Intraoperative 3D contrast-enhanced ultrasound (CEUS): a prospective study of 50 patients with brain tumours
Intraoperative 3D contrast-enhanced ultrasound (CEUS): a prospective study of 50 patients with brain tumours
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DOI：
10.1007/s00701-016-2738-z
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发表时间：
2016-04-01
影响因子：
2.4
通讯作者：
Lindner, Dirk
中科院分区：
文献类型：
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作者：
Arlt, Felix;Chalopin, Claire;Lindner, Dirk
恶性脑肿瘤手术期间可靠的术中切除控制与较长的患者总生存期相关。 B 型超声 (BUS) 是神经外科手术中常见的术中成像应用，可提供出色的图像质量。然而，由于切除引起的伪影，其区分肿瘤边界、水肿、周围组织和肿瘤残余物的能力有时受到限制。在经验丰富的人手中，这种“亮边效应”可能会减少。然而，应该确定对比增强超声是否可以通过在切除过程中提供高质量成像来改善这种情况。本临床研究的目的是检查对比增强和三维重建超声（3D CEUS）在脑肿瘤手术中对不同肿瘤实体肿瘤切除术前和术后造影剂的摄取、成像质量以及与术后磁共振成像的比较。本研究纳入了 50 名患有各种轴内和轴外脑肿瘤的患者，他们均在我院神经外科的神经导航支持下接受了手术。他们的中位年龄为 56 岁（范围：28-79 岁）。在打开硬脑膜之前进行超声成像，并在神经外科医生定义的肿瘤切除结束时进行切除控制。使用带有用于 B 模式和 CEUS 的线性和扇形探头的高端超声（美国）设备（东芝 Aplio XGA (R)）。使用 LOCALITE SonoNavigatorA (R) 进行导航和 3D 重建，并将图像以数字方式 (DVI) 传输到导航系统。造影剂由显示肿瘤血管化的回声微泡组成。将超声图像与相应的术后MR数据进行比较，以确定切除后肿瘤和肿瘤残留的准确性和成像质量。对不同类型的肿瘤进行研究。在 21 名胶质母细胞瘤患者中，有 19 名 (90%) 观察到高动态造影剂摄取，而 2 名患者摄取较低且不足。在 52.4% 的胶质母细胞瘤和 III 级星形细胞瘤患者中，与 BUS 相比，CEUS 改善了轮廓，并显示了肿瘤边缘和肿瘤边界的高分辨率成像质量。 II 级和 III 级星形细胞瘤 (n = 6) 以及转移瘤 (n = 18) 也显示出高造影剂摄取，这导致 50% 的成像质量得到改善。在这 17 例患者中，有 5 例用于切除控制的术中 CEUS 显示肿瘤残留，导致进一步切除肿瘤。接受 CEUS 治疗的患者在肿瘤切除后并未表现出神经功能缺损的增加。无药理副作用发生。三维超声造影是一种可靠的术中成像方式，可以提高成像质量。 90% 的高级别胶质瘤（HGG、胶质母细胞瘤和 III 级星形细胞瘤）显示出高对比剂摄取，成像质量提高了 50% 以上。术中 3D CEUS 充分突出了胶质母细胞瘤的大体全切除和不完全切除。超声造影剂的应用可能是一种有用的成像工具，特别是对于胶质母细胞瘤手术中的切除控制。
Reliable intraoperative resection control during surgery of malignant brain tumours is associated with the longer overall survival of patients. B-mode ultrasound (BUS) is a familiar intraoperative imaging application in neurosurgical procedures and supplies excellent image quality. However, due to resection-induced artefacts, its ability to distinguish between tumour borders, oedema, surrounding tissue and tumour remnants is sometimes limited. In experienced hands, this "bright rim effect" could be reduced. However, it should be determined, if contrast-enhanced ultrasound can improve this situation by providing high-quality imaging during the resection. The aim of this clinical study was to examine contrast-enhanced and three-dimensional reconstructed ultrasound (3D CEUS) in brain tumour surgery regarding the uptake of contrast agent pre- and post-tumour resection, imaging quality and in comparison with postoperative magnetic resonance imaging in different tumour entities.Fifty patients, suffering from various brain tumours intra-axial and extra-axial, who had all undergone surgery with the support of neuronavigation in our neurosurgical department, were included in the study. Their median age was 56 years (range, 28-79). Ultrasound imaging was performed before the Dura was opened and for resection control at the end of tumour resection as defined by the neurosurgeon. A high-end ultrasound (US) device (Toshiba Aplio XGA (R)) with linear and sector probes for B-mode and CEUS was used. Navigation and 3D reconstruction were performed with a LOCALITE SonoNavigatorA (R) and the images were transferred digitally (DVI) to the navigation system. The contrast agent consists of echoic micro-bubbles showing tumour vascularisation. The ultrasound images were compared with the corresponding postoperative MR data in order to determine the accuracy and imaging quality of the tumours and tumour remnants after resection.Different types of tumours were investigated. High, dynamic contrast agent uptake was observed in 19 of 21 patients (90 %) suffering from glioblastoma, while in 2 patients uptake was low and insufficient. In 52.4 % of glioblastoma and grade III astrocytoma patients CEUS led to an improved delineation in comparison to BUS and showed a high-resolution imaging quality of the tumour margins and tumour boarders. Grade II and grade III astrocytoma (n = 6) as well as metastasis (n = 18) also showed high contrast agent uptake, which led in 50 % to an improved imaging quality. In 5 of these 17 patients, intraoperative CEUS for resection control showed tumour remnants, leading to further tumour resection. Patients treated with CEUS showed no increased neurological deficits after tumour resection. No pharmacological side-effects occurred.Three-dimensional CEUS is a reliable intraoperative imaging modality and could improve imaging quality. Ninety percent of the high-grade gliomas (HGG, glioblastoma and astrocytoma grade III) showed high contrast uptake with an improved imaging quality in more than 50 %. Gross total resection and incomplete resection of glioblastoma were adequately highlighted by 3D CEUS intraoperatively. The application of US contrast agent could be a helpful imaging tool, especially for resection control in glioblastoma surgery.