The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection

Munkvold, Bodil Karoline Ravn; Jakola, Asgeir Store; Reinertsen, Ingerid; Sagberg, Lisa Millgård; Unsgård, Geirmund; Solheim, Ole

doi:10.1016/j.wneu.2018.03.208

Cited by 44 publications

(34 citation statements)

References 58 publications

(64 reference statements)

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“…Munkvold et al reported a series of 144 gliomas operated using NUS. 8 Their cohort of gliomas had a higher proportion of LGGs (33% vs 17%) and more recurrent cases (40% vs 20%) compared with our series. Munkvold Values are presented as number (%) of patients unless otherwise indicated.…”

Section: Discussioncontrasting

confidence: 57%

Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Shetty

Yeole

Singh

et al. 2021

Neurosurgical Focus

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OBJECTIVEIntraoperative imaging is increasingly being used for resection control in diffuse gliomas, in which the extent of resection (EOR) is important. Intraoperative ultrasound (iUS) has emerged as a highly effective tool in this context. Navigated ultrasound (NUS) combines the benefits of real-time imaging with the benefits of navigation guidance. In this study, the authors investigated the use of NUS as an intraoperative adjunct for resection control in gliomas.METHODSThe authors retrospectively analyzed 210 glioma patients who underwent surgery using NUS at their center. The analysis included intraoperative decision-making, diagnostic accuracy, and operative outcomes, particularly EOR and related factors influencing this.RESULTSUS-defined gross-total resection (GTR) was achieved in 57.6% of patients. Intermediate resection control scans were evaluable in 115 instances. These prompted a change in the operative decision in 42.5% of cases (the majority being further resection of unanticipated residual tumor). Eventual MRI-defined GTR rates were similar (58.6%), although the concordance between US and MRI was 81% (170/210 cases). There were 21 false positives and 19 false negatives with NUS, resulting in a sensitivity of 78%, specificity of 83%, positive predictive value of 77%, and negative predictive value of 84%. A large proportion of patients (13/19 patients, 68%) with false-negative results eventually had near-total resections. Tumor resectability, delineation, enhancement pattern, eloquent location, and US image resolution significantly influenced the GTR rate, though only resectability and eloquent location were significant on multivariate analysis.CONCLUSIONSNUS is a useful intraoperative adjunct for resection control in gliomas, detecting unanticipated tumor residues and positively influencing the course of the resection, eventually leading to higher resection rates. Nevertheless, resection is determined by the innate resectability of the tumor and its relationship to eloquent location, reinforcing the need to combine iUS with functional mapping techniques to optimize resections.

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Section: Discussioncontrasting

confidence: 57%

Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Shetty

Yeole

Singh

et al. 2021

Neurosurgical Focus

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“…They determined that tumor volume and tumor depth were the main factors that influenced the sensitivity for intraoperative US to detect residual tumor; small superficial tumors being more likely to be completely resected. 29 One can infer that the impact of the usage of intraoperative US on the clinical course of patients with brain tumors is related to the ability to locate and better resect these lesions.…”

Section: Discussion Intraoperative Ultrasound In Neurosurgerymentioning

confidence: 99%

Basic Principles of Intraoperative Ultrasound Applied to Brain Tumor Surgery

Jacobo

Avendaño

Moreno-Jiménez

et al. 2020

Indian Journal of Neurosurgery

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Intraoperative ultrasound (US) has been shown to possess great value in assessing tumor volume and localization, especially for primary resection of gliomas and metastatic lesions. Given that US is a technology that is highly user dependent, many surgeons have encountered problems with the usage of this technology, as well as interpretation of intraoperative US images, limiting its full potential. This article focuses on the basic knowledge a neurosurgeon must acquire to properly use and interpret intraoperative US to improve tumor localization and extent of resection during brain tumor surgery.

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“…Specificity was higher in LGG than in HGG (94 and 77%) and lowest in patients who undergone previous radiotherapy. The Authors conclude their analysis stating that ioUS specificity is high while the sensitivity for small residue is lower than post-operative MRI (22).…”

Section: Intraoperative Ultrasound In Glioma Surgerymentioning

confidence: 99%

“…Numerous studies have also investigated the diagnostic properties of ioUS in terms of sensitivity, specificity and ability to increase EOR and subsequently PFS and OS (9, 19–22).…”

Section: Introductionmentioning

confidence: 99%

Advanced Ultrasound Imaging in Glioma Surgery: Beyond Gray-Scale B-mode

et al. 2018

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Introduction: Glioma surgery is aimed at obtaining maximal safe tumor resection while preserving or improving patient's neurological status. For this reason, there is growing interest for intra-operative imaging in neuro-oncological surgery. Intra-operative ultrasound (ioUS) provides the surgeon with real-time, anatomical and functional information. Despite this, in neurosurgery ioUS mainly relies only on gray-scale brightness mode (B-mode). Many other ultrasound imaging modalities, such as Fusion Imaging with pre-operative acquired magnetic resonance imaging (MRI), Doppler modes, Contrast Enhanced Ultrasound (CEUS), and elastosonography have been developed and have been extensively used in other organs. Although these modalities offer valuable real-time intra-operative information, so far their usage during neurosurgical procedures is still limited.Purpose: To present an US-based multimodal approach for image-guidance in glioma surgery, highlighting the different features of advanced US modalities: fusion imaging with pre-operative acquired MRI for Virtual Navigation, B-mode, Doppler (power-, color-, spectral-), CEUS, and elastosonography.Methods: We describe, in a step-by-step fashion, the applications of the most relevant advanced US modalities during different stages of surgery and their implications for surgical decision-making. Each US modality is illustrated from a technical standpoint and its application during glioma surgery is discussed.Results: B-mode offers dynamic morphological information, which can be further implemented with fusion imaging to improve image understanding and orientation. Doppler imaging permits to evaluate anatomy and function of the vascular tree. CEUS allows to perform a real-time angiosonography, providing valuable information in regards of parenchyma and tumor vascularization and perfusion. This facilitates tumor detection and surgical strategy, also allowing to characterize tumor grade and to identify residual tumor. Elastosonography is a promising tool able to better define tumor margins, parenchymal infiltration, tumor consistency and permitting differentiation of high grade and low grade lesions.Conclusions: Multimodal ioUS represents a valuable tool for glioma surgery being highly informative, rapid, repeatable, and real-time. It is able to differentiate low grade from high grade tumors and to provide the surgeon with relevant information for surgical decision-making. ioUS could be integrated with other intra-operative imaging and functional approaches in a synergistic manner to offer the best image guidance for each patient.

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The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection

Abstract: The specificity of intraoperative US is good, but sensitivity for detecting the last milliliter is low compared with postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, although ultrasound image quality was not.

Cited by 44 publications

References 58 publications

Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Basic Principles of Intraoperative Ultrasound Applied to Brain Tumor Surgery

Advanced Ultrasound Imaging in Glioma Surgery: Beyond Gray-Scale B-mode

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