A comparison between preoperative magnetic resonance and intraoperative ultrasound tumor volumes and margins

LeRoux, Peter D.; Winter, Thomas C.; Berger, Michel S.; Mack, L A; Wang, Keith; Elliott, Joseph P.

doi:10.1002/jcu.1870220107

Cited by 96 publications

(45 citation statements)

References 30 publications

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“…2 Intraoperative ultrasonography provides reliable real-time updates of the operative field ("live anatomy"). 4,10,14,25,34,35,37 The limitation of ultrasound in delineating residual tumor is mainly related to 2 issues: image quality and anatomical orientation. Recent advances in ultrasound technology have significantly improved resolution.…”

Section: Discussionmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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OBJECTIVE Navigated 3D ultrasound is a novel intraoperative imaging adjunct permitting quick real-time updates to facilitate tumor resection. Image quality continues to improve and is currently sufficient to allow use of navigated ultrasound (NUS) as a stand-alone modality for intraoperative guidance without the need for preoperative MRI. METHODS The authors retrospectively analyzed cases involving operations performed at their institution in which a 3D ultrasound navigation system was used for control of resection of brain tumors in a “direct” 3D ultrasound mode, without preoperative MRI guidance. The usefulness of the ultrasound and its correlation with postoperative imaging were evaluated. RESULTS Ultrasound was used for resection control in 81 cases. In 53 of these 81 cases, at least 1 intermediate scan (range 1–3 intermediate scans) was obtained during the course of the resection, and in 50 of these 53 cases, the result prompted further resection. In the remaining 28 cases, intermediate scans were not performed either because the first ultrasound scan performed after resection was interpreted as showing no residual tumor (n = 18) and resection was terminated or because the surgeon intentionally terminated the resection prematurely due to the infiltrative nature of the tumor and extension of disease into eloquent areas (n = 10) and the final ultrasound scan was interpreted as showing residual disease. In an additional 20 cases, ultrasound navigation was used primarily for localization and not for resection control, making the total number of NUS cases where radical resection was planned 101. Gross-total resection (GTR) was planned in 68 of these 101 cases and cytoreduction in 33. Ultrasound-defined GTR was achieved in 51 (75%) of the cases in which GTR was planned. In the remaining 17, further resection had to be terminated (despite evidence of residual tumor on ultrasound) because of diffuse infiltration or proximity to eloquent areas. Of the 33 cases planned for cytoreduction, NUS guidance facilitated ultrasound-defined GTR in 4 cases. Overall, ultrasound-defined GTR was achieved in 50% of cases (55 of 111). Based on the postoperative imaging (MRI in most cases), GTR was achieved in 58 cases (53%). Final (postresection) ultrasonography was documented in 78 cases. The findings were compared with the postoperative imaging to ascertain concordance in detecting residual tumor. Overall concordance was seen in 64 cases (82.5%), positive concordance was seen in 33 (42.5%), and negative in 31 (40%). Discordance was seen in 14 cases—with ultrasound yielding false-positive results in 7 cases and false-negative results in 7 cases. Postoperative neurological worsening occurred in 15 cases (13.5%), and in most of these cases, it was reversible by the time of discharge. CONCLUSIONS The results of this study demonstrate that 3D ultrasound can be effectively used as a stand-alone navigation modality during the resection of brain tumors. The ability to provide repeated, high-quality intraoperative updates is useful for guiding resection. Attention to image acquisition technique and experience can significantly increase the quality of images, thereby improving the overall utility of this modality.

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Section: Discussionmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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“…2 During LGG surgery, ioMRI can detect residual tumor tissue that cannot be identified by visual inspection or intraoperative ultrasonography. 8,15,25 The tumor mass is defined as the T2-hyperintense area and the extent of resection is based on comparison of intraoperatively acquired T2-weighted images with preoperative ones. However, especially after resection of large LGGs with mass effect, intraoperative images may show T2-hyperintense areas at the resection border, and a differential diagnosis between tumoral and nontumoral tissue may be difficult.…”

Section: ©Aans 2013mentioning

confidence: 99%

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Pamir

Özduman²,

Yıldız

et al. 2013

JNS

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M axiMal safe resection is currently the most effective form of therapy for hemispheric LGGs and patients benefit from the extent of resection. 1,7,16,20 Intraoperative MRI has been used with success in LGG surgery, and the technique has been shown to both increase the extent of resection 2,[10][11][12]21,22,25 and significantly decrease recurrence and death rate in patients with LGGs. 2During LGG surgery, ioMRI can detect residual tumor tissue that cannot be identified by visual inspection or intraoperative ultrasonography. 8,15,25 The tumor mass is defined as the T2-hyperintense area and the extent of resection is based on comparison of intraoperatively acquired T2-weighted images with preoperative ones. However, especially after resection of large LGGs with mass effect, intraoperative images may show T2-hyperintense areas at the resection border, and a differential diagnosis between tumoral and nontumoral tissue may be difficult.15 The difficulty lies in that both tumor and nontumoral changes such as infarction, edema, or iatrogenic contusion or other surgically induced changes can appear similarly as T2 hyperintensities on MRI. This is a potential limiting factor for an optimum resection in certain Object. The authors had previously shown that 3-T intraoperative MRI (ioMRI) detects residual tumor tissue during low-grade glioma and that it helps to increase the extent of resection. In a proportion of their cases, however, the ioMRI disclosed T2-hyperintense areas at the tumor resection border after the initial resection attempt and prompted a differential diagnosis between residual tumor and nontumoral changes. To guide this differential diagnosis the authors used intraoperative long-TE single-voxel proton MR spectroscopy (ioMRS) and tested the correlation of these findings with findings from pathological examination of resected tissue.Methods. Patients who were undergoing surgery for hemispheric or insular WHO Grade II gliomas and were found to have T2 changes around the resection cavity at the initial ioMRI were prospectively examined with ioMRS and biopsies were taken from corresponding localizations. In 14 consecutive patients, the ioMRS diagnosis in 20 voxels of interest was tested against the histopathological diagnosis. Intraoperative diffusion-weighted imaging (ioDWI) was also performed, as a part of the routine imaging, to rule out surgically induced changes, which could also appear as T2 hyperintensity.Results. Presence of tumor was documented in 14 (70%) of the 20 T2-hyperintense areas by histopathological examination. The sensitivity of ioMRS for identifying residual tumor was 85.7%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 75%. The specificity of ioDWI for surgically induced changes was high (100%), but the sensitivity was only 60%.Conclusions. This is the first clinical series to indicate that ioMRS can be used to differentiate residual tumor from nontumoral changes around the resection cavity, with high sensitivity and specificity. ...

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“…Numerous papers have described the use of ultrasound [1][2][3][4] and more recently tracked ultrasound [5][6][7], in brain tumor surgery. Fluorescence imaging [8] and intraoperative magnetic resonance imaging (iMRI) [9,10] are other popular intraoperative modalities for brain tumors, although fluorescence is only useful for visualizing certain types of tumors and is currently limited to the imaging of surfaces.…”

Section: Introductionmentioning

confidence: 99%

Comparing two approaches to rigid registration of three-dimensional ultrasound and magnetic resonance images for neurosurgery

et al. 2011

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A comparison between preoperative magnetic resonance and intraoperative ultrasound tumor volumes and margins

Cited by 96 publications

References 30 publications

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Comparing two approaches to rigid registration of three-dimensional ultrasound and magnetic resonance images for neurosurgery

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