Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Shi, Jingwei; Zhang, Ye; Yao, Bing; Sun, Peixin; Hao, Yuanyuan; Piao, Haozhe; Zhao, Xia

doi:10.1155/2021/6651726

Cited by 21 publications

(30 citation statements)

References 108 publications

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“…The use of intraoperative imaging such as MRI (iopMRI) or ultrasound (iopUS) is well established in primary brain tumors to improve the extent of resection ( 14 – 16 ). The cost of an iopMRI unit ranges from $3 million to $7 million, plus the cost of remodeling the operating room.…”

Section: Introductionmentioning

confidence: 99%

MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases

et al. 2022

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ObjectRecent studies demonstrated that gross total resection of brain metastases cannot always be achieved. Subtotal resection (STR) can result in an early recurrence and might affect patient survival. We initiated a prospective observational study to establish a MRI-based risk assessment for incomplete resection of brain metastases.MethodsAll patients in whom ≥1 brain metastasis was resected were prospectively included in this study (DRKS ID: DRKS00021224; Nov 2020 – Nov 2021). An interdisciplinary board of neurosurgeons and neuroradiologists evaluated the pre- and postoperative MRI (≤48h after surgery) for residual tumor. Extensive neuroradiological analyses were performed to identify risk factors for an unintended STR which were integrated into a regression tree analysis to determine the patients’ individual risk for a STR.ResultsWe included 150 patients (74 female; mean age: 61 years), in whom 165 brain metastases were resected. A STR was detected in 32 cases (19.4%) (median residual tumor volume: 1.36ml, median EORrel: 93.6%), of which 6 (3.6%) were intended STR (median residual tumor volume: 3.27ml, median EORrel: 67.3%) - mainly due to motor-eloquent location - and 26 (15.8%) were unintended STR (uSTR) (median residual tumor volume: 0.64ml, median EORrel: 94.7%). The following risk factors for an uSTR could be identified: subcortical metastasis ≥5mm distant from cortex, diffuse contrast agent enhancement, proximity to the ventricles, contact to falx/tentorium and non-transcortical approaches. Regression tree analysis revealed that the individual risk for an uSTR was mainly associated to the distance from the cortex (distance ≥5mm vs. <5mm: OR 8.0; 95%CI: 2.7 – 24.4) and the contrast agent patterns (diffuse vs. non-diffuse in those with distance ≥5mm: OR: 4.2; 95%CI: 1.3 – 13.7). The preoperative tumor volume was not substantially associated with the extent of resection.ConclusionsSubcortical metastases ≥5mm distant from cortex with diffuse contrast agent enhancement showed the highest incidence of uSTR. The proposed MRI-based assessment allows estimation of the individual risk for uSTR and can help indicating intraoperative imaging.

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Section: Introductionmentioning

confidence: 99%

MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases

et al. 2022

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“…Ultrasound (US) is a well-known imaging test that has been used for many years. Although US has many advantages, such as low cost, non-invasive, and low radiation exposure, it also has drawbacks, such as high operator dependence and a demanding technique [5][6][7]. The classic gray-scale brightness mode is the most common type, called B-mode.…”

Section: Conventional Ultrasoundmentioning

confidence: 99%

“…In a US image, the brightness of anatomical structures shines back the magnitude of the reflected sound waves, which can have strong (hyperechoic), weak (hypoechoic), or neutral (isoechoic) acoustic gradients [5,6]. Typical brain structures may exhibit any acoustic gradient [1,2,5,6]. Tumors often appear hyperechoic, particularly at their margins, but the edema surrounding them can be hypoechoic [5,6,7].…”

Section: Conventional Ultrasoundmentioning

confidence: 99%

“…Since they are excreted from the lungs and liver, they are safe for patients with decreased renal function. CEUS provides a realtime view into the vascularization and blood flow distribution patterns within an organ or tumor, which may enhance the resolution, sensitivity, and specificity of ultrasound imaging and estimate the degree of tumoral resection [1,2]. This imaging modality can depict the targeted organ's micro and macro circulation, which may include the brain, liver, gallbladder, bile duct, pancreas, kidney, spleen, breast, thyroid, and prostate resulting in improved performance in diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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The Utility of CEUS as an Intraoperative Tool for Residual Brain Tumors: An Overview

Botero

2022

OAJNN

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Brain and other CNS tumors are the eight most common cancers in adults older than 40. This article reviews the main methods used to assess residual brain tumors, such as conventional ultrasound, magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). This opinion article points out the effectiveness of CEUS, compared to conventional ultrasound and MRI, as an intraoperative tool for residual brain tumors. Ultrasound (US) is a well-known imaging test that has been used for many years. This technology enables neurosurgeons to resect brain tumors more safely and preserve brain function without exposing the brain to ionizing radiation. Another vital tool frequently used is the MRI. This is a non-invasive imaging technology that produces three-dimensional detailed anatomical images. The most reliable imaging tool for brain tumors is gadolinium-enhanced resonance imaging. However, neurosurgeons have a postoperative time frame of 24-48 hours to perform an MRI with gadolinium enhancement; beyond that time frame, postoperative changes along the operative margins could be misinterpreted as residual enhancing tumors. Currently, the CEUS method is gaining popularity in the imaging field as a new radiological tool. CEUS has been effectively used to assess various organ afflictions, such as liver and renal tumors. However, there is limited evidence regarding its role in the central nervous system (CNS). The use of CEUS in brain tumors has shown to be more accurate in solid tumors when compared to cystic lesions. According to our research, contrast-enhanced ultrasound over conventional ultrasound in the US suggests a better outcome for patients undergoing neurosurgical procedures by reducing brain damage that could result from surgical removal of tumors. Therefore, CEUS should be considered in different operative stages for surgical brain tumor removal and postoperative clinical evaluation to ensure a better outcome for these patients.

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“…Nevertheless, after the craniotomy has been made, a brain shift and relaxation mismatch with the neuronavigation system usually occur, especially at the later stages of surgical resection (Wang & Song, 2011). To overcome this limitation, an MRI, a CT scan or an ultrasound (Shi et al, 2021) must be reobtained during surgery for a real‐time intraoperative tumour location based on real‐time image guidance. However, these specific and dedicated tools can be very expensive and not easily available in an operating room.…”

Section: Introductionmentioning

confidence: 99%

Sulci and gyri are topological cerebral landmarks in individual subjects: a study of brain navigation during tumour resection

Tomaiuolo

Raffa

Morelli

et al. 2022

Eur J of Neuroscience

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Surgical resection of brain tumours aims at the maximal safe resection of the pathological tissue with minimal functional impairment. To achieve this objective, reliable anatomical landmarks are indispensable to navigate into the brain. The neuronavigation system can provide information to target the location of the patient's lesion, but after the craniotomy, a brain shift and relaxation mismatch with it often occur. By contrast, sulci/gyri are topological cerebral landmarks in individual patients and do shift with the brain parenchyma during lesion removal, but remain independent from brain shift in relation to the sulci/gyri. Here, we present a case report of a novel strategy based on anatomical landmarks to guide intraoperative brain tumour resection, without using a standard neuronavigation system. A preoperative brain mapping of the peri-tumoural sulci by the MRI and surface reconstruction was followed by confirmation of the anatomical landmarks for the motor cortex using navigated transcranial magnetic stimulation. The resulting location was used as a seed for diffusion tensor imaging tractography to reconstruct the corticospinal tracts. These selected cortical landmarks (sulci/gyri) delimited the margins of the two lesions and the specific location under which the corticospinal tract courses, thus facilitating monitoring of the peri-tumoural region during brain resection. In this case, 96% of the brain tumour from the pericentral somatomotor region was successfully removed without chronic post-operative motor impairments. This approach is based on cortical anatomy that is fixed during surgery and does not suffer from the brain shift that could misplace the lesion according to the neuronavigation system.

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Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Cited by 21 publications

References 108 publications

MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases

MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases

The Utility of CEUS as an Intraoperative Tool for Residual Brain Tumors: An Overview

Sulci and gyri are topological cerebral landmarks in individual subjects: a study of brain navigation during tumour resection

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