Intraoperative Strain Elastosonography in Brain Tumor Surgery

Francesco Prada, Massimiliano Del Bene, Angela Rampini, Luca Mattei, Cecilia Casali, Ignazio Gaspare Vetrano, Antonio Giulio Gennari, Silvana Sdao, Marco Saini, Luca Maria Sconfienza, Francesco DiMeco

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited.

OBJECTIVE: To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization.

METHODS: We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization.

RESULTS: (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90% of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64% of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76% of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89%. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7% sensitivity and 94.7% specificity in differentiating LGG from HGG.

CONCLUSION: SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.

Original languageEnglish
JournalOperative Neurosurgery
DOIs
Publication statusE-pub ahead of print - Nov 28 2018

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Elasticity Imaging Techniques
Brain Neoplasms
Glioma
Brain
Neurosurgery
Ultrasonography

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Intraoperative Strain Elastosonography in Brain Tumor Surgery. / Prada, Francesco; Del Bene, Massimiliano; Rampini, Angela; Mattei, Luca; Casali, Cecilia; Vetrano, Ignazio Gaspare; Gennari, Antonio Giulio; Sdao, Silvana; Saini, Marco; Sconfienza, Luca Maria; DiMeco, Francesco.

In: Operative Neurosurgery, 28.11.2018.

Research output: Contribution to journalArticle

Prada, Francesco ; Del Bene, Massimiliano ; Rampini, Angela ; Mattei, Luca ; Casali, Cecilia ; Vetrano, Ignazio Gaspare ; Gennari, Antonio Giulio ; Sdao, Silvana ; Saini, Marco ; Sconfienza, Luca Maria ; DiMeco, Francesco. / Intraoperative Strain Elastosonography in Brain Tumor Surgery. In: Operative Neurosurgery. 2018.
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abstract = "BACKGROUND: Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited.OBJECTIVE: To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization.METHODS: We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization.RESULTS: (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90{\%} of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64{\%} of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76{\%} of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89{\%}. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7{\%} sensitivity and 94.7{\%} specificity in differentiating LGG from HGG.CONCLUSION: SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.",
author = "Francesco Prada and {Del Bene}, Massimiliano and Angela Rampini and Luca Mattei and Cecilia Casali and Vetrano, {Ignazio Gaspare} and Gennari, {Antonio Giulio} and Silvana Sdao and Marco Saini and Sconfienza, {Luca Maria} and Francesco DiMeco",
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T1 - Intraoperative Strain Elastosonography in Brain Tumor Surgery

AU - Prada, Francesco

AU - Del Bene, Massimiliano

AU - Rampini, Angela

AU - Mattei, Luca

AU - Casali, Cecilia

AU - Vetrano, Ignazio Gaspare

AU - Gennari, Antonio Giulio

AU - Sdao, Silvana

AU - Saini, Marco

AU - Sconfienza, Luca Maria

AU - DiMeco, Francesco

PY - 2018/11/28

Y1 - 2018/11/28

N2 - BACKGROUND: Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited.OBJECTIVE: To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization.METHODS: We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization.RESULTS: (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90% of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64% of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76% of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89%. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7% sensitivity and 94.7% specificity in differentiating LGG from HGG.CONCLUSION: SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.

AB - BACKGROUND: Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited.OBJECTIVE: To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization.METHODS: We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization.RESULTS: (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90% of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64% of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76% of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89%. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7% sensitivity and 94.7% specificity in differentiating LGG from HGG.CONCLUSION: SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.

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