The Utility of CEUS as an Intraoperative Tool for Residual Brain Tumors: An Overview

Abstract

Brain and other CNS tumors are the eight most common cancers in adults older than 40. This article reviews the main methods used to assess residual brain tumors, such as conventional ultrasound, magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). This opinion article points out the effectiveness of CEUS, compared to conventional ultrasound and MRI, as an intraoperative tool for residual brain tumors. Ultrasound (US) is a well-known imaging test that has been used for many years. This technology enables neurosurgeons to resect brain tumors more safely and preserve brain function without exposing the brain to ionizing radiation. Another vital tool frequently used is the MRI. This is a non-invasive imaging technology that produces three-dimensional detailed anatomical images. The most reliable imaging tool for brain tumors is gadolinium-enhanced resonance imaging. However, neurosurgeons have a postoperative time frame of 24-48 hours to perform an MRI with gadolinium enhancement; beyond that time frame, postoperative changes along the operative margins could be misinterpreted as residual enhancing tumors. Currently, the CEUS method is gaining popularity in the imaging field as a new radiological tool. CEUS has been effectively used to assess various organ afflictions, such as liver and renal tumors. However, there is limited evidence regarding its role in the central nervous system (CNS). The use of CEUS in brain tumors has shown to be more accurate in solid tumors when compared to cystic lesions. According to our research, contrast-enhanced ultrasound over conventional ultrasound in the US suggests a better outcome for patients undergoing neurosurgical procedures by reducing brain damage that could result from surgical removal of tumors. Therefore, CEUS should be considered in different operative stages for surgical brain tumor removal and postoperative clinical evaluation to ensure a better outcome for these patients.

The Use of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of the Neonatal Brain

“…However, its ability to differentiate between different subtypes is limited [ 60 , 61 ]. So far, it has been most extensively used in intraoperative settings for surgical guidance [ 62 , 63 ]. Neoplastic tissue shows a higher contrast enhancement compared to that of the normal surrounding brain parenchyma because of its higher vessel density.…”