Application of intraoperative B-mode ultrasound and shear wave elastography for glioma grading

Abstract

Background: To evaluate the value of intraoperative B-mode ultrasound and shear wave elastography (SWE) in differentiating low-grade and high-grade gliomas.Methods: A total of 172 patients with glioma were examined by B-mode ultrasound to obtain a tumor sonogram. Intraoperative SWE was performed on 52 patients to obtain Young's modulus values of peritumor tissue and tumor tissue, and the differences in conventional B-mode signs and Young's modulus values of gliomas of different grades were then compared. The diagnostic performance of SWE in glioma grading was assessed by receiver operating characteristic (ROC) curve analysis, and the intra-and interobserver reliability of SWE was analyzed by the intraclass correlation coefficient (ICC).Results: For B-mode ultrasound, patient age, cystic degeneration, and peritumor edema were independent risk factors for high-grade glioma (P<0.05, OR >1). For SWE, Young's modulus values of peritumor tissue,

Multiparametric Intraoperative Ultrasound in Oncological Neurosurgery: A Pictorial Essay

“…LGGs, in most cases, appear stiffer than the surrounding healthy brain as shown in Figure 5 . This characteristic can help the neurosurgeon in defining its borders and eventually post-resection residue ( Chauvet et al, 2016 ; Prada et al, 2019 ; Chan et al, 2021 ; Yin et al, 2021 ).…”

“…In general, the margins are more identifiable than that in LGGs even it is still difficult to differentiate between tumor boundaries and peri-lesional edema. However, B-mode is highly informative in HGG resection as demonstrated in numerous papers ( Chacko et al, 2003 ; Solheim et al, 2010 ; del Bene et al, 2018 ; Carai et al, 2021 ; Incekara et al, 2021 ; Yin et al, 2021 ). At first, it allows a real-time anatomical study of the lesion, surrounding structures, and tumor architecture even before the dural opening.…”

“…In addition, the neurosurgeon can observe which gyrus is infiltrated and thus tailoring the corticectomy preserving the spared gyrus. During surgery, B-mode US can be repeated multiple times to guide the surgery and estimate the extent of resection ( Solheim et al, 2010 ; Prada et al, 2014b , 2016b ; del Bene et al, 2018 ; Incekara et al, 2021 ; Yin et al, 2021 ).…”

“…Elastosonography demonstrates HGGs to be usually softer than the healthy brain parenchyma ( Figure 6 ), thus helping to discern between HGGs and LGGs ( Cepeda et al, 2021b ). Quantitative analysis made possible by SWE is particularly interesting for the creation of algorithms to discern intraoperatively the nature of the lesion, such as distinguishing HGGs from solitary brain metastases ( Prada et al, 2016b , 2019 ; Cepeda et al, 2021b ; Yin et al, 2021 ). SE and SWE are useful even for assisting tumoral resection ( Newman and Rozycki, 1998 ).…”

“…This technique exploits a US stimulus to induce tissue displacement, thus providing a quantitative representation of the stiffness. In the current practice, elastosonography seems useful mainly in gliomas and meningiomas characterization ( Figure 4 ; Prada et al, 2015 , 2016b , 2019 ; della Pepa et al, 2020 ; Cepeda et al, 2021a ; Chan et al, 2021 ; Menna et al, 2021 ; Yin et al, 2021 ).…”