The Value Of Ultrasound Multi-modality Imaging In Intraoperative Localization,Accurate Diagnosis And Prognosis Prediction Of Brain Tumors

ObjectiveThe goal of brain tumor surgery is to achieve gross total removal(GTR),which relies on precise localization of the brain tumor and accurate identification of the tumor border and residual tumor.In this study,we aimed to investigate whether the SMI technique could improve the clarity of brain tumor boundary delineation by intraoperative ultrasound(IoUS)compared with conventional ultrasound,and to investigate the ultrasound performance related to GTR,and further compare the GTR rate and 1-month postoperative KPS with the neuronavigation group and intraoperative MRI group to investigate the value of IoUS in tumor boundary delineation and GTR.GTR,and to investigate the application value of IoUS in tumor border delineation and GTR.Materials and MethodsPatients with a single supratentorial superficial brain tumor scheduled for brain tumor resection at our neurosurgery department from October 2020 to October 2022 were prospectively included to assess the surgical border definition under conventional ultrasound and SMI,and logistic regression analysis was performed to investigate the factors associated with GTR.Patients with single supratentorial superficial glioma who underwent surgery in our neurosurgery department from May 2018 to January 2023 were retrospectively included as the control group,and according to the intraoperative imaging modality,they were divided into blank group,intraoperative nuclear magnetic group,and IoUS group of glioma patients as the study group,and the GTR rate,preoperative and 1-month postoperative KPS scores were compared among the three groups.Results1.Intraoperative ultrasound boundary definition evaluation and study of factors associated with GTRA total of 74 patients had intraoperative ultrasound-assisted brain tumor resection,including 35 HGGs,18 LGGs,17 metastases,and 4 meningiomas.The Cohen’s kappa coefficient was 0.648(95%CI:0.476-0.820,P<0.001)for conventional ultrasound and 0.788(95%CI:0.627-0.949)for Cohen’s kappa coefficient under SMI in the assessment of tumor border definition(P<0.001).There was a significant difference between B-mode and SMI in the demarcation of HGG borders(P=0.008),while there was no statistical difference in LGG,metastases and meningiomas.Regression analysis showed that brain tumor size≤5cm and clear demarcation under SMI were clearly associated with GTR(x 2=19.114,P<0.001).2.Comparative analysis of resection results in the IoUS+Navi group versus the Navi group and the IoMRI+Navi groupThe GTR rate of glioma in the IoUS+Navi group was 75.5%,which was greater than the GTR rate of 72.1%in the Navi group and less than the GTR rate of 82.8%in the IoMRI+Navi group.the KPS score at 1 month after surgery in the Navi group was less than that before surgery,and there was a statistical difference(P<0.05).the KPS scores before surgery and at 1 month after surgery in the IoMRI+Navi group and the IoUS+Navi group scores were not statistically different.ConclusionIntraoperative use of SMI for brain tumors is beneficial to improve lesion border definition than conventional ultrasound,and the assessment is more consistent.Brain tumor size and lesion border definition under SMI are clearly correlated with GTR;intraoperative ultrasound is beneficial to improve GTR rate than not used,and does not decrease postoperative KPS score,and IoUS is a IoUS is a safe,convenient and effective intraoperative imaging tool.ObjectiveTo investigate the diagnostic value and feasibility of intraoperative superb microvascular imaging(SMI)and shear-wave elastography(SWE)in the glioma grading.Materials and MethodsPatients with single superficial supratentorial glioma scheduled for brain tumor resection in our neurosurgery department from October 2020 to October 2022 were prospectively included.High-grade glioma(HGG)and low-grade glioma(LGG)were classified by pathological histological grading,and the differences in conventional ultrasound,SWE Young’s modulus,and SMI intra-tumoral and peritumoral blood flow architecture between HGG and LGG were analyzed,and the SWE diagnostic cut-off value was calculated by the Youdon index.Logistic regression model were used to analyze the independent predictive ultrasound signs associated with the diagnosis of HGG.ResultsForty-eight patients with glioma admitted to our hospital from October 2020 to October 2022 were included in the study,including 30(62.5%)with HGG and 18(37.5%)with LGG.For conventional ultrasound,HGG was often associated with severe peritumoral edema compared with LGG(P=0.048).The sensitivity of HGG was 88.9%,the specificity was 86.7%,and the AUC was 0.855(95%confidence interval:0.741-0.968,P=0.001)using Young’ s mode 13.90 kPa as the threshold.Logistic analysis showed that SWE Young’s modulus values,peri-tumoral and intra-tumoral SMI blood flow structures were associated with the diagnosis of HGG.architecture correlated with the diagnosis of HGG.ConclusionThe elasticity value of SWE and the vascular architecture of SMI were significantly correlated with the diagnosis of HGG,and the evaluation of tumor stiffness and vascularity facilitated the classification and evaluation of glioma grade.These ultrasound manifestations should be taken into account when diagnosing the grading of glioma by intraoperative ultrasonography.ObjectiveTo investigate the correlation between intraoperative conventional ultrasound,SWE,and SMI ultrasound manifestations of glioma and the expression of immunohistochemical markers.Materials and MethodsForty-nine patients with single superficial supratentorial glioma scheduled for brain tumor resection in our neurosurgery department from October 2020 to October 2022 were prospectively included.HGG and LGG were classified according to pathological histological grading,and Ki67 index and IDH1 expression were measured by immunohistochemical methods.The correlation of Ki-67 index and IDH1 expression in glioma with clinical and ultrasound features was analyzed.Results1.Correlation of Ki-67 index expression in glioma with clinical and ultrasound features.Among the 48 gliomas,there were 18 cases(37.5%)in the Ki-67 positive group and 30 cases(62.5%)in the negative group,with statistical differences in age and glioma histological grading between the two groups(P<0.05).The lesions in the Ki-67-positive group tended to have regular morphology,peritumoral edema,cystic changes,and a distorted and expanded flow architecture in the peritumoral tissue and in the intratumoral tissue.2.Correlation of IDH1 expression in gliomas with clinical and ultrasound features.Among the 48 gliomas,22(45.8%)were in the IDH1-positive group and 26(54.2%)were in the IDH1-negative group,with no statistical difference in age between the two groups.Logistic echo model showed that peritumoral and intratumoral SMI flow structures were effective predictors of IDH1 positivity,with a classification accuracy of 81.3%,sensitivity of 90.9%,and specificity of 73.1%.73.1%.Further group analysis of mutant Young’s modulus values in LGG was higher than wild-type Young’s modulus values(P=0.031).ConclusionGlioma morphology,peritumoral edema,cystic change,calcification,SMI intratumoral and peritumoral tissue vascular architecture were correlated with Ki-67 index expression,and peritumoral and intratumoral tissue SMI vascular architecture was a valid predictor of IDH1 positivity.Based on intraoperative ultrasound multimodality images,we can preoperatively determine the expression of molecular markers of lesions,which is of clinical significance for optimizing surgical strategies and predicting prognosis.