Correlation of intra-operative ultrasound with histopathologic findings after tumour resection in supratentorial gliomas

Woydt, M.; Krone, A.; Becker, Georg; Schmidt, Kathrin; Roggendorf, Wolfgang; Roosen, K.

doi:10.1007/bf01411117

Cited by 112 publications

(58 citation statements)

References 80 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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“…The overall picture shows that in B-mode the main differences between lesions at different grades of malignancy are the degree of hyperechogenicity when compared to the surrounding parenchyma, the presence of cystic/necrotic areas, and a more or less defined brain/tumor interface. These findings account for the fact that the role of B-mode imaging is mainly limited in assisting tumor localization, providing only morphological information regarding the lesion, with little or no information about vascularization [7,8]. Conversely, once enhanced, the tumor is highlighted and reveals other specific characteristics.…”

Section: Discussionmentioning

confidence: 86%

“…The role of imaging techniques in surgical resection of brain lesions is crucial in every step of surgery: they help planning surgical strategy, provide orientation during surgery, and indicate tumor boundaries and relationships with eloquent areas and vital structures, thus enhancing precision, accuracy, and safety for the patients while maximizing resection [1][2][3][4]. In recent years we are witnessing an increased use of ultrasounds (US) in neurosurgery, as their reliability as an intraoperative tool for tumor detection has been shown in multiple studies [5][6][7][8][9]. US obviates the need for high costs and specialized surgical instruments.…”

Section: Introductionmentioning

confidence: 99%

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

Prada¹,

Mattei²,

Filippini³

et al. 2014

Neurosurgery

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Background. Contrast enhanced ultrasound (CEUS) is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before. Aim. To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas. Methods. We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology. Results. We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns. Conclusion. Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors' biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.

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“…In our opinion, the main application of this technique is surely for intra-parenchymal tumors removal, because iUS can be of help in identifying the lesion and residual mass with great sensitivity [21,22], but we should not underestimate its use in skull base tumors, abscesses, cysts, hematomas or aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

et al. 2014

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The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.Keywords Navigation Á Brain shift Á Intraoperative imaging Á Ultrasound Á Brain tumor Á Fusion imaging Sommario Il principale difetto della neurochirurgia guidata da immagini è il basarsi su immagini acquisite prima dell'intervento, che per ovvie ragioni non possono tenere conto di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti e l'asportazione di tessuto patologico. L'ecografia intra-operatoria (iUS) sta acquisendo sempre maggior rilevanza in ambito neurochirurgico ma è limitata dalla difficoltosa interpretazione dell'orientamento delle immagini e dalla scarsa panoramicità. In questo articolo descriviamo la nostra tecnica di neuronavigazione real-time basata sull'ecografia intra-operatoria. Fino ad ora abbiamo impiegato la fusione d'immagini tra la risonanza magnetica (MRI) pre-operatoria e l'iUS in 67 pazienti affetti da neoplasie cerebrali. La pianificazione dell'intervento e l'approccio chirurgico è basata sulla (MRI) pre-operatoria mentre l'intervento è guidato dall'iUS. Basandosi sull'iUS è possibile correggere la calibrazione delle immagini (MRI) pre-operatorie correggendo il brain-shift, aggiornando continuamente le due modalità. L'ecografia intra-operatoria permette una eccellente identificazione dei target, dei margini e delle strutture circostanti. L'uso del navigatore basato su (MRI) pre-operatoria è utile nella comprensione delle immagini ecografiche soprattutto per quanto riguarda l'orientazione e la visione panoramica. Le correzione del sistema di neuronavigazione basate sull'iUS sono accurate e utili nel caso di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti ...

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Correlation of intra-operative ultrasound with histopathologic findings after tumour resection in supratentorial gliomas

Cited by 112 publications

References 80 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

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

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