OBJECTIVE: To assess the efficacy of high intensity focused ultrasound (HIFU) to target and ablate the fetal intra-umbilical vessels and terminate fetal perfusion in a pregnant rabbit model. METHODS: Pregnant New Zealand white rabbits (gestational age: E25-27, n = 6 rabbits, n = 18 treated fetuses, n = 6 controls) underwent high-resolution MRI for fetal localization, orientation assessment, beam guidance, and treatment monitoring. Ultrafast ultrasound with power Doppler quantified cardiac output and placental perfusion pre- and post-treatment. HIFU (100-120Wac, 16-20s) induced thermal ablation; MR-thermometry monitored intraoperative temperature; histology confirmed ablation. Ultrafast ultrasound imaging and gross examination confirmed termination. Ultrafast ultrasound imaging confirmed the termination of target fetuses, verifying the treatment success in 11 fetuses. Successfully treated fetuses showed a 95% ± 7.4% decrease in cardiac output compared with 11% ± 4.6% decrease in controls, p = 0.022. Placental perfusion dropped 83% ± 10.0% in successfully treated fetuses compared with 16% ± 5.5% in control fetuses, p = 0.002. Overall, 83% (15/18) of targeted fetuses were terminated, with adjacent controls surviving. Thermal necrosis was present in all targeted livers. CONCLUSIONS: MR-guided HIFU can effectively ablate fetal rabbit umbilical vessels to cause selective termination, modeling a non-invasive treatment for twin reversed arterial perfusion sequence.
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Danialy et al. (2025) studied this question.
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