TY - JOUR
T1 - Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection
AU - Prada, Francesco
AU - Del Bene, Massimiliano
AU - Fornaro, Riccardo
AU - Vetrano, Ignazio G.
AU - Martegani, Alberto
AU - Aiani, Luca
AU - Sconfienza, Luca Maria
AU - Mauri, Giovanni
AU - Solbiati, Luigi
AU - Pollo, Bianca
AU - DiMeco, Francesco
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objective The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection. Methods The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence. Results In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings. Conc lusions As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.
AB - Objective The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection. Methods The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence. Results In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings. Conc lusions As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.
KW - Contrast-enhanced ultrasound
KW - Extent of resection
KW - Glioblastoma
KW - Intraoperative imaging
KW - Intraoperative ultrasound
KW - Residual tumor
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U2 - 10.3171/2015.11.FOCUS15573
DO - 10.3171/2015.11.FOCUS15573
M3 - Article
AN - SCOPUS:84963657415
VL - 40
JO - Neurosurgical Focus
JF - Neurosurgical Focus
SN - 1092-0684
IS - 3
M1 - E7
ER -