Reliability of transcranial colour-coded real-time sonography in assessment of brain tumours: correlation of ultrasound, computed tomography and biopsy findings

Abstract

Transcranial colour-coded real-time sonography (TCCS) was carried out in 25 patients with brain tumours to determine whether this noninvasive method provides additional information about the extent of solid tumour, its differentiation from oedema, and its tissue components. All 25 patients had serial computed tomography (CT)-guided stereotactic biopsies. Comparison of ultrasound, CT and histological findings revealed that the vast majority of contrast enhancing areas on CT were hyperechogenic (32/33; 97%) and contained tumour tissue (29/32; 91%). Hyperechogenic areas always represented solid tumour (23/23 patients), even when CT showed low density non-enhancing lesions. In lesions hypoechogenic on TCCS and low density on CT, histology consistently revealed necrotic tumour (7/7). Biopsies obtained from parenchyma with normal echogenicity revealed tumour in only 3 of 16 specimens. Despite the high specificity of TCCS in the differentiation of tumour components, its sensitivity to tumour was inferior to that of CT (24/25; 96%). TCCS thus allows noninvasive preoperative identification of tumour tissue and its extent setting.

Correlation of intra-operative ultrasound with histopathologic findings after tumour resection in supratentorial gliomas

“…The peri-operative morbidity and mortality, in the literature between 0% [80] and 16% [2], was not higher due to the biopsies in comparison to other series [24]. For transcranial sonography the correlation between CT or MRI, histological and sonographic findings of residual tumour and tumour regrowth has been shown for children [21,36,37,84] and recently for adults [6,7,47]. In another ongoing study (authors) a correlation between IOUS and early postoperative CT/MRI and histological findings of tumour remnants will be done.…”

“…Ultrasound has shown intra-operatively [5,8,11,15,22,26,30,32,48,50,59,61,62,64,66,73,76,79,81] and transcranially [6,9,10,17,69,75,77] to be a reliable real-time method in the delineation of tumour tissue before resection, even superior to contrast-enhanced CT or MRI [35,43,47].…”

Multiplanar MRI–CT fusion neuronavigation-guided serial stereotactic biopsy of human brain tumors: proof of a strong correlation between tumor imaging and histopathology by a new technical approach

“…This approach gives us the opportunity to learn even more about brain tumor imaging and the most eVective approach in serial stereotactic biopsy. Similar studies correlating transcranial color-coded real-time ultrasound and computed tomography with biopsy characteristics or combining stereo-EEG, CT and morphology showed a correlation between imaging and morphology (Becker et al 1994;Munari et al 1985).…”

Frontal Bone Windows for Transcranial Color-Coded Duplex Sonography

“…1,2,6 -8 Furthermore, the temporal bone window allows the identification of parenchymal abnormalities such as intracerebral hemorrhage, tumors, and pathology of the ventricular system. [3][4][5] However, because of the unfavorable insonation angle, measurements of flow velocities of the A2 segment of the ACA, the PCoA, and the venous midline vasculature are often unreliable. The same difficulties apply to imaging of the frontal parenchyma.…”

“…1,2 New aspects of TCCS are assessment of the brain parenchyma [3][4][5] and intracranial veins and sinuses. 6 -8 The standard approach is insonation through a temporal bone window.…”