gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Contrast enhanced ultrasound during surgery of low-grade brain tumor

Meeting Abstract

  • M. Engelhardt - Klinik für Neurochirurgie, Knappschaftskrankenhaus Bochum
  • C. Hansen - Institut für Hochfrequenztechnik, Bochum
  • H. Ermert - Institut für Hochfrequenztechnik, Bochum
  • A. Harders - Klinik für Neurochirurgie, Knappschaftskrankenhaus Bochum
  • K. Schmieder - Klinik für Neurochirurgie, Knappschaftskrankenhaus Bochum

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.05-05

doi: 10.3205/09dgnc022, urn:nbn:de:0183-09dgnc0228

Published: May 20, 2009

© 2009 Engelhardt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The aim of this study was to adapt Ultrasonographic techniques first developed to show brain perfusion in cerebral ischemia to an intraoperative setting during surgery of low grade astrocytoma. The aim was to show the tumor and the surrounding brain tissue during brain tumor surgery by means of perfusion differences for online navigation and resection control. Ultrasound as a diagnostic tool in surgery of high-grade tumors and metastases has been shown already in former studies. With the underlying purpose we developed an algorithm using ultrasound contrast agent and were able to differentiate brain tissue and tumor as an online navigation tool.

Methods: Preoperatively a MRI with navigational setting was performed. After registration patients underwent several contrast-enhanced Ultrasonographic investigations (Phase Inversion Harmonic Imaging, bolus kinetic, fitted model function) during surgery. Off-line, time-intensity curves as well as perfusion maps were calculated and different analysis parameters, e.g. time to peak, peak intensity, peak width, were extracted to characterize perfusion and to detect the best analyzing parameter differentiating tumor tissue from normal brain.

Results: 5 patients with low-grade brain tumors (Gliomas WHO Grade 1 and 2) without contrast enhancement in MRI were investigated with contrast-enhanced ultrasonography during surgery. The contrast enhancement within the normal brain tissue was visible and tumor identification was possible by using peak width and time to peak analysis. Overall tissue differentiation with contrast agent was superior compared to conventional B-mode ultrasound imaging.

Conclusions: Intraoperative contrast-enhanced ultrasonography enabled visualization of low-grade brain tumors. Tumor borders could be displayed with this technique and the adequate analysis. Therefore this investigation could emerge to a low cost solution for intraoperative analysis and probably resection control in surgery of no contrast enhanced tumors.