of M. _sw and the rate of decrease in T _sl (y=6.47x+0.04; r=0.86, P<0.05). The results suggest that sweating response in the early stages of exercise may be influenced by changes in local skin temperature due to evaporative cooling. Received: 31 August 1995 / Revised: 26 February 1996 / Accepted: 26 July 1996,     

Modeling and simulation of novel antenna for the treatment of hepatocellular carcinoma using finite element method

In this article, new interstitial antenna operating at a frequency of 2.45 GHz for the treatment of hepatocellular carcinoma (HCC) using microwave ablation has been investigated. This antenna is basically an asymmetrical miniaturized choke dipole antenna with a pointed needle at the tip. A commercial finite element method (FEM) package, COMSOL Multiphysics 3.4a, has been used to simulate the performance of needle tip choke antenna. The performance of the antenna has been evaluated numerically, taking into account the specific absorption rate, antenna impedance matching and geometry of the obtained thermal lesion, and the temperature distribution plot obtained shows that maximum temperature was attained in this simulation. The antenna is also capable of creating a spherical-shaped ablation zone. The size and shape of the ablation zone can be slightly adjusted by adjusting the choke position in order to maintain spherical ablation zones.     

Real-time monitoring of nitric oxide and blood flow during ischemia-reperfusion in the rat testis

In the present study, we attempted to clarify the role of nitric oxide (NO) and its release during the ischemia-reperfusion rat testis. Eight-week-old male Sprague-Dawley rats were divided into seven groups: age-matched control rats, ischemia (30 minutes)-reperfusion (30 minutes) rats without N^G-nitro-L-arginine methyl ester (L-NAME) and L-arginine (L-Arg) treatment, ischemia (30 minutes)-reperfusion (30 minutes) rats treated with L-NAME (10, 30, and 100 mg/kg), ischemia-reperfusion rats treated with L-Arg (10 and 30 mg/kg). Sixty minutes prior to induction of ischemia, L-NAME or L-Arg was administrated intraperitoneally. Real-time monitoring of blood flow and NO release were measured simultaneously with a laser Doppler flowmeter and an NO-selective electrode, respectively. NO₂-NO₃ and malonaldehyde (MDA) concentrations were measured in the experimental testes. Furthermore, we investigated possible morphological changes in the testis. Clamping of the testicular artery decreased blood flow to 5–20% of the basal level measured before clamping. Immediately following clipping of the artery, NO release rapidly increased. After removing the clip, NO release gradually returned to the basal level. This phenomenon was enhanced by treatment with L-Arg and inhibited by treatment with L-NAME. NO₂-NO₃ concentrations were increased by treatment with L-Arg and decreased by treatment with L-NAME, while MDA concentrations were increased by treatment with L-NAME and were decreased by treatment with L-Arg. In histological studies, the ischemia-reperfusion caused infiltration of leukocytes and a rupture of microvessels in the testis. Our data suggest that NO has cytoprotective effects on ischemia-reperfusion injury in the rat testis.     

Estimation of tumor characteristics in a breast tissue with known skin surface temperature

Presence of a tumor and its characteristics like location, size and properties are estimated. Estimation is based on the measurement of the skin surface temperature of the breast. Consideration is given to a 2-D breast tissue infected with a tumor. Heat transfer in the breast tissue modeled using the Pennes bioheat equation is solved by the finite volume method. Skin surface temperature profile of the breast is characteristic of the tumor location, its size and grade. In the inverse analysis, the objective function is minimized using the genetic algorithm. Exact estimation is obtained if one parameter is estimated at a time. However, the accuracies are acceptable even when blood perfusion rate, location and size are estimated simultaneously.     

In vitro differentiation of mouse ES cells into hepatocytes with coagulation factors VIII and IX expression profiles

Coagulation factors II, V, VII, VIII, IX and X are produced by hepatocytes. So factors VIII and IX deficiencies, which result in hemophilia A and B, have the potential to respond to cellular replacement therapy. Embryonic stem (ES) cells provide a unique source for therapeutic applications. Here, E14 mouse ES cells have been induced into hepatocytes in vitro. Morphology revealed that ES-derived hepatic-like cells were round or polyhedral shaped with distinct boundary of individual cells, and some arranged in trabeculae. These cells expressed endodermal-or liver-specific mRNA—transthyretin (TTR), α1-anti-trypsin (AAT), α-fetoprotein (AFP), albumin (ALB), glucose-6-phoshpatase (G6P) and tyrosine aminotransferase (TAT). Approximately (85.1±0.5)% of the ES-derived cells was stained positive green with ICG uptake. These cells were also stained magenta as a result of PAS reaction. In this paper, expression of coagulation factors VIII and IX mRNA in the ES-derived cells is documented. Therefore, ES cells might be developed as substitute donor cells for the therapy of coagulation factor deficiencies.