title: Pulsed cavitational ultrasound: a noninvasive technology for controlled tissue ablation (histotripsy) in the rabbit kidney.
abstract: OBJECTIVE
  The optimal minimally invasive treatment for small renal masses continues to evolve. Current ablative technologies rely on thermal mechanisms for tissue destruction. However, the creation of precise lesions is limited by inhomogeneous heating/cooling due to tissue variability, perfusion effects and tissue charring. We hypothesized that nonthermal mechanical effects of ultrasound (cavitation) can be used to progressively homogenize tissue in controlled fashion with predictable results.
  
  
  METHODS
  We developed a focused annular array ultrasound system capable of delivering high intensity (greater than 20 kW/cm) short pulses (20 microseconds) of energy to a target volume. This system operates at a repetition frequency of 100 Hz, resulting in a low time averaged power output (approximately 5 W total acoustic output). Following approval from the institutional animal care committee a series of transcutaneous ablations were performed in the normal kidneys of 10 rabbits.
  
  
  RESULTS
  Lesions created with a small number of pulses (10 or 100) produced scattered areas of damage characterized by focal hemorrhage and small areas of cellular injury in the targeted volume. Lesions created with greater numbers of pulses (1,000 or 10,000) demonstrated complete destruction of the targeted volume. Gross examination revealed that lesions contained a liquefied core with smooth walls and sharply demarcated boundaries. Histological examination demonstrated extensive areas of acellular debris surrounded by a narrow margin of cellular injury.
  
  
  CONCLUSIONS
  This pulsed cavitational ultrasound system is capable of transcutaneous nonthermal destruction of renal tissue. Refinement of this technology for noninvasive ablation of small renal masses is currently under way.
authors.affiliation: Michigan Urology Center and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Roberts
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Hall
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ives
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.forename: J Brian
authors.initials: JB
authors.lastname: Fowlkes
authors.forename: Charles A
authors.initials: CA
authors.lastname: Cain
mesh_terms: D000818:Animals; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D011817:Rabbits; D014464:Ultrasonic Therapy