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Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using
Francesco Prada1, Valerio Vitale1, Massimiliano Del Bene1
1From the Department of Neurosurgery (F.P., M.D.B., F.D.), Department of Neuroradiology (C.B., L.D.), and Radiotherapy Unit (V.P.), Fondazione IRCCS Istituto Neurologico "C. Besta," Via Celoria n.11, 20133 Milan, Italy; Department of Imaging and Radiation Therapy, Azienda Socio-sanitaria Territoriale di Lecco, Lecco, Italy (V.V.); Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy (L.M.S.); Department of Biomedical Sciences for Health, University of Milan, Milan, Italy (L.M.S.); Department of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Radiology, Humanitas Research Hospital, Rozzano, Italy (L.S.); Department of Research and Development, MedCom, Darmstadt, Germany (G.S., V.K.); and Department of Neurologic Surgery, Johns Hopkins Medical School, Baltimore, Md (F.D.).
Intraoperative contrast-enhanced ultrasonography (CEUS) accurately visualizes glioblastoma multiforme (GBM) enhancement, matching preoperative MRI. This technique shows potential for guiding GBM tumor resection.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Glioblastoma multiforme (GBM) is an aggressive brain tumor.
- Accurate intraoperative assessment of GBM enhancement is crucial for surgical planning and resection.
- Preoperative gadolinium-enhanced T1-weighted MRI is the standard for visualizing GBM enhancement.
Purpose of the Study:
- To compare contrast material enhancement of glioblastoma multiforme (GBM) using intraoperative contrast-enhanced ultrasonography (CEUS) versus preoperative gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging.
- To evaluate the utility of real-time fusion imaging in correlating these two modalities.
Main Methods:
- Ten patients with GBM underwent navigated contrast-enhanced US before tumor resection.
- Fusion imaging was used to match real-time CEUS scans with preoperative gadolinium-enhanced T1-weighted MR images.
- Glioblastoma contrast enhancement characteristics (location, morphology, margins, dimensions, pattern) were compared between the two imaging techniques.
Main Results:
- Fusion imaging enabled accurate matching of CEUS and MR images with a positional discrepancy of less than 2 mm.
- Contrast enhancement was superimposable between CEUS and MR imaging in terms of location, margins, dimensions, and morphologic features in all cases.
- The enhancement pattern was similar in nine out of ten patients, with CEUS showing potential for visualizing the entire tumor bulk.
Conclusions:
- Intraoperative CEUS provides comparable visualization of glioblastoma enhancement to preoperative gadolinium-enhanced T1-weighted MR imaging.
- CEUS demonstrates potential as a valuable tool in the surgical management of GBM.
- Real-time fusion imaging facilitates accurate correlation between intraoperative CEUS and preoperative MR imaging.
