Extent of Glioma Resection on Intraoperative Ultrasound Correlates Well with Postoperative MRI Results

Abstract

Background: Maximal surgical resection is thought to confer survival benefit for both high- and low-grade gliomas. Intraoperative imaging assists with achieving maximal surgical resection. Different intraoperative imaging modalities have been implemented, but intra-operative MRI has a high cost that may limit its uptake in resource scarce healthcare systems. Objectives: This study aims to evaluate intraoperative ultrasound as a surrogate for intra and post-operative MRI for assessing the extent of resection of glioma. Methods: A partially prospective comparative study, which compares a prospective cohort group with a historical control group. We evaluated 74 glioma patients, who all underwent surgery in a regional UK Neurosurgical centre between October 2013 and October 2017. The study population was divided into 2 groups based on the use of ultrasound to guide the resection. We compared the size of the lesion prior and after excision to evaluate the extent of resection and undertook comparison with post-operative MRI. Results: The mean extent of resection on the ultrasound images was 96.1 % and 97.7 % on the postoperative MR. Using Spearman’s correlation; extent of resection on the ultrasound images was strongly correlated with the extent of resection on the postoperative MR images (P=value <0.001). The use of intraoperative ultrasound was associated with a significant increase in the number of patients in whom 95% or greater extent of resection was achieved (Fisher’s exact test P= value 0.033). Conclusion: Intra-operative ultrasonography could provide a reliable and cheaper alternative to intraoperative MRI to improve the extent of resection in glioma surgery.

Revisiting Intraoperative 2D USG with Saline–Air Mixture as Contrast for Resection of Eloquent Area Glioma in Resource-Deficient Countries

“…In some series, the extent of tumor resection as determined by IOUSG correlated strongly with postoperative MRI. 7 12 However, some of these patients were operated in awake condition or with intraoperative use of ALA for tumor localization and resection. 12 In another meta-analysis, where the extent of tumor resection was assessed, the concordance rate between IOUSG and MRI was 82%.…”

“… 7 12 However, some of these patients were operated in awake condition or with intraoperative use of ALA for tumor localization and resection. 12 In another meta-analysis, where the extent of tumor resection was assessed, the concordance rate between IOUSG and MRI was 82%. 13 Yet again intraoperative image guidance system and ALA-induced fluorescence were used in many of the studies analyzed.…”

“…1B, 2E, 3E) Out of 58 cases, tumor was predominantly hyperechoic in 27, uniformly hyperechoic in 7, mixed echogenic in 21, and hyperechoic rim in 3 cases. The tumor-brain interface was good in 46 patients (34 HGG, 12 LGG) and poor in 12 patients (4 HGG, 8 LGG).…”