Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT

Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings. As a general result, all investigated lesions could be identified during intraoperative US investigations with the exception of small aneurysms. Most of the lesions gave at least partly higher echosignals than normal brain tissue, except arachnoid cysts. Size and shape of lesions were comparable in US and CT with the exception of some gliomas; in the latter group, the diffuse image in US was more akin to the situation likely to be found by the surgeon during operation, whereas CT used to give a misleading picture of a more or less clearly delineated tumour. US allowed more accurate differentiation between intratumoural necrosis and cysts than CT: the latter was misleading in many instances. At the present state of development, real time US imaging does not allow a histopathological diagnosis. The ease of handling and the high quality of morphological imaging, however, warrant a number of practical applications in daily neurosurgical practice.