Article
Intraoperative contrast enhanced 3D-ultrasound in patients with brain tumours, resection control and navigated biopsies
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Authors
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Felix Arlt
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig
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Claire Chalopin
- ICCAS (Innovation Centre Computer Assisted Surgery), Leipzig
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Andrea Müns
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig
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Jürgen Meixensberger
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig; ICCAS (Innovation Centre Computer Assisted Surgery), Leipzig
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Dirk Lindner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig
| Published: | June 2, 2015 |
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Outline
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Objective: A convincing intraoperative resection control in surgery of malignant brain tumors is associated with a longer overall survival of the patients. B-mode ultrasound (BUS) is a well known intraoperative imaging application in neurosurgical procedure but it's limited in the differentiation of tumor, tumor borders, edema or tumor remnants.
The aim of this clinical study is the investigation of contrast enhanced and 3D- reconstructed ultrasound (CEUS) in surgery of brain tumour.
Method: We investigated prospectively 21 patients suffering from a glioblastoma multiforme (GBM).
Ultrasound imaging for resection control was acquired at the end of tumor resection defined by the neurosurgeon. A high end ultrasound (US) device (Toshiba Aplio XG®) with contrast mode was used. The navigation and 3D reconstruction was performed with the LOCALITE SonoNavigator®. Furthermore navigated biopsies were taken after the resection defined by localization in residual contrast agent uptaking areas or contrast negative areas. Subsequently the ultrasound images were segmented with itk-Snap® and compared to the corresponding postoperative MR data.
Results: In 17 of the 21 tumors we noticed a high contrast uptake while in 3 patients the uptake was slightly and not sufficient. A gross total resection was achieved in 54% (7/13 patients) with CEUS. In 6 patients a subtotal resection (>90% tumour mass), in 1 patient a tumour debulking (>80% tumour mass) and 1 tumour biopsie was planned. In 5 patients 3D-CEUS showed tumour remnants wich leads to a further tumour resection in 4 patients. In these patients 50% showed no tumour remnant in the MRI. In 6 of 21 patients no biopsies after tumour resection were perfomed. Each 3 biopsies of the 15 GBM patients were taken. In 45 biopsies 27 were located in contrast agent uptaking areas, 12 of them showed tumour (44%), 11 samples showed infiltration of tumour (41%) and 4 samples were tumour negative. A sensitivity of 85% and a specificity of 28% for tumour in contrast agent uptaking areas could be attested.
Conclusions: 3D-contrast enhanced intraoperative ultrasound (CEUS) is a save and convincing intraoperative imaging modality. High resolution images in real time 3D could be acquired in 5 to 10 minutes. Gross total resection and incomplete resection of glioblastoma were sufficient demonstrated with CEUS intraoperatively. Even the taken biopsies showed a high sensitivity of 85%, low specificity might be explained with well known tissue infiltration.
