Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using Intraoperative Fusion Imaging

Abstract

Supported by the Seventh Framework Programme (grant 602 923).q RSNA, 2017 Purpose:To compare contrast material enhancement of glioblastoma multiforme (GBM) with intraoperative contrast-enhanced ultrasonography (US) versus that with preoperative gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging by using real-time fusion imaging. Materials andMethods:Ten patients with GBM were retrospectively identified by using routinely collected, anonymized data. Navigated contrastenhanced US was performed after intravenous administration of contrast material before tumor resection. All patients underwent tumor excision with navigated intraoperative US guidance with use of fusion imaging between real-time intraoperative US and preoperative MR imaging. With use of fusion imaging, glioblastoma contrast enhancement at contrast-enhanced US (regarding location, morphologic features, margins, dimensions, and pattern) was compared with that at gadolinium-enhanced T1-weighted MR imaging. Results:Fusion imaging for virtual navigation enabled matching of realtime contrast-enhanced US scans to corresponding coplanar preoperative gadolinium-enhanced T1-weighted MR images in all cases, with a positional discrepancy of less than 2 mm. Contrast enhancement of gadolinium-enhanced T1-weighted MR imaging and contrast-enhanced US was superimposable in all cases with regard to location, margins, dimensions, and morphologic features. The qualitative analysis of contrast enhancement pattern demonstrated a similar distribution in contrast-enhanced US and gadolinium-enhanced T1-weighted MR imaging in nine patients: Seven lesions showed peripheral inhomogeneous ring enhancement, and two lesions showed a prevalent nodular pattern. In one patient, the contrast enhancement pattern differed between the two modalities: Contrast-enhanced US showed enhancement of the entire bulk of the tumor, whereas gadolinium-enhanced T1-weighted MR imaging demonstrated peripheral contrast enhancement. Conclusion:Glioblastoma contrast enhancement with contrast-enhanced US is superimposable on that provided with preoperative gadolinium-enhanced T1-weighted MR imaging regarding location, margins, morphologic features, and dimensions, with a similar enhancement pattern in most cases. Thus, contrast-enhanced US is of potential use in the surgical management of GBM.q RSNA, 2017

Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study

“…Moreover, this technique was demonstrated to be effective also in the treatment of several benign and malignant diseases around the human body [35][36][37][38]. Thanks also to the wider application of advanced techniques, such as CEUS [39][40][41] and virtual navigation, with fusion imaging [20,42,43], US-guided RF myolysis represent an effective alternative to conventional surgery for the treatment of uterine fibroids. The VT system provides effective guidance in RF ablation of uterine fibroids.…”

The role of contrast-enhanced ultrasound in neurosurgical disease

“…Prada and colleagues assessed CEUS in comparison to Gd-enhanced MRI in the visualization of high-grade GBM and in vessel localization in skull base tumors in particular. 21,26 Using fusion imaging between preoperative MRI and real-time CEUS, these authors proved the capability of the latter modality to highlight the same target volume shown by preoperative Gd-enhanced MRI in patients with GBM ( Fig. 1).…”

Oncological, Vascular, and Spinal Uses of Contrast-Enhanced Ultrasound in Neurosurgery

“…CEUS can also be compared with perfusion MRI in both preoperative and postoperative settings: US offers a morphologic representation of GBM similar to the one provided by preoperative gadolinium-enhanced T1-weighted MRI [40]. Several experiences in literature compared, instead, CEUS with pMRI in a postoperative setting [41,42] and suggested it as a cost-effective method in evaluating changes in tumor vascularity during the follow-up period in patients with brain tumors who are undergoing radiotherapy, chemotherapy, or antiangiogenic therapy.…”