Use of contrast agents to increase the effectiveness of high intensity focused ultrasound therapy

• US 20050038340A1
• Filed: 02/02/2004
• Published: 02/17/2005
• Est. Priority Date: 09/18/1998
• Status: Active Grant

• Current Assignee: University of Washington, Washington University In St Louis
• Original Assignee: University of Washington
• Inventors: Vaezy, Shahram, Martin, Roy W., Crum, Lawrence A., Carter, Stephen J.
• Granted Patent: US 7,686,763 B2
• Time in Patent Office: Days
• US Class Current: 600/439
• CPC Class Codes: A61B 2017/4216 Operations on uterus, e.g. endometrium
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 8/06 Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/0833 involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/4483 characterised by features of the ultrasound transducer
• CPC Class Codes: A61B 8/481 involving the use of contrast agent, e.g. microbubbles introduced into the bloodstream analysis of echo signal exploiting properties of a contrast enhancer in devices for short-range imaging with acoustic waves G01S7/52039
• CPC Class Codes: A61B 8/483 involving the acquisition of a 3D volume of data
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

Ultrasound contrast agents are used to enhance imaging and facilitate HIFU therapy in four different ways. A contrast agent is used: (1) before therapy to locate specific vascular structures for treatment; (2) to determine the focal point of a HIFU therapy transducer while the HIFU therapy transducer is operated at a relatively low power level, so that non-target tissue is not damaged as the HIFU is transducer is properly focused at the target location; (3) to provide a positive feedback mechanism by causing cavitation that generates heat, reducing the level of HIFU energy administered for therapy compared to that required when a contrast agent is not used; and, (4) to shield non-target tissue from damage, by blocking the HIFU energy. Various combinations of these techniques can also be employed in a single therapeutic implementation.

Claims

1. A method for using an ultrasound contrast agent to enhance administration of a high intensity focused ultrasound (HIFU) therapy to a specific treatment site within a target area with a therapeutic ultrasonic transducer, comprising the steps of:

(a) introducing a contrast agent to the target area, the contrast agent having a characteristic of altering reflection characteristics of an ultrasonic wave; and

(b) using the contrast agent to enhance the administration of the HIFU therapy in at least one of the following;

(i) producing an image in which a vascular system associated with the target area is clearly visible, and selecting the specific treatment site within the target area based on the visualization of the vascular structure in the image, thereby enabling the HIFU therapy to be targeted at the vascular structure;

(ii) enabling a focal point of the therapeutic ultrasonic transducer to be visualized in an image generated when the therapeutic ultrasonic transducer is energized at a power level insufficient to damage tissue, the focal point being readily visually identifiable in the image due to a change in the reflection characteristics of an ultrasonic wave produced by the therapeutic ultrasonic transducer caused by the contrast agent, thereby enabling the focal point of the therapeutic ultrasonic transducer to be targeted at the treatment site, and not at non-target tissue;

(iii) directing a focal point of the therapeutic ultrasonic transducer at a fluid filled volume containing the contrast agent, the fluid filled volume being disposed proximate to tissue to be treated, and energizing the therapeutic ultrasonic transducer at an energy level sufficient to induce cavitation in the contrast agent disposed in the fluid filled volume, the cavitation increasing an efficiency with which the HIFU therapy produces heat, said heat causing a therapeutic change in the tissue to be treated at the specific treatment site; and

(iv) directing a focal point of the therapeutic ultrasonic transducer at a fluid filled volume containing the contrast agent, the contrast agent acting as a shield to prevent tissue not disposed at the specific treatment site from being adversely affected by the HIFU therapy administered to the specific treatment site.

2. The method of claim 1, wherein the step selecting the specific treatment site within the target area based on the visualization of the vascular structure in the image comprises the steps of analyzing the image to identify abnormal blood flows, such abnormal blood flows being indicative of an undesirable condition, and selecting the portion of the target area corresponding to the undesirable condition as the treatment site.

3. The method of claim 1, wherein the step of selecting the specific treatment site within the target area based on the visualization of the vascular structure in the image comprises the steps of analyzing the image to identify at least one major blood vessel in the target area, and selecting at least one major blood vessel in the target area as the treatment site.

4. The method of claim 1, wherein when cavitation is to be induced to enhance therapeutic application of HIFU, the step of introducing a contrast agent to the target area comprises the step of introducing a volatile liquid wherein the contrast agent vaporizes in response to heat levels that are insufficient to damage biological tissue, thus forming bubbles that alter the echogenicity of the therapeutic waves of HIFU.

5. The method of claim 1, wherein the step of directing a focal point of the therapeutic ultrasonic transducer at a fluid filled volume containing the contrast agent, the contrast agent acting as a shield to prevent tissue not disposed at the specific treatment site from being adversely affected by the HIFU therapy administered to the specific treatment site comprises the step of directing the focal point of the therapeutic ultrasonic transducer such that a first distance separating the fluid filled volume from the therapeutic ultrasonic transducer is greater than a second distance separating the treatment site from the therapeutic ultrasonic transducer.

6. The method of claim 1, wherein when the contrast agent is to be used as a shield to protect non-target tissue from damage to enhance therapeutic application of HIFU, the step of introducing a contrast agent to the target area comprises the steps of determining which portions of the target area the contrast agent needs to be disposed in to protect non-target tissue, and introducing the contrast agent into the portions so determined.

7. The method of claim 6, wherein if no fluid volume is disposed in a portion of the target area where the contrast agent needs to be disposed to be used as a shield to protect non-target tissue from damage, further comprising the step of introducing the contrast agent into tissue corresponding to that portion.

8. The method of claim 6, wherein if no fluid volume is disposed in a portion of the target area where the contrast agent needs to be disposed to be used as a shield to protect non-target tissue from damage, further comprising the steps of creating a void in that portion of the target area, and introducing the contrast agent into the void created.

9. The method of claim 1, wherein the step of using the contrast agent to enhance a therapeutic application of HIFU in at least one of the following manners further comprises the step of using the contrast agent to enhance a therapeutic application of HIFU in at least two of the manners identified in claim 1.

10. A method for using an ultrasound contrast agent to enhance administration of a high intensity focused ultrasound (HIFU) therapy to a specific treatment site within a target area, comprising the steps of:

(a) introducing a contrast agent into the target area, the contrast agent having a characteristic of altering reflection characteristics of an ultrasonic wave;

(b) positioning a scanning ultrasonic transducer and a therapeutic ultrasonic transducer generally adjacent to the target area;

(c) energizing the scanning ultrasonic transducer to produce an image of the target area;

(d) displaying the image of the target area;

(e) energizing the therapeutic ultrasonic transducer to produce ultrasonic waves generally directed toward the treatment site, but at a power level insufficient to adversely affect tissue;

(f) identifying a focal point of the therapeutic ultrasonic transducer in the image of the target area that is displayed, the focal point being readily identifiable due to a change in the reflection characteristics caused by the contrast agent; and

(g) moving the therapeutic ultrasonic transducer until its focal point, which is visible in the image of the target area, is directed at the treatment site.

11. The method of claim 10, further comprising the step of increasing the power level of the therapeutic ultrasonic transducer to a level sufficient to induce a therapeutic effect, to produce pulses of therapeutic waves of the HIFU energetic enough to induce a therapeutic effect at the treatment site.

12. The method of claim 10, wherein the step of energizing the therapeutic ultrasonic transducer to produce therapeutic waves comprises the step of producing pulses of the therapeutic waves, and further comprising the steps of:

(a) synchronizing the pulses of therapeutic waves produced by the therapeutic ultrasonic transducer relative to the imaging waves produced by the scanning ultrasonic transducer, such that noise in the imaging data arising from the therapeutic waves is displayed in a specific portion of the displayed target area; and

(b) enabling a user to shift the noise arising from the therapeutic waves that is displayed in the specific portion of the displayed target area to a different portion of the displayed target area, so that the noise arising from the therapeutic waves can be moved to a portion of the displayed target area that does not correspond to the treatment site, thereby enabling the treatment site to be observed in real time as the pulses of therapeutic waves of the HIFU are administered to the treatment site.

13. The method of claim 12, further comprising the step of increasing the power level of the therapeutic ultrasonic transducer to a level sufficient to induce a therapeutic effect, to produce pulses of therapeutic waves of the HIFU energetic enough to induce a therapeutic effect at the treatment site.

14. The method of claim 12, further comprising the step of enabling a user to adjust a duration of each pulse of therapeutic waves, to ensure that the duration of each pulse of therapeutic waves is not so great as to overwhelm the imaging data used to generate the visual representation.

15. The method of claim 10, wherein the step of introducing a contrast agent to the target area comprises the step of introducing a blood soluble contrast agent into a patient'"'"'s blood stream.

16. The method of claim 10, wherein the contrast agent vaporizes in response to heat levels that are insufficient to damage biological tissue, thus forming bubbles that alter the reflection characteristics of ultrasonic waves used to produce the imaging data.

17. The method of claim 16, wherein the step of moving the therapeutic ultrasonic transducer comprises the step of moving the therapeutic ultrasonic transducer such that the treatment site selected is a fluid filled volume disposed adjacent to tissue to be treated, the contrast agent being disposed in the fluid filled volume, and further comprising the step of increasing the power level of the therapeutic ultrasonic transducer to a level sufficient to induce cavitation in the contrast agent disposed at the treatment site, such cavitation resulting in a feedback mechanism that increases an efficiency with which the therapeutic waves of the HIFU are transformed into heat, such heat inducing a therapeutic change in the tissue to be treated.

18. The method of claim 16, wherein the contrast agent comprises an anesthetic agent.

19. The method of claim 10, wherein before the step of energizing the therapeutic ultrasonic transducer at a power level insufficient to induce a therapeutic effect, further comprising the step of selecting the specific treatment site to apply HIFU therapy to, based on portions of the displayed target area that are readily identifiable due to the contrast agent'"'"'s altering the reflection characteristics of the ultrasonic scanning waves.

20. The method of claim 19, wherein the step of selecting the specific treatment site to apply HIFU therapy to comprises the step of observing the displayed target area to monitor a movement of the contrast agent through a vascular system associated with the target area, and selecting a desired portion of the vascular system associated with the target area as the treatment site.

21. The method of claim 10, wherein the step of moving the therapeutic ultrasonic transducer comprises the step of moving the therapeutic ultrasonic transducer such that a fluid filled volume containing a quantity of the contrast agent is disposed adjacent to the treatment site, a first distance separating the fluid filled volume from the therapeutic ultrasonic transducer being greater than a second distance separating the treatment site from the therapeutic ultrasonic transducer, the contrast agent in the fluid filled volume acting as a shield to prevent non-target tissue from being treated by the therapeutic waves of the HIFU when the therapeutic ultrasonic transducer is energized at a level sufficient to induce therapy at the treatment site.

22. The method of claim 10, wherein if the contrast agent is to be used as a shield to protect non-target tissue from damage to enhance the therapeutic application of HIFU, the step of introducing a contrast agent to the target area comprises the steps of determining which portions of the target area the contrast agent needs to be disposed in to protect non-target tissue, and introducing the contrast agent into the portions so determined.

23. The method of claim 22, wherein if no fluid volume is disposed in a portion of the target area in which the contrast agent is required to be disposed to be used as a shield to protect non-target tissue from damage, further comprising the step of injecting the contrast agent into tissue corresponding to that portion.

24. The method of claim 22, wherein if no fluid volume is disposed in a portion of the target area in which the contrast agent is required to be disposed to be used as a shield to protect non-target tissue from damage, further comprising the steps of creating a void in that portion of the target area, and introducing the contrast agent into the void created.

25. A method for using a contrast agent to both enhance the ultrasound imaging of a target area and to facilitate providing a focused ultrasound therapy to a specific treatment site disposed within the target area, comprising the steps of:

(a) introducing a contrast agent into the target area, the contrast agent altering reflection characteristics of an ultrasonic wave;

(b) positioning a scanning ultrasonic transducer and a therapeutic ultrasonic transducer generally adjacent to the specific treatment site;

(c) energizing the scanning ultrasonic transducer to scan the target area, producing an image of the target area;

(d) displaying the image of the target area;

(e) energizing the therapeutic ultrasonic transducer at a reduced power level to produce high intensity focused ultrasound (HIFU) beam, generally directed toward the treatment site, but at an energy insufficient to adversely affect tissue in the target area;

(f) observing a visual representation of a focal point of the HIFU beam in the image, the focal point being readily visible in the image due to a change in reflection characteristics caused by the contrast agent;

(g) positioning the therapeutic ultrasonic transducer as required until the focal point displayed in the image of the target area is directed at the treatment site; and

(h) energizing the therapeutic ultrasonic transducer at a greater power level sufficient to administer the focused ultrasound therapy to the treatment site.

26. The method of claim 25, wherein the step of energizing the therapeutic ultrasonic transducer at a greater power level sufficient to administer the focused ultrasound therapy to the treatment site comprises the step of producing pulses of the therapeutic waves.

27. The method of claim 25, further comprising the steps of:

(a) synchronizing the pulses of therapeutic waves produced by the therapeutic ultrasonic transducer relative to the imaging waves produced by the scanning ultrasonic transducer, such that noise in the imaging data arising from the therapeutic waves is displayed in a specific portion of the displayed target area; and

(b) enabling a user to shift the noise arising from the therapeutic waves that is displayed in the specific portion of the displayed target area to a different portion of the displayed target area, so that the noise arising from the therapeutic waves can be moved to a portion of the displayed target area that does not correspond to the treatment site, thereby enabling the treatment site to be observed in real time as the pulses of therapeutic waves of the HIFU are administered to the treatment site.

28. The method of claim 25, wherein:

(a) the contrast agent vaporizes in response to heat levels that are insufficient to damage biological tissue, thus forming bubbles that alter the echogenicity of the therapeutic waves of the HIFU;

(b) the step of positioning the therapeutic ultrasonic transducer comprises the step of positioning the therapeutic ultrasonic transducer such that the treatment site selected is a fluid filled volume including the contrast agent disposed adjacent to tissue to be treated; and

(c) the step of energizing the therapeutic ultrasonic transducer at a greater power level comprises the step of energizing the therapeutic ultrasonic transducer at a power level sufficient to induce cavitation in the contrast agent disposed in the fluid filled volume, such cavitation resulting in a feedback mechanism that increases an efficiency with which the therapeutic waves of the HIFU are transformed into heat, such heat inducing a therapeutic change in the tissue to be treated.

29. The method of claim 25, wherein the step of positioning the therapeutic ultrasonic transducer comprises the step of positioning the therapeutic ultrasonic transducer such that the treatment site selected is adjacent to a fluid filled volume containing a quantity of the contrast agent, the contrast agent in the fluid filled volume acting as a shield to prevent non-target tissue from being treated by the therapeutic waves of the HIFU.

30. The method of claim 25, wherein before the step of energizing the therapeutic ultrasonic transducer at a reduced power level to produce high intensity focused ultrasound (HIFU) beam, further comprising the step of selecting the specific treatment site to which HIFU therapy is to be applied, based on portions of the displayed target area that are readily identifiable due to the contrast agent'"'"'s altering the reflection characteristics of ultrasonic scanning waves generated by the scanning ultrasonic transducer.

31. The method of claim 30, wherein the step of selecting the specific treatment site comprises the step of observing the displayed target area to monitor a movement of the contrast agent through a vascular system associated with the target area, and selecting a desired portion of the vascular system associated with the target area as the treatment site.