A robotic MR-guided high-intensity focused ultrasound platform for intraventricular hemorrhage: assessment of clot lysis efficacy in a brain phantom

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  • 1 Posluns Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Ontario;
  • | 2 The Institute of Biomedical Engineering, University of Toronto, Ontario;
  • | 3 Departments of Medical Imaging,
  • | 4 Mechanical Engineering, and
  • | 5 Neurosurgery, University of Toronto, Ontario;
  • | 6 Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta; and
  • | 7 Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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OBJECTIVE

Intraventricular hemorrhage (IVH) is a neurovascular complication due to premature birth that results in blood clots forming within the ventricles. Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) has been investigated as a noninvasive treatment to lyse clots. The authors designed and constructed a robotic MRgHIFU platform to treat the neonatal brain that facilitates ergonomic patient positioning. The clot lysis efficacy of the platform is quantified using a brain phantom and clinical MRI system.

METHODS

A thermosensitive brain-mimicking phantom with ventricular cavities was developed to test the clot lysis efficacy of the robotic MRgHIFU platform. Whole porcine blood was clotted within the phantom’s cavities. Using the MRgHIFU platform and a boiling histotripsy treatment procedure (500 W, 10-msec pulse duration, 1.0% duty cycle, and 40-second duration), the clots were lysed inside the phantom. The contents of the cavities were vacuum filtered, and the remaining mass of the solid clot particles was used to quantify the percentage of clot lysis. The interior of the phantom’s cavities was inspected for any collateral damage during treatment.

RESULTS

A total of 9 phantoms were sonicated, yielding an average (± SD) clot lysis of 97.0% ± 2.57%. Treatment resulted in substantial clot lysis within the brain-mimicking phantoms that were apparent on postsonication T2-weighted MR images. No apparent collateral damage was observed within the phantom after treatment. The results from the study showed the MRgHIFU platform was successful at lysing more than 90% of a blood clot at a statistically significant level.

CONCLUSIONS

The robotic MRgHIFU platform was shown to lyse a large percentage of a blood clot with no observable collateral damage. These results demonstrate the platform’s ability to induce clot lysis when targeting through simulated brain matter and show promise toward the final application in neonatal patients.

ABBREVIATIONS

GMH = germinal matrix hemorrhage; HIFU = high-intensity focused ultrasound; IVH = intraventricular hemorrhage; MR-ARFI = magnetic resonance acoustic radiation force imaging; MRgHIFU = magnetic resonance–guided HIFU; PHVD = posthemorrhagic ventricular dilation; tPA = tissue plasminogen activator; TTMP = thermosensitive tissue-mimicking phantom.

Supplementary Materials

    • Appendix A (PDF 426 KB)

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