Spatial variability in acoustic backscatter as an indicator of tissue homogenate production in pulsed cavitational ultrasound therapy.

Spatial variability in acoustic backscatter is investigated as a potential feedback metric for assessment of lesion morphology during cavitation-mediated mechanical tissue disruption ("histotripsy"). A 750-kHz annular array was aligned confocally with a 4.5 MHz passive backscatter receiver during ex vivo insonation of porcine myocardium. Various exposure conditions were used to elicit a range of damage morphologies and backscatter characteristics [pulse duration = 14 micros, pulse repetition frequency (PRF) = 0.07-3.1 kHz, average I(SPPA) = 22-44 kW/cm2]. Variability in backscatter spatial localization was quantified by tracking the lag required to achieve peak correlation between sequential RF A-lines received. Mean spatial variability was observed to be significantly higher when damage morphology consisted of mechanically disrupted tissue homogenate versus mechanically intact coagulation necrosis (2.35 +/- 1.59 mm versus 0.067 +/- 0.054 mm, p < 0.025). Statistics from these variability distributions were used as the basis for selecting a threshold variability level to identify the onset of homogenate formation via an abrupt, sustained increase in spatially dynamic backscatter activity. Specific indices indicative of the state of the homogenization process were quantified as a function of acoustic input conditions. The prevalence of backscatter spatial variability was observed to scale with the amount of homogenate produced for various PRFs and acoustic intensities.