Potential adverse effects of high-intensity focused ultrasound exposure on blood vessels in vivo.

The aim of the study was to evaluate the potential adverse effects of high intensity ultrasound exposure on blood vessels during noninvasive focused ultrasound surgery. A hydraulic MR-compatible positioning device was used to manipulate a focused ultrasound transducer (frequency 1.49 MHz, f-number = 0.8) in an MRI scanner. The system was used to sonicate a branch of the femoral artery and vein of 19 rabbits (26 thighs) in vivo at intensity levels above the threshold for transient cavitation; i.e., between 4400 and 8800 W cm-2 with multiple 1 s pulses stepped across the vessels (step size = 0.7 mm). The vessels were located and followed by MR angiography. In 13 rabbits, x-ray angiograms were also performed after the animals were euthanized. The results demonstrated that the 1 s high-intensity exposures caused the arteries to constrict at all exposure levels tested. At the intensity of 5800 W cm-2 and above, the MRI angiogram immediately after the sonications showed no flow. The x-ray angiograms (1-2 h later) showed that the blood vessels were open, but constricted to about 50% or less of their diameter. Both the MR and x-ray angiograms showed that the vessel diameters relaxed toward their initial diameter during the first week after sonication. In five cases, hemorrhage or vessel rupture was caused by the sonication. This study demonstrates that short, high-intensity focused ultrasound exposure can cause vessel spasm and hemorrhage when transient cavitation is present. This condition should be avoided during noninvasive focused ultrasound surgery.